Vomiting Bile – Causes of Yellow to Green Bilious Vomit

Vomiting bile often presents as a bright yellow to dark green color in the vomitus. While the color may be due to the breakdown of food, the presence of bile should not be ignored as it could be related to serious causes that require immediate medical attention, especially if it is of a sudden onset. In most cases, the vomiting is accompanied by nausea and small bowel obstruction has to always be excluded, especially in infants. If the vomiting occurs with no nausea, raised intracranial pressure needs to be excluded.

Bile is often present in the vomit but goes unnoticed in small quantities. It becomes more evident as the ingested contents are passed out and only water and mucus are remaining. Therefore many of the same causes of vomiting, especially recurrent vomiting, will lead to bile vomitus.

Persistent vomiting, especially a short while after eating a meal, may lead to bile vomitus. Bile secretion is at the greatest 20 to 40 minutes after eating, particularly following the ingestion of a fatty meal. In the event that vomiting ensues a short while after eating, the partially digested food lying in the small intestine and mixed with a number of digestive enzymes, mucus and bile, will eventually be passed out after repeated bouts of vomiting.

Causes of Bile Vomit

Yellow to green vomit should not be immediately considered as bile vomitus. Foods and drinks that can color the gastric contents in this manner need to be excluded. The causes below are not a complete list of conditions resulting in bile vomitus.

Intestinal Obstruction

The presence of bile in the vomit should always raise the concern of bowel obstruction. Any obstruction of the small intestine, even as far as the the jejunum and ileum of the small intestine, will usually cause the expulsion of intestinal contents which have already mixed with bile in the duodenum. As mentioned under vomiting control, antiperistaltic contractions which move contents up the gut can begin as low as the ileum of the small intestine. However, bile vomiting will not be present in a case of gastric outlet obstruction or any blockage lying proximal to the duodenum.

The most common symptoms are constipation (also referred to as obstipation in intestinal obstruction) and abdominal distention. Abdominal pain is typically present but in infants this may only be evident as constant crying. The causes of small bowel obstruction include :

  • Newborns and Infants
    • Malrotation
    • Hirschsprung’s disease
    • Congenital duodenal atresia – distal to the ampulla of Vater
    • Pyloric stenosis
    • Intussusception
    • Foreign bodies
  • Adults
    • Adhesions (post-operative)
    • Malignant tumor
    • Inflammatory bowel disease
    • Volvulus
    • Gallstone ileus, foreign bodies

Bile Reflux

This is the backflow of bile into the stomach. Apart from vomiting bile, other signs and symptoms may be present including :

Bile reflux may be a result of :

  • Surgery
    • Bile may enter the stomach following a cholescystectomy (surgical removal of the gallbladder). This is known as postcholecystectomy syndrome and often results in gastritis and esophagitis. The irritation of the stomach lining may lead to vomiting of the bile and other gastric contents.
    • Any gastric surgery that may affect the pyloric sphincter of the stomach may allow bile to enter the stomach during intestinal peristalsis. This is sometimes seen in a gastrectomy and gastric bypass surgery and is often associated with rapid gastric emptying.
  • Peptic ulcer

Drugs and Alcohol

Certain drugs and alcohol, especially in large quantities, are known irritants of the gastrointestinal tract.

If the irritation is ongoing as seen with alcohol abuse and poisoning, bile vomiting may occur. With the consumption of certain drinks, particularly cocktails, the dyes used to color these drinks may at times be mistaken for bile.

Drugs like morphine and digitalis derivatives may stimulate the chemoreceptor trigger zone and lead to prolonged bouts of vomiting with bile vomitus.

Cyclic Vomiting Syndrome

This is a chronic functional disorder and the exact cause is unknown. In CVS, there may be bouts of nausea and vomiting that may last for a few hours to day and then spontaneously resolve. It can recur anywhere between a few days to weeks or months later. Bouts of vomiting of this nature with no known cause with at least 3 episodes in a 6 month period are usually considered as CVS.

