Gastrointestinal bleeding

Definition

Gastrointestinal bleeding refers to any bleeding that starts in the gastrointestinal tract, which extends from the mouth to the large bowel. The degree of bleeding can range from nearly undetectable to acute, massive, and life-threatening. Bleeding may come from any site along the gastrointestinal tract, but is often divided into:

• Upper GI bleeding: The upper gastrointestinal (GI) tract is located between the mouth and outflow tract of the stomach.
• Lower GI bleeding: The lower GI tract is located from the outflow tract of the stomach to the anus (small and large bowel included).

Considerations

Gastrointestinal bleeding can range from microscopic bleeding (the amount of blood is so small that it can only be detected by laboratory testing) to massive bleeding (pure blood is passed).

It is important to be aware of gastrointestinal bleeding, because it may point to many significant diseases and conditions. Prolonged microscopic bleeding can lead to massive loss of iron, causing anemia. Acute, massive bleeding can lead to hypovolemia, shock, and even death.

Gastrointestinal bleeding can occur at any age from birth on. The degree and suspected location of the bleeding determines what tests should be performed to find the cause. Once a bleeding site is identified, many therapies are available to stop the bleeding.

Common Causes

Some of the possible causes of gastrointestinal bleeding include:

• Hemorrhoids
• Duodenal ulcer
• Gastric (stomach) ulcer
• Bleeding diverticulum
• Ulcerative colitis
• Crohn's disease
• Esophageal varices
• Arterio-venous malformations
• Nosebleed
• Mallory-Weiss tear (tear in esophagus after vomiting)
• Esophagitis
• Dysentery (bloody, infectious diarrhea)
• Ischemic bowel
• Colon cancer
• Intestinal polyps
• Celiac sprue
• Radiation injury to the bowel
• Portal hypertensive gastropathy
• Stomach cancer
• Intestinal vasculitis
• Small intestinal cancer
• Dieulafoy's lesion
• Meckel's diverticulum
• Aorto-enteric fistula
• Cow's milk allergy
• Intestinal obstruction (twisted bowel)
• Intussusception (bowel telescoped on itself)
• Anal fissure

Home Care

There are home stool tests for microscopic blood that may be recommended for people with anemia or for colon cancer screening.

Call your health care provider if

• You have black, tarry stools (this may be a sign of upper GI bleeding).
• You have blood in your stool.
• You vomit blood or you vomit material that looks like coffee grounds.

What to expect at your health care provider's office

GI bleeding can be an emergency condition requiring immediate medical attention. Intravenous fluids and medications, blood transfusions, drainage of the stomach contents through a nasogastric (NG) tube, and other measures may be required.

Once the condition is stable, a physical examination, including a detailed abdominal examination, will be performed.

Medical history questions to document GI bleeding in detail may include:

• When did it start?
• Is it off-and-on or does it continue?
• What did you notice?
• Were there black, tarry stools or was there obvious blood in the stools?
• Were you vomiting blood?
• Did you vomit material that looks like coffee grounds?
• Do you have a history of peptic ulcer or duodenal ulcer?
• Have you ever had symptoms like this before?
• What other symptoms do you have?
• Did you notice anything that you think may have caused the bleeding?

GI bleeding is diagnosed by a doctor -- you may or may not have been aware of its presence.

Diagnostic tests may include:

• CBC, clotting tests (PT, PTT, INR), platelet count, and other laboratory tests
• Abdominal x-ray
• Abdominal CT scan
• EGD
• Colonoscopy
• Sigmoidoscopy
• Small bowel enteroscopy
• Bleeding scan (tagged red blood cell scan)
• Angiography
• Abdominal MRI scan
• Capsule endoscopy (camera pill that is swallowed to look at the small intestine)

Illustrations

Intussusception - X-ray

Volvulus - X-ray

Page Content:

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