Can an ulcer kill you

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Attack Of The Killer Ulcer: What You Can Do To Prevent An Ulcer From Changing Your Life In Kingston, New York

Medical Malpractice Mistakes

Have you ever suffered from an ulcer? Just lay off the spicy food until you feel better, right? Did you know that a stomach ulcer can kill you? Do I have your attention, yet?

Stomach ulcers (also known as peptic ulcers) originate in the lining of the stomach and are caused (in 90% of cases) by a bacteria known as H pylori. Stomach ulcers are like small blisters that you might get on your lips in the winter and usually they heal themselves. But stomach ulcers are no joke–they can kill you if not diagnosed and treated.

How can a stomach ulcer kill me?

When a stomach ulcer forms, you have a blister in the inner lining of your stomach. Without treatment, the ulcer can become aggravated by acidic substances, like spicy foods, cigarettes and alcohol. If the ulcer deepens, you face the risk that it will perforate the wall of the stomach and that is a serious problem.

When a stomach ulcer perforates the stomach wall, the gastric contents (food and fluids) will pass through the hole in your stomach into your abdominal cavity. Food and fluids were not meant to flow into your abdominal cavity and when this happens, you will become severely sick with the worst pain you can imagine called peritonitis.

Peritonitis is the inflammation of the peritoneum, and it occurs within 24-48 hours of the stomach perforation. You now have a medical emergency on your hands. The acidic substances in your abdominal cavity can destroy the tissues in your peritoneum (this is called necrosis) and when that occurs, infection will set into your bloodstream known as sepsis. At this point, you are in real trouble of dying from a peptic ulcer.

What are the symptoms of a stomach ulcer?

The primary symptom of a peptic ulcer is epigastric pain. Epigastric refers the upper abdomen (above your belly button). Upper abdominal pain is a classic symptom that can be associated with a peptic ulcer. The epigastric pain will generally worsen as your stomach ulcer gets deeper and penetrates through the stomach wall.

You will often have difficulty sleeping and doing just about any physical activities with stomach ulcers. Vomiting, nausea and loss of weight are common side effects of stomach ulcers.

What you can do to prevent a stomach ulcer

If you suspect you have a stomach ulcer, the most definitive test is upper endoscopy. This is a simple 5-minute procedure done in the office setting by a gastroenterologist where he/she passes a long tube down your throat to look directly into your stomach and first part of your small intestine. The gastroenterologist can see the inner lining of your stomach during an upper endoscopy and thus, he will be able to see your ulcer. A CT scan of the abdomen is much less worthwhile for purposes of diagnosing a stomach ulcer. Rarely will a peptic ulcer be revealed by a CT scan of the abdomen.

If you suspect that you have a stomach ulcer, don’t let your guard down–this can be serious! The doctor of choice for treating a peptic ulcer is a gastroenterologist, who specializes in treating disorders of the gastrointestinal tract (esophagus, stomach, small and large intestine, and the rectum). Only a gastroenterologist can perform an upper endoscopy, but your primary care physician can make the order for upper endoscopy.

Once you confirm that you have a peptic ulcer, the next step is treatment. Because ulcers are caused by the H pylori bacteria, you should take an antibiotics over the course of 7-10 days and begin antacid medications. Giving the stomach ulcer time to heal is important, so you want to stay away from acidic foods, alcohol and smoking. With time and the right treatment, your stomach ulcer will heal.

What you can do if you have questions

If you want more information, or have any questions, I welcome your phone call on my toll-free cell at 1-866-889-6882. You can always request my FREE book, The Seven Deadly Mistakes of Malpractice Victims, at the home page of my website, www.protectingpatientrights.com. If you have questions about your case, consult a dedicated attorney right away. Thank you for taking the time to read this article.

Types of Ulcers

What is an ulcer?

An ulcer is a painful sore that is slow to heal and sometimes recurs. Ulcers aren’t uncommon. How they appear and corresponding symptoms depend on what caused them and where they occur on your body.

Ulcers can appear anywhere in or on your body, from the lining in your stomach to the outer layer of your skin.

Some cases of ulcers disappear on their own, but others require medical treatment to prevent serious complications.

