What is coughing up blood and what is vomiting blood? What is the difference between the two

Patients cannot distinguish between vomiting blood and hemoptysis, and often call them both hematemesis. If it is vomiting blood, the doctor will consider it as upper gastrointestinal bleeding, while hemoptysis is more likely to be pulmonary or bronchial bleeding. So what is the difference between the two?

Coughing up blood

Hemoptysis, also known as coughing up blood, refers to bleeding from the larynx and the respiratory tract below the larynx that is coughed up through the mouth, mostly due to bronchial or pulmonary bleeding. There is often an itchy sensation in the throat before hemoptysis, and the blood is weakly alkaline. The sputum is foamy, bright red, and often mixed with sputum. Bloody sputum is often coughed up within a few days after hemoptysis. The patient usually has a history of lung disease or heart disease.

Vomiting blood

Hematemesis is upper gastrointestinal bleeding caused by upper gastrointestinal diseases (referring to the gastrointestinal tract above the Treitz ligament, including esophagus, stomach, duodenum, liver, gallbladder, and pancreas diseases) or systemic diseases, and blood is vomited out through the mouth.

The symptoms of these two types of bleeding are sometimes very similar, especially when the amount of bleeding is above 100 to 500 ml, they are more likely to be confused.

The following are the key points for distinguishing hematemesis from hemoptysis:

Patients with vomiting blood usually have a history of gastric, intestinal, biliary tract diseases or portal hypertension due to cirrhosis. Before vomiting blood, there may be precursor symptoms such as upper abdominal discomfort, nausea and vomiting. Vomiting blood may be accompanied by dizziness, palpitations, pale complexion, sweating, and changes in blood pressure and pulse. Generally speaking, patients with vomiting blood bleed relatively more and in a more urgent manner. The color of the vomited blood is mostly dark red or brown, which is the result of the blood being affected by gastric acid. However, if the patient vomits blood continuously, the blood may be bright red, often mixed with undigested food residues and gastric juice. The patient often has symptoms of black stools shortly after vomiting blood.

Hemoptysis The underlying lesions of hemoptysis patients may include bronchial, lung, and cardiovascular system diseases. Before hemoptysis, patients often have symptoms of throat itching and cough. When hemoptysis occurs, there may be accompanying symptoms such as chest pain, palpitations, and cyanosis. The amount of hemoptysis is relatively less than the amount of hematemesis, and the color of the blood is mostly bright red. Patients often do not have symptoms of melena after hemoptysis, but it should be noted that melena may also occur if patients with hemoptysis swallow blood into the gastrointestinal tract.

Hemoptysis nasal bleeding mostly flows out from the anterior nostril, and the bleeding focus is often found in the front and lower part of the nasal septum. It is relatively easy to diagnose. Sometimes the amount of bleeding in the back of the nose is larger, and it is easy to misdiagnose it as hemoptysis: blood is seen flowing down from the posterior nostril along the pharyngeal wall, and the diagnosis can be confirmed by nasopharyngeal endoscopy. In addition, it is necessary to check for the possibility of nasopharyngeal cancer, laryngeal cancer, oral ulcers, pharyngitis and bleeding gums.