Related Articles

  1. What is Vomiting?

References

  1. Cyclic Vomiting Syndrome. Emedicine
  • Pingback: Vomiting During Pregnancy - Obstetric and Non-Obstetric Causes | Healthhype.com()

  • Lorraine WhIte

    Female, age 67. Healthy. No alcohol. Hours after light meal. Lower back pain [pressure]followed by need to toilet [not much]and bloating with discomfort, abdominal cramping and nausea then bouts of vomiting green bile. Tired tooday but OK. What is going on. Nothing like this before. Help.

  • Dr. Chris

    Hi Lorraine

    You should see your doctor. This could be related to your gallbladder and/or pancreas. A number of conditions from gallstones, to an inflamed pancreas can cause these symptoms. Do not delay a visit to your doctor or complications can arise, some of which are very serious. These conditions may be of sudden onset, with no prior warning signs and symptoms.

  • Josephine

    Asian, aged 50 healthy and active. Woke up at 5.30am with bloted stomach and vomit. Tried drinking water but puke out every bit. Could not lie down flat on bed, else had to puke again. Finally exaustion took over, slept but woke up at 8.30am, had diarrhea and vomit bile.
    Having systom of dehyration, nauseaand giddy.

  • Dr. Chris

    Hi Josephine

    Given that it started up so suddenly, it could be related to medication or alcohol that you had previously taken or gastroenteritis – food poisoning or foodborne illness. Recurrent vomiting due to gastroenteritis may result in bilious vomit and this will also explain the diarrhea. Of course, there are other causes and it is advisable to see a doctor.

  • Courtney

    Female age 21.

    Woke up at 5 a.m. with the sudden feeling of having to vomit. There were no previous symptoms and after vomiting thick yellow bile, I started to feel better and could go back to sleep. The vomiting seemed very forced and out of nowhere. Have noticed hick-ups, irregular bowel movements and acidic feeling in stomach. Could that be related? I also took my birth control less than 5 hours before vomiting, could this be the cause?

  • Dr. Chris

    Hi Courtney

    Yes, the birth control could have been the cause especially if this was the first time that you used it. If you are referring to the “morning after pill” (emergency oral contraceptive) then this is very likely the cause. If your symptoms are persisting it may be worth considering some obstruction within the bowels. This would explain your projectile vomiting, nausea and irregular bowel movements. You should see your doctor even if it was a once-off incident.

  • ARamine

    Pakistani origin, 28 year old male, have episodes of vomitting bile. He feels cold and sweats excessively. This has been happening for the past 3-4 years. Symptoms settle within 24-48 hours upon admission in hospital. They occur every 4-6 months. Patient is a smoker, smokes 10-15 cig a day. He has had CT scan, Xray , barium test. All lab results were normal.

  • Dr. Chris

    Hi ARamine

    Considering this has been occurring for 3 to 4 years and the investigations you mention have come back normal, testing for chronic infections like HIV or schistosomiasis may be advisable. An endocoscopy should also be conducted to check if there is any obstruction in the bowels. He should see a gastroeneterologist who can overlook his case over a period of time so that further testing and investigation will be collated and monitored by a single practitioner. If you knew what was being administered in hospital that makes these symptoms settle, then you may get a better indication of the cause. Obviously the attending doctors are able to treat this within 24 o 48 hours so the cause is known to them or they would not be able to treat it so effectively.

  • Ali

    Female: Age: 20: Yesterday a sore throat occured with severe pain around the tonsil area and an hour or so later threw up a foamy yellow-green substance, body procceded to be in a lot of pain with pressure around the lower cranium and throughout the body, fever and vomitted around two hours later, throwing up a yellow-green bile. Whole body hurt including the bones, persisant headache and trouble swallowing, several hours later vomitted again while walking. a large puddle of the yellow-green liquid, light fever and constant craninal pressure with sore body and throat around the tonsils and lymphnod area. Should I see a doctor?