The different types of ulcers

While the most common types of ulcers are peptic ulcers, there are many types, including:

  • arterial ulcers
  • venous ulcers
  • mouth ulcers
  • genital ulcers

Peptic ulcers

Peptic ulcers are sores or wounds that develop on the inside lining of your stomach, the upper portion of your small intestine, or your esophagus. They form when digestive juices damage the walls of your stomach or intestine.

Peptic ulcers are most often caused from inflammation after being infected with Helicobacter pylori (H. pylori) bacteria and long-term use of painkillers.

There are three types of peptic ulcers:

  • gastric ulcers, or ulcers that develop in the stomach lining
  • esophageal ulcers, or ulcers that develop in the esophagus
  • duodenal ulcers, or ulcers that develop in the duodenum (small intestine)

The most common symptom of this condition is a burning pain. Other symptoms may include:

  • bloating or the feeling of being full
  • belching
  • heartburn
  • nausea
  • vomiting
  • unexplained weight loss
  • chest pain

Treatment depends on the underlying cause of your ulcer. If you have an H. pylori infection, your doctor may prescribe antibiotics to kill the harmful bacteria.

If your ulcers formed as a result of prolonged use of painkillers or medication, your doctor may prescribe medication that reduces your stomach acid or protectively coats your stomach to prevent acid damage.

Arterial ulcers

Arterial (ischemic) ulcers are open sores that primarily develop on the outer side of your ankle, feet, toes, and heels. Arterial ulcers develop from damage to the arteries due to lack of blood flow to tissue. These forms of ulcers can take months to heal and require proper treatment to prevent infection and further complications.

Arterial ulcers have a “punched out” appearance accompanied with a number of symptoms, including:

  • red, yellow, or black sores
  • hairless skin
  • leg pain
  • no bleeding
  • affected area cool to the touch from minimal blood circulation

Treatment for arterial ulcers depends on the underlying cause. Primary treatment includes restoring blood circulation to the affected area. While antibiotics may help reduce symptoms, your doctor may recommend surgery to increase blood flow to your tissues and organs. In more severe circumstances, your doctor may recommend amputation.

Venous ulcers

Venous ulcers — the most common type of leg ulcers — are open wounds often forming on your leg, below your knee and on the inner area of your ankle. They typically develop from damage to your veins caused by insufficient blood flow back to your heart.

In some cases, venous ulcers cause little to no pain unless they’re infected. Other cases of this condition can be very painful.

Other symptoms you may experience include:

  • inflammation
  • swelling
  • itchy skin
  • scabbing
  • discharge

Venous ulcers can take months to fully heal. In rare cases, they may never heal. Treatment focuses on improving flow to the affected area. Antibiotics can help prevent infection and reduce symptoms, but they aren’t enough to heal venous ulcers.

Alongside medication, your doctor may recommend surgery or compression therapy to increase blood flow.

Mouth ulcers

Mouth ulcers are small sores or lesions that develop in your mouth or the base of your gums. They’re commonly known as canker sores.

These ulcers are triggered by a number of causes, including:

  • biting the inside of your cheek
  • food allergies
  • hard teeth brushing
  • hormonal changes
  • vitamin deficiencies
  • bacterial infection
  • diseases

Mouth ulcers are common and often go away within two weeks. They can be uncomfortable but shouldn’t cause significant pain. If a mouth ulcer is extremely painful or doesn’t go away within two weeks, seek immediate medical attention.

Minor mouth ulcers appear as small, round ulcers that leave no scarring. In more severe cases, they can develop into larger and deeper wounds. Other serious symptoms associated with this type of ulcer may include:

  • unusually slow healing (lasting longer than three weeks)
  • ulcers that extend to your lips
  • issues eating or drinking
  • fever
  • diarrhea

Mouth ulcers often go away on their own without treatment. If they become painful, your doctor or dentist may prescribe an antimicrobial mouthwash or ointment to reduce your discomfort.

If your condition is the result of a more serious infection, seek medical attention to receive the best treatment.

Genital ulcers

Genital ulcers are sores that develop on genital areas, including the penis, vagina, anus or surrounding areas. They are usually caused by sexually transmitted infections (STIs), but genital ulcers can also be triggered by trauma, inflammatory diseases, or allergic reactions to skin care products.

