Regional Gastrointestinal Consultants

Gastrointestinal Bleeding

Gastrointestinal Bleeding

Gastrointestinal Bleeding

Overview

Bleeding may occur anywhere along the digestive (gastrointestinal [GI]) tract, from the mouth to the anus. Blood may be easily seen by the naked eye (overt) or may be present in amounts too small to be visible (occult). Occult bleeding is detected only by chemical testing of a stool specimen.

Blood may be visible in vomit (hematemesis), which indicates the bleeding is coming from the upper GI tract, usually from the stomach or the first part of the small intestine. When blood is vomited, it may be bright red if bleeding is brisk and ongoing. Alternatively, vomited blood may have the appearance of coffee grounds if bleeding has slowed or stopped, due to the partial digestion of the blood by acid in the stomach.

Blood may also be passed from the rectum, either as black, tarry stools (melena), as bright red blood (hematochezia), or in apparently normal stool if bleeding is less than a few teaspoons per day. Melena is more likely when bleeding comes from the esophagus, stomach, or small intestine. The black color of melena is caused by blood that has been exposed for several hours to stomach acid and enzymes as well as to bacteria that normally reside in the large intestine. Melena may continue for several days after bleeding has stopped. Hematochezia is more likely when bleeding comes from the large intestine, although it can be caused by very rapid bleeding from the upper portions of the digestive tract as well.

People who have lost only a small amount of blood may feel well otherwise. However, serious and sudden blood loss may be accompanied by a rapid pulse, low blood pressure, and reduced urine flow. A person may also have cold, clammy hands and feet. Severe bleeding may reduce the flow of blood to the brain, causing confusion, disorientation, sleepiness, and even extremely low blood pressure (shock). Slow, chronic blood loss may cause symptoms and signs of anemia (such as weakness, easy fatigue, paleness [pallor], chest pain, and dizziness). People with underlying ischemic heart disease may develop chest pain (angina) or a have a heart attack (myocardial infarction) because of decreased blood flow through the heart.

The causes are divided into three areas: upper GI tract, lower GI tract, and small intestine. The most common causes are difficult to specify because causes vary by the area that is bleeding and the person’s age. However, in general, the most common causes of upper GI bleeding are:

  • Ulcers or erosions of the esophagus, stomach, or duodenum
  • Enlarged veins in the esophagus (esophageal varices)
  • A tear in the lining of the esophagus after vomiting (Mallory-Weiss syndrome)
  • Polyps of the large intestine
  • Diverticular disease
  • Hemorrhoids
  • Inflammatory bowel disease
  • Colon cancer

Other causes of lower GI bleeding include abnormal blood vessels in the colon, a split in the skin of the anus (anal fissure), ischemic colitis, and large bowel inflammation resulting from radiation or poor blood supply. Bleeding from the small intestine is rare but can result from blood vessel abnormalities, tumors, or a Meckel diverticulum.

Bleeding from any cause is more likely, and potentially more severe, in people who have chronic liver disease (caused by alcohol abuse or chronic hepatitis), who have hereditary disorders of blood clotting, or who are taking certain drugs. Drugs that can cause or worsen bleeding include anticoagulants (such as heparin and warfarin), those that affect platelet function (such as aspirin and certain other nonsteroidal anti-inflammatory drugs [NSAIDs] and clopidogrel), and those that affect the stomach’s protective barrier against acid (such as NSAIDs).

Symptoms

In people with GI bleeding, certain symptoms and characteristics are cause for concern. They include:

  • Fainting (syncope)
  • Sweating (diaphoresis)
  • Rapid heart rate (over 100 beats per minute)
  • Passing more than 1 cup (250 milliliters) of blood

Treatment

Doctors first ask questions about the person’s symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the GI bleeding and the tests that may need to be done.

The history is focused on finding out exactly where the bleeding is coming from, how rapid it is, and what is causing it. Doctors need to know how much blood (for instance, a few teaspoons or several clots) is being passed and how often blood is being passed. Doctors ask people with hematemesis whether blood was passed the first time they vomited or only after they vomited a few times with no blood.

Doctors ask people with rectal bleeding whether pure blood was passed; whether it was mixed with stool, pus, or mucus; or whether blood simply coated the stool. People with bloody diarrhea are asked about recent travel or other possible forms of exposure to other agents that can cause digestive tract illness (for instance, food poisoning or parasites).

Doctors then ask about symptoms of abdominal discomfort, weight loss, and easy bleeding or bruising and symptoms of anemia (such as weakness, easy exhaustion [fatigability], and dizziness). Doctors need to know about any current or past digestive tract bleeding and the results of any previous colonoscopy (examination of the entire large intestine, the rectum, and the anus using a flexible viewing tube). People should tell doctors whether they have inflammatory bowel disease, bleeding tendencies, and liver disease and whether they use any drugs that increase the likelihood of bleeding or chronic liver disease (such as use of alcohol).

The physical examination is focused on the person’s vital signs (such as pulse, breathing rate, blood pressure, and temperature) and other indicators of shock or a decrease in the volume of circulating blood (hypovolemia—rapid heart rate, rapid breathing, pallor, sweating, little urine production, and confusion) as well as anemia.

Doctors also look for small purplish red (petechiae) and bruise-like (ecchymoses) spots on the skin, which are signs of bleeding disorders. Doctors also look for signs of chronic liver disease (such as spider angiomas, fluid in the abdominal cavity [ascites], and red palms) and portal hypertension (such as an enlarged spleen [splenomegaly] and dilated abdominal wall veins).

Doctors do a rectal examination to search for stool color, masses, and fissures and to check the stool for blood. Doctors also examine the anus to look for hemorrhoids.

Most GI bleeding stops without treatment. Sometimes, however, it does not. The type and location of bleeding tells the doctors what treatment to use. For example, doctors can often stop peptic ulcer bleeding during endoscopy by using a device that uses an electrical current to produce heat (electrocautery), heater probes, laser, or injections of certain drugs (injection sclerotherapy). If endoscopy does not stop the bleeding, surgery is required.

IMPORTANT HEALTH NOTE

We recommend that people experiencing gastrointestinal symptoms do not attempt self-treatment. With many medications being available over the counter, and numerous do-it-yourself online unqualified remedy recommendation, it is natural to consider treating yourself but we highly recommend against this.

If you are experiencing gastrointestinal symptoms you may have a more significant issue than you would expect from the sometimes muted or infrequent symptom you may be experiencing. It is important to keep in mind that is you are having gastrointestinal symptoms or concerns it is best see a doctor to have those symptoms diagnosed and any conditions treated. Also, it is worth noting, that if health conditions do exist, the earlier they are diagnosed and treated, the greater the probability will be to successfully eliminate or manage a present condition, in fact successful outcomes will increase significantly with early detection.

If you have gastrointestinal concerns or are experiencing any gastrointestinal symptoms, please contact us promptly to schedule a consultation with a physician.


DISCLAIMER: PLEASE READ CAREFULLY

The information on this website is to provide general information. In no way, does any of the information provided reflect definitive medical advice and self-diagnoses should not be made based on information obtained online. It is important to consult a best in class physician regarding ANY and ALL symptoms or signs as it may a sign of a serious illness or condition. A thorough consultation and examination should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call a physician or call our office today at (215) 321-4700 to schedule a consultation.