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What is Bilious Vomiting : Causes & Treatment

What is Bilious Vomiting?

Bilious vomiting is a term given to vomit that is yellowish-green in color, which is the color of bile. If someone is having bilious vomiting it means there is an obstruction somewhere in the gastrointestinal tract.

Bilious vomiting also occurs when the person vomits on empty stomach.

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If bile-colored vomit is noticed in a baby, especially in one or two days of life, emergency care should be taken. Bilious vomiting in infants can be a sign of malformation of the gastrointestinal tract.(1)

Bilious vomiting is otherwise harmless or benign.

Causes of Bilious Vomiting

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The cause of bilious vomiting can be anything stopping the bile from passing normally through the digestive tract. It signals some type of obstruction.

Duodenal atresia is one of the most common problems in newborns and young infants.(1) In it, the bowel does not develop properly. Infants who have this condition are believed to be born with it.

In the case of duodenal atresia, there is vomiting that is often bilious, in the first two days of life.

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Other conditions that may be the cause of bilious vomiting in children and adults include:

  • Vomiting due to an empty stomach
  • Gallbladder stones in adults
  • Congenital obstructions including the duodenal diaphragm
  • Bowel obstruction
  • Hirschsprung disease, an intestinal disease affecting the large intestine.(2)
  • Hyperemesis gravidarum- cause of vomiting during pregnancy that can endanger the life of a pregnant female

Any person can be at risk of bilious vomiting. There are certain circumstances that may increase the risk of its occurrence:

  • Newborn infants
  • Pregnant females
  • Those suffering from liver and gallbladder disease
  • Having congenital anomalies
  • Having a recent illness that can lead to intense vomiting

Diagnosis of Bilious Vomiting

If there is bilious vomiting in a newborn or an infant, it is assumed that obstruction in the intestinal tract could be the cause. It therefore would be treated as a medical emergency.

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There will be imaging tests including, x-rays or contrast imaging involving injecting dye into the body and performing a scan.

In adults, a wider context is taken in which bilious vomiting can have many other causes. They may enquire about the following:

  • Recent illness or may order a pregnancy test
  • Ask if the person was empty stomach
  • Look for upper abdomen tenderness
  • Order tests to look for gallstone obstruction

Treatment of Bilious Vomiting

Treatment of bilious vomiting depends on its cause. In case of no obvious cause, the doctor may wait for the person’s condition to improve.

If bilious vomiting occurs in children, it is treated as a medical emergency. If duodenal atresia is the cause of the blockage, surgery can be done to treat the condition.

Without surgery, it would be difficult for the infant to absorb nutrients, which may affect growth.

Some potential treatment for bilious vomiting includes:

  • Antinausea drugs to stop vomiting
  • Surgery to remove the obstruction
  • Treatment of any underlying condition
  • Intravenous fluids to help a person avoid dehydration
  • Removal of gall bladder if a person has gallstones(3)

The outlook of bilious vomiting depends on its cause. If appropriate treatment is given the outlook can be great. Most of the time no treatment is needed and the condition improves. In the case of severe vomiting, a person can suffer from dehydration. In the case of hyperemesis gravidarum, a person may need antinausea medications or IV fluids.

Bilious vomiting can be of concern if a person does not know the reason it is occurring. It is treatable or can also go away on its own. In children, it might need immediate care especially if the baby vomits after the 1st meal. It is important to determine the cause of the vomiting and start the treatment immediately.

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