In addition to sores, symptoms that may accompany genital ulcers include:

  • rash or bumps in the affected area
  • pain or itching
  • swollen glands in the groin area
  • fever

Similar to types of ulcers, treatment depends on the underlying cause of your condition. In some cases, these sores will go away on their own. If diagnosed with an STI, your doctor may prescribe antiviral or antibiotic medication or ointment. If you feel you’ve been exposed to a STI, seek immediate medical attention.

Outlook

Many cases of ulcers disappear on their own without treatment. However, ulcers can be an indication of a more serious condition. Visit your doctor to ensure you’re receiving the best treatment to improve your condition.

Treatment for Peptic Ulcers (Stomach Ulcers)

In this section:

  • How do doctors treat peptic ulcer disease?
  • How do doctors treat an NSAID-induced peptic ulcer?
  • What if I still need to take NSAIDs?
  • How do doctors treat an NSAID-induced peptic ulcer when you have an H. pylori infection?
  • How do doctors treat an H.pylori-induced peptic ulcer?
  • How do doctors treat peptic ulcers caused by ZES?
  • What if a peptic ulcer doesn’t heal?
  • Can a peptic ulcer come back?
  • How can I prevent a peptic ulcer?

How do doctors treat peptic ulcer disease?

There are several types of medicines used to treat a peptic ulcer. Your doctor will decide the best treatment based on the cause of your peptic ulcer.

How do doctors treat an NSAID-induced peptic ulcer?

If NSAIDs are causing your peptic ulcer and you don’t have an H. pylori infection, your doctor may tell you to

  • stop taking the NSAID
  • reduce how much of the NSAID you take
  • switch to another medicine that won’t cause a peptic ulcer

Your doctor may also prescribe medicines to reduce stomach acid and coat and protect your peptic ulcer. Proton pump inhibitors (PPIs), histamine receptor blockers, and protectants can help relieve pain and help your ulcer heal.

PPIs

PPIs reduce stomach acid and protect the lining of your stomach and duodenum. While PPIs can’t kill H. pylori, they do help fight the H. pylori infection.

PPIs include

Histamine receptor blockers

Histamine receptor blockers work by blocking histamine, a chemical in your body that signals your stomach to produce acid. Histamine receptor blockers include

  • cimetidine (Tagamet)
  • famotidine (Pepcid)
  • ranitidine (Zantac)
  • nizatidine (Axid) Protectants

Protectants

Protectants coat ulcers and protect them against acid and enzymes so that healing can occur. Doctors only prescribe one protectant—sucralfate (Carafate)—for peptic ulcer disease.

Tell your doctor if the medicines make you feel sick or dizzy or cause diarrhea or headaches. Your doctor can change your medicines.

If you smoke, quit. You also should avoid alcohol. Drinking alcohol and smoking slow the healing of a peptic ulcer and can make it worse.

What if I still need to take NSAIDs?

If you take NSAIDs for other conditions, such as arthritis, you should talk with your doctor about the benefits and risks of using NSAIDs. Your doctor can help you determine how to continue using an NSAID safely after your peptic ulcer symptoms go away. Your doctor may prescribe a medicine used to prevent NSAID-induced ulcers called Misoprosotol.

Tell your doctor about all the prescription and over-the-counter medicines you take. Your doctor can then decide if you may safely take NSAIDs or if you should switch to a different medicine. In either case, your doctor may prescribe a PPI or histamine receptor blocker to protect the lining of your stomach and duodenum.

If you need NSAIDs, you can reduce the chance of a peptic ulcer returning by

  • taking the NSAID with a meal
  • using the lowest effective dose possible
  • quitting smoking
  • avoiding alcohol

How do doctors treat an NSAID-induced peptic ulcer when you have an H. pylori infection?

If you have an H. pylori infection, a doctor will treat your NSAID-induced peptic ulcer with PPIs or histamine receptor blockers and other medicines, such as antibiotics, bismuth subsalicylates, or antacids.

PPIs reduce stomach acid and protect the lining of your stomach and duodenum. While PPIs can’t kill H. pylori, they do help fight the H. pylori infection.

