 |
 |
 |
|
Bleeding may occur anywhere along the digestive tract, from the mouth to the anus, for a variety of reasons. Blood may be visible in the stool or in vomit or may be hidden (occult) and detectable only by diagnostic tests.
Signs & Symptoms
Aside from those mentioned below, symptoms of gastrointestinal bleeding also include vomiting blood (hematemesis). Vomited blood may be red, or black like coffee grounds.
The following symptoms may indicate rapid blood loss, which is very serious:- a rapid pulse rate
- low blood pressure
- reduced urine flow
- cold, clammy hands and feet
- confusion, disorientation, sleepiness, and even shock caused by a reduced supply of blood to the brain.
Diagnosis & Tests
Once it has been established that bleeding has occurred or is occurring, the first step is to rule out hemorrhoids, rectal tears (fissures), and tumors by performing a rectal examination. The next step may include tests such as different types of X-rays and/or endoscopy, depending on whether the doctor suspects that the bleeding is coming from the upper digestive tract (esophagus, stomach, and first segment of the small intestine) or lower digestive tract (lower small intestine, large intestine, rectum, and anus).
Laboratory findings:- Gross or occult blood in stool, vomitus, or gastric contents
- Hypochromic, microcytic anaemia, iron-deficiency type, due to chronic blood loss
- Altered liver function tests suggest cirrhosis of the liver with oesophageal varices as the source of bleeding
- Increased BUN due to breakdown of blood in the colon by bacteria resulting in increased nitrogen formation
- Laboratory findings or any of the underlying conditions listed above.
Treatment & Prevention
If a large amount of blood has been lost, fluids are given intravenously, and a blood transfusion may be needed. After a blood transfusion, the person is observed closely for evidence of continued bleeding, such as an increased pulse rate, a drop in blood pressure, or a loss of blood from the mouth or anus.
Bleeding from esophageal varices can be treated in several ways. In one method, an irritating chemical is injected into the bleeding vessels through an endoscope, causing inflammation and scarring of the veins, which stops the bleeding (sclerotherapy). In a second, more frequently used method, the varices are tied off with rubber bands during endoscopy (rubber band ligation). In a third method, now rarely used, a catheter with a deflated balloon at its tip is inserted through the mouth into the esophagus, and the balloon is then inflated to apply pressure on the bleeding area (esophageal tamponade).
Bleeding in the stomach often can be stopped with one of several procedures performed with an endoscope; these involve using an electrical current to destroy the portion of a vessel that is bleeding (cauterization) or injecting a material that causes clotting within the bleeding vessel. If these procedures fail, surgery may be needed.
Bleeding of the lower intestine usually does not require emergency treatment unless the person loses a large amount of blood quickly. Tests to locate the bleeding precisely, such as endoscopy or radionuclide scans, may be needed. Surgery can be performed if bleeding does not stop.
Prognosis
Gastrointestinal bleeding is self-limiting in more than 80% of cases: the body is able to stop the bleeding on its own. Patients who continue to bleed or who have symptoms of a sudden loss of a large amount of blood usually are hospitalized and often are admitted to an intensive care unit.
|
|
 |
|
 |
Signs, symptoms & indicators of Gastrointestinal Bleeding: | | | | | Symptoms - Bowel Movements |  Black or tarry stools | Black, tarry stools usually result from bleeding that occurs high up in the digestive tract - for example, in the stomach or first segment of the small intestine (duodenum); blood in the stomach turns black when exposed to stomach acid and enzymes. A single severe bleeding episode can produce tarry stools for as long as a week, so continuing tarry stools do not necessarily indicate persistent bleeding. |
 (Significant/frequent) red blood in stools| | Passing visible blood from the rectum (hematochezia) may indicate bleeding in the lower intestines. |
|
| | | | |
Conditions that suggest Gastrointestinal Bleeding: | | | | | Circulation |  Anemia (Iron deficiency)| | People with long-term bleeding that tends to occur in small amounts or intermittently may develop symptoms of anemia, such as tiring easily and looking unnaturally pale. |
|
| | | | |
Risk factors for Gastrointestinal Bleeding:
Recommendations and treatments for Gastrointestinal Bleeding: | | | | | Drug | Not recommended:
 NSAIDs
Aspirin| | Certain drugs, such as aspirin and many other nonsteroidal anti-inflammatory drugs (NSAIDs), can irritate the digestive tract and cause bleeding. |
Anticoagulant / Blood Thinner| | Drugs that reduce the blood's tendency to clot (anticoagulants) or that dissolve clots once they have formed (thrombolytics or tissue plasminogen activator) can cause gastrointestinal bleeding. |
|
Lab Tests/Rule-Outs |
 Occult Blood Tests| | If gastrointestinal bleeding is suspected due to other symptoms, but no blood is visible in the stool, a doctor may decide to test for occult (hidden) blood. |
|
| | | | |
KEY | | Weak or unproven link | | | Strong or generally accepted link | | | Proven definite or direct link | | | Likely to help | | | Reasonably likely to cause problems |
GLOSSARY
Anemia (Anaemia, Anemias)
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Anti-inflammatory (Antiinflammatory)
Reducing inflammation by acting on body mechanisms, without directly acting on the cause of inflammation, e.g., glucocorticoids, aspirin.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Cirrhosis (Liver Cirrhosis)
A long-term disease in which the liver becomes covered with fiber-like tissue. This causes the liver tissue to break down and become filled with fat. All functions of the liver then decrease, including the production of glucose, processing drugs and alcohol, and vitamin absorption. Stomach and bowel function, and the making of hormones are also affected.
Colon (Colonic)
The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.
Duodenum (Duodenal)
First portion of the small intestine between the pylorus and jejunum, connecting to the stomach.
Endoscope
Instrument for examining the interior of a hollow organ.
Endoscopy
A procedure that uses an Endoscope: Examination with a flexible viewing tube.
Enzymes (Enzyme)
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Esophagus (Esophageal)
Commonly called the "food pipe", it is a narrow muscular tube, about nine and a half inches long, that begins below the tongue and ends at the stomach. It consists of an outer layer of fibrous tissue, a middle layer containing smoother muscle, and an inner membrane, which contains numerous tiny glands. It has muscular sphincters at both its upper and lower ends. The upper sphincter relaxes to allow passage of swallowed food that is then propelled down the esophagus into the stomach by the wave-like peristaltic contractions of the esophageal muscles. There is no protective mucosal layer, so problems can arise when digestive acids reflux into the esophagus from the stomach.
Gastric
Of, relating to, or associated with the stomach.
Gastrointestinal (GI, GI Tract)
Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.
Hemorrhoids
Varicose disorder causing painful swellings at the anus; piles.
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
NSAID (NSAIDs)
Non-steroidal anti-inflammatory drug.
Occult Blood
Usually detected through an occult blood test: A test used in screening for blood found in the stool, sputum or urine. The most common test is for hidden blood in the stool, also known as a stool guaiac or hemoccult test, which usually indicates the presence of ulceration or cancer.
Small Intestine (Small Bowel)
The small intestine lies between the stomach and the large intestine. It is about 6 meters (20 feet) long and its primary function is to digest (break down) food and absorb nutrients (vitamins, minerals, proteins, carbohydrates, and fats). The small intestine makes up more than 70% of the length and 90% of the surface area of the gastrointestinal (GI) tract.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
X-rays (X-ray)
High-energy radiation used to take pictures of areas inside the body.
Last updated: Jul 19, 2008
|
 |
|
|
