Hemoptysis Versus Hematemesis

Hemoptysis [Coughing up blood]

Hemoptysis is when a person is coughing up blood from the lower regions of the respiratory tract usually indicating a problem related to the respiratory or cardiovascular system.

There are several reasons why a person may cough up blood in respiratory conditions such as pneumonia, tuberculosis, bronchiectasis, and cystic fibrosis. Simply coughing too hard with too much pressure, and too much can lead to some bleeding due to microscopic vessel rupture which can happen if a person has a respiratory illness.

A pulmonary embolism, lung cancer, and even cardiovascular disease can also lead to hemoptysis. Bleeding may be mild or in extreme cases, severe. It is when hemorrhage is uncontrolled that the risk of death is increased and treatment to stop the bleeding becomes urgent and necessary.

Hematemesis [ vomiting up of blood]

Hematemesis is when a person vomits blood, usually indicating bleeding in the digestive system. This may be confused with hemoptysis which is bleeding from a different system.

The most common causes of vomiting blood are problems in the gastrointestinal system. A peptic ulcer, gastritis, and malignant stomach tumors all are causes of hematemesis. Gastric varices /esophageal varices are when blood vessels dilate/swell up and burst in the stomach and esophagus, usually occurring with portal hypertension/liver failure. A Mallory–Weiss tear is a tear in part of the esophagus due to the excessive force of vomiting or even coughing, which may result in bleeding. Alcohol and NSAID drugs badly inflame the stomach and have been implicated in causing hematemesis.  Bleeding can be dangerous leading to anemia but most importantly, shock due to blood loss, which could lead to death. 

Hematemesis can be dangerous and often the doctor needs to perform an endoscopy to locate the source of bleeding and stop it. Bleeding is stopped is usually by sclerotherapy or endoscopic band ligation. The sclerotherapy procedure is when a substance is injected into a blood vessel that causes the blood to clot. Band ligation is when an elastic band is put around a bleeding vein.

Difference Between Hemoptysis and Hematemesis -

1) There is usually a tingling sensation in the throat in hemoptysis while in hematemesis the patient will usually complain of nausea and upset stomach.

2) The blood is usually frothy and bright red in hemoptysis while it is dark red in hematemesis, non-frothy and food particles may also be present at the same time.

3) Blood in hematemesis will give an acidic pH when tested with litmus paper whereas that in hemoptysis will be neutral to alkaline.

4) Stools will be almost always positive for occult blood in hematemesis while it is usually negative in case of hemoptysis. But it can also be positive at times if the patient has swallowed his sputum.