PPIs include

Histamine receptor blockers work by blocking histamine, a chemical in your body that signals your stomach to produce acid. Histamine receptor blockers include

  • cimetidine (Tagamet)
  • famotidine (Pepcid)
  • ranitidine (Zantac)
  • nizatidine (Axid)

Antibiotics

A doctor will prescribe antibiotics to kill H. pylori. How doctors prescribe antibiotics may differ throughout the world. Over time, some types of antibiotics can no longer destroy certain types of H. pylori.

Antibiotics can cure most peptic ulcers caused by H. pylori or H. pylori-induced peptic ulcers. However, getting rid of the bacteria can be difficult. Take all doses of your antibiotics exactly as your doctor prescribes, even if the pain from a peptic ulcer is gone.

Bismuth subsalicylates

Medicines containing bismuth subsalicylate, such as Pepto-Bismol, coat a peptic ulcer and protect it from stomach acid. Although bismuth subsalicylate can kill H. pylori, doctors sometimes prescribe it with antibiotics, not in place of antibiotics.

Antacids

An antacid may make the pain from a peptic ulcer go away temporarily, yet it will not kill H. pylori. If you receive treatment for an H. pylori-induced peptic ulcer, check with your doctor before taking antacids. Some of the antibiotics may not work as well if you take them with an antacid.

Check with your doctor before taking antacids while your ulcers are healing.

How do doctors treat an H.pylori-induced peptic ulcer?

Doctors may prescribe triple therapy, quadruple therapy, or sequential therapy to treat an H. pylori-induced peptic ulcer.

Triple therapy

For triple therapy, your doctor will prescribe that you take the following for 7 to 14 days:

  • the antibiotic clarithromycin
  • the antibiotic metronidazole or the antibiotic amoxicillin
  • a PPI

Quadruple therapy

For quadruple therapy, your doctor will prescribe that you take the following for 14 days:

  • a PPI
  • bismuth subsalicylate
  • the antibiotics tetracycline and metronidazole

Doctors prescribe quadruple therapy to treat patients who

  • can’t take amoxicillin because of an allergy to penicillin. Penicillin and amoxicillin are similar.
  • have previously received a macrolide antibiotic, such as clarithromycin.
  • are still infected with H. pylori after triple therapy treatment.

Doctors prescribe quadruple therapy after the first treatment has failed. In the second round of treatment, the doctor may prescribe different antibiotics than those that he or she prescribed the first time.

Sequential therapy

For sequential therapy, your doctor will prescribe that you take the following for 5 days:

  • a PPI
  • amoxicillin

Then the doctor will prescribe you the following for another 5 days:

  • a PPI
  • clarithromycin
  • the antibiotic tinidazole

Triple therapy, quadruple therapy, and sequential therapy may cause nausea and other side effects, including

  • an altered sense of taste
  • darkened stools
  • a darkened tongue
  • diarrhea
  • headaches
  • temporary reddening of the skin when drinking alcohol
  • vaginal yeast infections

Talk with your doctor about any side effects that bother you. He or she may prescribe you other medicines.

How do doctors treat peptic ulcers caused by ZES?

Doctors use medicines, surgery, and chemotherapy to treat Zollinger-Ellison syndrome. Learn more about Zollinger-Ellison syndrome treatment.

What if a peptic ulcer doesn’t heal?

Most often, medicines heal a peptic ulcer. If an H. pylori infection caused your peptic ulcer, you should finish all of your antibiotics and take any other medicines your doctor prescribes. The infection and peptic ulcer will heal only if you take all medicines as your doctor prescribes.

When you have finished your medicines, your doctor may do another breath or stool test in 4 weeks or more to be sure the H. pylori infection is gone. Sometimes, H. pylori bacteria are still present, even after you have taken all the medicines correctly. If the infection is still present, your peptic ulcer could return or, rarely, stomach cancer could develop. Your doctor will prescribe different antibiotics to get rid of the infection and cure your peptic ulcer.

Can a peptic ulcer come back?