  • Dr. Chris

    Hi Ali

    Yes, it is advisable to see a doctor. It is very likely that you have an infection (gastroenteritis) or it is food poisoning. The rising stomach acid can irritate the throat and cause severe and sudden vomiting. Diarrhea may only develop later. Another possibility is that these symptoms are related to poisoning. This is not to say that it was intentional – something you ate could have been tainted with a toxic substance. While these are the first considerations, it is also possibility that meningitis (inflammation of the brain lining) or encephalitis (inflammation of the brain), usually due to an infection, would cause these symptoms. See your doctor.

  • Sinead88

    I’m 21 female, this is really horrible, I have been vomiting bile for the past 6 days which is constant throughout the day, especially if I cough – I tend to cough up mucas then throw up bile immediately, it changes in colour from brown/green/yellow, I’m unable to keep food down completely, I cant eat during the day but manage to have a small meal in the evenings which I throw up in the early hours of the morning if not shortly after. What are the causes of vomiting bile and what do I need to do to make it stop?

    Thanks
    Sinead

  • Dr. Chris

    Hi Sinead88

    It could be related to an obstruction in the small intestine, just past the area where bile is secreted but given the sudden onset of symptoms and your age, you should consider gallstones, cholecystitis (inflamed gallbladder) or pancreatitis (inflamed pancreas). You need to see a doctor because it has been persisting for quite a while. Failure to seek medical attention can lead to serious complications.

  • jane

    11 yr daughter has bad pain in lower left region of her stomach. she is vomiting for third day has gone from yellow to green and not eating

  • Dr. Chris

    Hi Jane

    Please see a doctor IMMEDIATELY. This should not have been left for 3 days. May just be a case of gastroenteritis but could be related to several other very serious conditions. At this point, dehydration may be significant and could lead to a host of complications.

  • Shieleena

    Well ive thrown up bile twice this month it starts with an itchy unconfortable cough and then I throw up yellow tart liquid and I instantly feel.better . I smoke cigars mabey one or just half a day and I also get hives 4to 5 days a week. Itchy and hugee.

  • michel

    I am a 21 year old male. I have jaundice which has been detected during last week. i can hardly eat. i vomit as soon as i try to eat. i vomit bile atleast thrice. my doctor said its due to liver damage. can you please explain. thanks

  • Dr. Chris

    Hi Michel

    There are many causes of liver damage and you need to sit down with your doctor and get a better idea of what is going on. He/she will know you case better. Basically the liver processes all types of wastes in the blood stream and releases this through bile. Our red blood cells are constantly produced and destroyed in the body. One of the functions is to take the breakdown products of red blood cell destruction, known as bilirubin, and convert it into a form that can be excreted out with the bile. If the liver cannot do this, these breakdown products stay in the blood and deposit in the skin and linings of the mouth and eyes. This is known as jaundice. Another possibility is that your liver is processing these byproducts but due to some diseases, the release of bile is being hampered and the waste products are then being absorbed back into the blood stream. It is important to get more clarity directly from your doctor. Given your age, this is a bit of a concern but it may just be transient and liver function could return to normal.

  • Sonia

    I’m a 23 year old female. I started vomiting after eating chocolate as the first thing I ate at let’s say 1:15pm. After a while I had rice which was quite spicy. After an hour of eating I began to feel sick. I have vomited 5 times now. The first 3 times were during the day and all that was coming up was rice. The recent 2 times have been of dark green bile. Do u think i should seek medical attention or will it just get better.

  • Jayne

    Hello (I’m female 23)
    I’ve had short bursts of stomach pain followed by a sense of nausea with little flows of saliva into my mouth (3-5 times a day) with slight irregular bowel movement for the past three weeks.
    However for the past week I have had diahorea (towards the start of the week immediately after food, now a least it’s after a few hours).
    For the past 3/4 days now I have been vomiting bile. Only once a day, around breakfast time or tonight in the middle of the night. Originally thought it was mucas, but now sure it is bile. This has accompanied bowel movement. Earlier they were simultaneous.
    Saw my GP yesterday and have been prescribed Lansoprazole 30mg- my main question is.. It’s just my luck my period has started today and am having aweful period pains. Can I take Ibruprofen with my new meds? And is there any more I can be doing to help myself? Or can you shed any more light on it for me please.
    Many thanks