Yes, a peptic ulcer can come back. If you smoke or take NSAIDs, peptic ulcers are more likely to come back. If you need to take an NSAID, your doctor may switch you to a different medicine or add medicines to help prevent a peptic ulcer. Peptic ulcer disease can return, even if you have been careful to reduce your risk.

How can I prevent a peptic ulcer?

To help prevent a peptic ulcer caused by NSAIDs, ask your doctor if you should

  • stop using NSAIDs
  • take NSAIDs with a meal if you still need NSAIDs
  • take a lower dose of NSAIDs
  • take medicines to protect your stomach and duodenum while taking NSAIDs
  • switch to a medicine that won’t cause ulcers

To help prevent a peptic ulcer caused by H. pylori, your doctor may recommend that you avoid drinking alcohol.

That ‘Downton Abbey’ ulcer could happen to you

PBSThere was a reason for the Earl’s bellyaching after all!

In Sunday’s episode of “Downton Abbey,” dinner at the Abbey turned into a Quentin Tarantino scene when Robert Crawley, the Earl of Grantham (Hugh Bonneville), began vomiting blood all over the linens — and his shocked wife, Cora (Elizabeth McGovern), too.

The reason: He had a burst ulcer, which explains his stomach-clutching over the past few episodes.

But that was 1925 England — surely the same diagnosis today wouldn’t result in such a bloodbath, right?

Wrong. Dr. Paresh Shah, director of general surgery at NYU Langone and a “Downton” fan, says he’s seen the condition before. It happens when a patient’s ulcer carves into a blood vessel in their stomach, triggering bleeding and the vomiting of blood.

“The presentation of this was actually done fairly well and fairly accurately,”

– NYU’s Dr. Paresh Shah “I’ve certainly seen it more than a few times,” he says. “The presentation of this was actually done fairly well and fairly accurately.”

Nowadays, burst ulcers are less common, thanks to the discovery in the 1980s that most ulcers are caused by a bacterial infection and the development of endoscopies and X-rays to catch it — medical advances the “Downton” crew wouldn’t have had.

Gastrectomies — like the one the Earl received to remove the burst ulcer and a section of his stomach — have dropped significantly.

“We’ve gotten much, much better at treating them,” Shah says. “We’ll see half a dozen a year nowadays, where you used to see half a dozen a week.”

Shah says if you notice persistent upper abdominal pain or blood in your stool, or you’re vomiting blood, you should see your physician immediately.

It’s advice the Earl could have used.

“He is a classic example of someone who’s got symptoms but doesn’t actually seek treatment until it’s too late.”

What Is a Peptic Ulcer?

It’s a myth that spicy foods and stress cause peptic ulcers.

A peptic ulcer is a type of sore that develops in the digestive system.

The word “ulcer” means open sore, and “peptic” means that acid is the cause of the sore.

However, this terminology is from a prior era when all ulcers in the esophagus, stomach, and duodenum were thought to be caused by acid damage.

Nowadays, we know that most ulcers are not caused by excessive acid, so the term “peptic ulcer” is somewhat misleading.

Types of Peptic Ulcers

The most common kinds of peptic ulcers are:

Gastric ulcers: A common type of ulcer, these occur on the inside of the stomach.

Duodenal ulcers: These are located at the beginning of the small intestine (called the small bowel or duodenum).

Esophageal ulcers: These occur inside the esophagus (the tube that carries food from your throat to your stomach).

You can have more than one kind of peptic ulcer at the same time.

Causes of Peptic Ulcers

For a long time, it was believed that spicy foods or stress could lead to peptic ulcers – but doctors now know that this isn’t the case.

In fact, the most common causes of ulcers are:

  • Helicobacter pylori, a type of bacteria that can infect your stomach
  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, Advil or Motrin (ibuprofen), Aleve (naproxen), and others

If you’re at risk for peptic ulcers, talk to your doctor about taking Tylenol (acetaminophen) for pain, since it’s not an NSAID and does not contain aspirin.

Peptic Ulcer Symptoms

While many people with peptic ulcers don’t experience any symptoms, upper abdominal pain is the most common symptom.

This abdominal pain may:

  • Extend from your navel up to your breastbone
  • Feel worse when your stomach is empty
  • Feel better temporarily when you eat certain foods or take an antacid
  • Get worse at night
  • Come and go for days or weeks

Other symptoms of a peptic ulcer may include:

  • Nausea
  • Vomiting of red or dark blood
  • Feeling bloated or full
  • Bloody, black, or tarry stools
  • Unexplained weight loss
  • Changes in your appetite

Complications

Ulcers can cause bleeding that occurs slowly over time or quickly, possibly resulting in life-threatening hemorrhaging due to shock.

Sometimes you may not notice a bleeding ulcer until you become anemic, a condition in which your body lacks red blood cells due to inadequate iron.

This occurs when ulcers result in chronic, low-grade blood loss.

If you have anemia, you may feel tired, experience shortness of breath, and have pale skin.

If bleeding occurs quickly, you may notice:

  • Dark, sticky, or bloody stools
  • Bloody vomit
  • Lightheadedness

If you experience any of these symptoms, seek medical attention immediately.

Peptic Ulcer Treatment

Your course of treatment will be based on what’s causing the ulcer.

Possible treatments include antibiotic drugs to kill Helicobacter pylori bacteria in your digestive tract.

Your doctor may also recommend antacids to neutralize stomach acid and reduce pain.

Proton pump inhibitors (PPIs) are drugs that block acid production and promote healing.

PPI drugs include:

Acid reducers, also called H2 blockers, reduce acid production and relieve ulcer pain.

  • Cimetidine (Tagamet)
  • Ranitidine (Zantac)
  • Famotidine (Pepcid)
  • Nizatidine (Axid)

Additionally, there are cytoprotective agents – drugs that protect the lining of your stomach and small intestine – that can relieve symptoms of an ulcer.

Ulcer Emergencies

There are three types of ulcer emergencies:

  • You have bleeding in your stomach, esophagus, or duodenum due to the ulcer opening a blood vessel.
  • You develop a perforated ulcer, which means it has eaten through your stomach or intestinal wall.
  • You have swelling or scarring related to your ulcer that is preventing your food from being digested properly.

The signs that you are having an ulcer emergency are:

  • Blood (black or red) in stool
  • Blood in vomit or vomit that looks like coffee grounds
  • Increasing pain
  • Weakness
  • Mental confusion
  • Severe abdominal distension

If you think you or someone you know is having an ulcer emergency, seek immediate medical attention.

Peptic Ulcer Diet and Other Home Remedies

Here are the most important lifestyle changes you can make to recover from an ulcer:

Watch Your Diet: In the past, people with ulcers were told to eat small, bland meals and drink lots of milk to help heal ulcers, but today doctors know otherwise.

But if you know that there are specific foods that make your ulcer feel worse, avoid them until your treatment is over.

Back when spicy food was believed to cause an ulcer, milk was thought to heal it. Now the prevailing wisdom is that milk may improve the symptoms of an ulcer, but cannot heal it.

Interestingly, spicy food could have a preventive effect.

According to one study, researchers in Singapore found that people who ate mostly Chinese food, which does not have a high amount of capsaicin, had three times the frequency of ulcers as those who mostly ate the much spicier Malay or Indian food.

Stop Smoking: If you smoke, you are already at increased risk for getting an ulcer.

The data also show that ulcers take longer to heal in smokers and that the ulcer medication you are taking may be less effective.

Scientists don’t know exactly why smoking has these negative effects.

Beware of NSAIDs: NSAIDs, such as aspirin, ibuprofen, and many others, are taken for pain and fever, but can cause an ulcer if used too often.

NSAIDs also can prevent an ulcer from healing as quickly as you would like, so talk to your doctor about what you can take for your other aches and pains while you are waiting for your ulcer to heal.

Also, be sure to read all drug labels; some products such as cough and cold liquids have NSAID ingredients in them and you should avoid them, too.

Acetaminophen (Tylenol) does not cause ulcers, so it may be an effective substitute.

Cut back on alcohol: Stop drinking alcohol if you want to completely reduce your risk of additional ulcers and help your body heal.

Eat a diet rich in fruits and vegetables: A comprehensive review of published studies related to ulcer prevention shows that eating a lot of fiber from fruits and veggies may help reduce your risk of ulcer.

Vitamin A, found in many vegetables, may also be helpful.

Manage your stress: Most ulcers are caused by H. pylori or NSAIDs, but for a small group of people, stress does appear to have a connection to ulcers.

Many doctors recommend some form of stress release for these people, including yoga, exercise, or massage.

Vomiting blood (haematemesis)

Common causes of vomiting blood

If you vomit blood, it means there may be bleeding somewhere in your food pipe, stomach or the first part of your small intestine (duodenum).

This is a summary of the most likely causes of blood in vomit. Do not use this list to diagnose yourself – always see a GP or go to A&E.

Stomach ulcer or severe gastritis

If you vomit blood and also have a burning or gnawing pain in your tummy (stomach), the most likely causes are a stomach ulcer or severe inflammation of the stomach lining (gastritis).

Bleeding happens when the ulcer or inflammation damages an artery.

Oesophageal varices

Oesophageal varices are enlarged veins in the lower part of the food pipe (oesophagus). They bleed, but do not usually cause any pain.

They’re often caused by alcoholic-related liver disease. If a GP or A&E doctor suspects oesophageal varices are the cause of blood in your vomit, you’ll need to be admitted to hospital immediately.

Severe gastro-oesophageal reflux disease

Gastro-oesophageal reflux disease (GORD) is where acid leaks out of the stomach and up into your food pipe (oesophagus).

If you have severe GORD, the acid can irritate the lining of your oesophagus and cause bleeding.

Tear in the food pipe (oesophagus)

Prolonged retching can tear the lining of your oesophagus, which can also result in bleeding.

Swallowed blood

It’s possible to swallow blood in certain circumstances – for example, after a severe nosebleed.

These conditions may also cause you to have blood in your poo, which can make it look black and like tar.

Coughing Up Blood (Hemoptysis)

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Patient Education – Lung Cancer Program at UCLA

Educating yourself about lung cancer:

Signs and symptoms: Coughing up blood; Hemoptysis

Coughing up blood; Hemoptysis

Definition

Coughing up blood is the spitting up of blood or bloody mucus from the lungs and throat (respiratory tract).

Alternative Names

Hemoptysis; Spitting up blood; Bloody sputum

Considerations

Hemoptysis is the medical term for coughing up blood from the respiratory tract.

Coughing up blood is not the same as bleeding from the mouth, throat, or gastrointestinal tract.

Blood that comes up with a cough often looks bubbly because it is mixed with air and mucus. It is usually bright red.

Causes

A number of conditions, diseases, and medical tests may make you cough up blood.

Diseases and conditions may include:

  • Bleeding gums such as with gingivitis
  • Blood clot in the lung
  • Bronchiectasis
  • Bronchitis
  • Cystic fibrosis
  • Esophageal cancer
  • Goodpasture’s syndrome
  • Irritation of the throat from violent coughing
  • Nosebleed
  • Laryngitis
  • Lung cancer (see metastatic lung cancer)
  • Pneumonia
  • Pulmonary aspiration (inhaling blood into the lungs)
  • Pulmonary edema
  • Systemic lupus erythematosus
  • Tuberculosis
  • Wegener’s granulomatosis

Diagnostic tests that may make you cough up blood may include:

  • Bronchoscopy
  • Laryngoscopy
  • Lung biopsy
  • Mediastinoscopy
  • Spirometry
  • Tonsillectomy
  • Upper airway biopsy

Home Care

Cough suppressants may help if this condition is due to throat irritation from violent coughing. However, cough suppressants may lead airway obstruction in some cases. Always check with your doctor first.

It is very important to note how long you cough up blood. You should also keep track of the following:

  • How much blood is mixed with the mucus
  • Symptoms such as lightheadedness, dizziness, or thirst, which might indicate a severe amount of blood loss
  • Other symptoms such as fever, chest pain, shortness of breath, and blood in the urine

When to Contact a Medical Professional

If there is any unexplained coughing up of blood, call an ambulance or go to the nearest emergency department. This is very important if your cough produces large volumes of blood (more than a few teaspoons), or if it is accompanied by severe shortness of breath, lightheadedness, or dizziness.

What to Expect at Your Office Visit

In emergency cases, your doctor will give you treatments to control your condition. You will then be asked questions about your cough such as:

  • Type
    • Can you see blood when you cough up something?
    • Is there blood-streaked mucus (phlegm)?
    • Are large amounts of blood (massive hemoptysis) coughed up?
    • How many times have you coughed up blood?
  • Time pattern
    • Is the cough worse at night?
    • Did it begin suddenly?
    • Has it increased recently?
    • How many weeks has the cough lasted?
    • What other symptoms do you have?

The doctor will do a complete physical exam and check your chest and lungs. Tests that may be done include:

  • Chest x-ray
  • Chest CT scan
  • Complete blood count
  • Coagulation studies such as PT or PTT
  • Bronchoscopy
  • Lung biopsy
  • Lung scan
  • Pulmonary arteriography
  • Sputum culture and smear

Rakel RE. Textbook of Family Practice. 6th ed. Philadelphia, Pa: WB Saunders; 2005:402-413.

Murray J, Nadel J. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: WB Saunders; 2000:497.

Patient Education

Esophageal Ulcer

An esophageal ulcer is an open sore in the lining of the esophagus. The esophagus is the tube that carries food and liquid from your mouth to your stomach. This sheet tells you more about esophageal ulcers and how they are treated.

Causes of an esophageal ulcer

Esophageal ulcers can be caused by:

  • GERD (gastroesophageal reflux disease). This condition occurs when stomach acid flows back into the esophagus. It is the most common cause of esophageal ulcers.

  • Infection of the esophagus. This is caused by certain types of fungus and bacteria. It’s also caused by viruses such as herpes simplex virus 1 (HSV-1) or cytomegalovirus (CMV).

  • Irritants that damage the esophagus. These include cigarette smoke, alcohol, lye, and certain medications.

  • Certain types of treatments done on the esophagus. These include chemotherapy and radiation.

  • Excessive vomiting.

Symptoms of an esophageal ulcer

Esophageal ulcer symptoms can include:

  • Pain when you swallow or trouble swallowing

  • Pain behind your breastbone (heartburn)

  • Upset stomach (nausea) and vomiting

  • Vomiting blood

  • Chest pain

Diagnosing an esophageal ulcer

Your provider will ask about your symptoms and health history. He or she will also give you a full exam. Tests will be done as well. These can include:

  • Upper endoscopy. This is done to see inside your esophagus. This lets your provider check for ulcers. During the test, an endoscope (scope) is used. This is a thin, flexible tube with a tiny camera and light on the end. The scope is placed into your mouth. It is then guided down the esophagus. Small brushes may be passed through the scope to loosen cells from the lining of the esophagus. Other tools may also be passed through the scope to remove tiny tissue samples (biopsy). These samples are then sent to a lab for study.

  • Barium swallow. This is done to take X-rays of your esophagus. This helps your provider check for ulcers. For this test, you’ll drink a chalky liquid that contains a substance called barium. The barium coats your esophagus so that it will show up clearly on X-rays.

  • Blood tests. These check for infection, such as HSV-1 and CMV in the esophagus. For a blood test, a small sample of your blood is taken and sent to a lab.

Treating an esophageal ulcer

Treatment focuses on giving the ulcer time to heal, easing symptoms, and preventing further damage. Treatment may include:

  • Medicines to reduce the amount of acid your stomach makes

  • Medicines to treat infection

  • Quitting smoking and not drinking alcohol

  • Avoiding irritating medicines (such as aspirin, ibuprofen, potassium, tetracyclines, quinidine, iron, and alendronate)

Recovery and follow-up

With treatment, an esophageal ulcer takes several weeks or longer to heal. A follow-up endoscopy may be done to check the ulcer’s healing. Let your provider know if your symptoms don’t get better or if they come back again. If you have GERD, work with your provider to manage it. You can take steps to help keep your esophagus healthy and prevent future problems.

When to call your healthcare provider

Call your provider right away if you have any of the following:

  • Fever of 100.4°F (38.0°C) or higher, or as advised by your healthcare provider

  • Continued pain or trouble swallowing

  • Coughing up blood

  • Frequent nausea or vomiting that looks like bloody coffee grounds

  • Dark, tarry, or bloody stools

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