Gastrointestinal Bleeding

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1 Gastrointestinal Bleeding Introduction Gastrointestinal bleeding is a symptom of many diseases rather than a disease itself. A number of different conditions can cause gastrointestinal bleeding. Some causes of bleeding may be life-threatening. However, most conditions can be healed or managed. Finding the source of the bleed is important. Knowing if the bleeding is coming from the upper or lower digestive tracts can help your healthcare provider make a diagnosis. This reference summary will help you understand gastrointestinal bleeding. It will discuss the symptoms and causes, diagnosis, and treatment of gastrointestinal bleeding. The Digestive System The digestive system is also known as the gastrointestinal system. Swallowed food passes through the esophagus, also known as the feeding tube, then through the stomach, where it is partially digested. Digested food travels from the stomach to the small intestines, where nutrients are further digested and absorbed. The small intestines are divided into 3 parts: the duodenum, the jejunum and the ileum. Digested food that has not been absorbed in the small intestines reaches the colon, or the large intestines. In the colon, the remaining nutrients get absorbed and stools are formed. Stools are then stored in the last section of the colon, between the sigmoid and the rectum, before being excreted. The sigmoid is the S-shaped section of the colon that connects to the rectum. 1

2 The colon is made up of the following parts: The ascending colon The transverse colon The descending colon The sigmoid colon The rectum and the anus Ascending Colon The gastrointestinal system is also called the GI tract. It is sometimes divided into two parts: the upper GI tract and the lower GI Rectum and Anus tract. The upper GI tract includes the mouth, esophagus, stomach and duodenum (first part of the small intestines). The lower GI tract includes the rest of the small intestines, large intestines, and anus. Symptoms The symptoms of gastrointestinal bleeding depend on the site of the bleeding and how bad the bleed is. Signs of bleeding in the upper digestive tract include traces of blood in the vomit or stool. The vomit may include bright red blood spots or may look like coffee grounds. Signs of upper GI bleeding in the stool include: Black stool Stool that looks like tar Dark blood mixed with stool Stool mixed or coated with bright red blood Transverse Colon Descending Colon Sigmoid Colon Signs of bleeding in the lower digestive tract show up in the stool but not in the vomit. They include: Black stool Stool that looks like tar Dark blood mixed with stool Stool mixed or coated with bright red blood 2

3 Sudden, severe bleeding is called acute bleeding. Acute bleeding is often accompanied by: Abdominal Cramping Diarrhea Dizziness or faintness Paleness Shortness of breath Weakness Acute bleeding is a medical emergency. A person with acute bleeding should call for an ambulance or contact a healthcare provider right away. Bleeding that continues for a long time is known as chronic bleeding. It is usually light bleeding and starts and stops from time to time. A person with chronic bleeding may experience tiredness and shortness of breath. Both chronic and acute blood loss can lead to anemia. Anemia is a condition that happens when the blood is deficient. It can be deficient in red blood cells, which help bring oxygen to tissues throughout the body, or in volume. Being anemic can cause fatigue and dizziness. Another type of bleeding is called occult bleeding. This is a small amount of bleeding and may not be noticeable by the naked eye. Simple tests can detect occult blood in the stool. Causes A variety of conditions may cause bleeding in the digestive tract. Peptic ulcers are a break in the lining of the lower part of the esophagus, stomach, or upper part of the small intestine that may cause bleeding. They may be caused by bacterial infections and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. 3

4 Enlarged veins that are located at the lower end of the esophagus are called esophageal varices. These varices may burst and bleed a lot. Liver cirrhosis is the most common cause of esophageal varices. Cirrhosis is a type of chronic, progressive liver disease in which liver cells are replaced by scar tissue. Tears that happen in the esophagus can also cause upper digestive tract bleeding. These are called Mallory Weiss tears. They are usually caused by vomiting. Other causes of Mallory Weiss tears are coughing, hiatal hernia, or childbirth. A hiatal hernia is a bulging of part of the stomach into the chest through the diaphragm opening. Liver Cirrhosis Mallory Weiss Tear Inflammation in the lining of the stomach may cause bleeding. It is known as gastritis. NSAIDs, infections, and certain medical conditions can cause gastritis. Bleeding may also be caused by esophagitis. Esophagitis is inflammation of the esophagus. It is most often caused by esophageal reflux also known as GERD. GERD is gastroesophageal reflux disease. In GERD, the muscle between the esophagus and stomach fails to close properly. This allows food and stomach juices to flow back into the esophagus. Upper digestive tract bleeding may also be caused by tumors in the esophagus, stomach, or duodenum. Tumors are abnormal tissue growth that may or may not be cancerous. Noncancerous tumors are called benign tumors. Unlike malignant tumors, benign tumors do not spread to other parts of the body. Now we will look at some causes of bleeding in the lower digestive tract. Diverticular disease is one cause. This disease is caused by pouches in the colon wall. These pouches are called diverticula. Colitis may also cause lower digestive tract bleeding. Colitis is an inflammation of the colon. It may be caused by infections, Crohn s disease, lack of blood flow to the colon, radiation, and other diseases of the colon. 4

5 Crohn s Disease is a type of inflammatory bowel disease in which the gastrointestinal tract is inflamed over a long period of time. Bleeding may also be caused by hemorrhoids or fissures. Hemorrhoids are enlarged veins in the anus or rectum. These veins can rupture and bleed. Fissures, or ulcers, are cuts or tears in the anal area. Abnormalities in the blood vessels of the intestine can be a Polyps cause of lower digestive tract bleeding. These abnormalities are known as angiodysplasia and are caused by aging. Lower digestive tract bleeding may also be caused by polyps in the colon. Polyps are abnormal growths that may or may not be cancerous. Colorectal cancer is a common type of cancer that often causes mild bleeding that is not noticeable by the naked eye. Colorectal cancer is cancer that begins in the colon or rectum. Diagnosis The first thing your healthcare provider will want to figure out is whether the bleeding is coming from the upper or lower digestive tract. He or she will ask you about your symptoms and perform a physical exam. Sometimes certain foods can make your stool look like there is bleeding. Deep red foods like tomatoes and beets as well as dark juices that contain red dye may have this effect. Your healthcare provider may also ask for a stool sample to confirm there is bleeding. Stool tests can also show bleeding that is not visible. A blood test can also help diagnose gastrointestinal bleeding. This can tell your healthcare provider the extent of the bleeding. It also shows if you are anemic due to bleeding. 5

6 Nasogastric lavage is another test that may help determine the source of bleeding. A tube is inserted through the nose and into the stomach for this test. The contents of the stomach are removed and tested for blood. An endoscopy is the most common test for diagnosing gastrointestinal bleeding. During an upper GI endoscopy, a thin, lighted tube called an endoscope is inserted through the mouth. It examines the esophagus, stomach, and duodenum. A colonoscopy also uses an endoscope. However, for this procedure the endoscope is inserted through the rectum. This way the colon can be examined. This is known as lower GI endoscopy or colonoscopy. A biopsy may be done during either an upper GI endoscopy or a colonoscopy. A biopsy is a removal of cells or tissue. The sample is then examined under a microscope. An enteroscopy examines the small intestines for signs of bleeding. Special endoscopes are used for enteroscopy. This is because traditional endoscopes are not long enough to reach the small intestines. There are three different types of enteroscopy: push enteroscopy, double-balloon enteroscopy, and capsule enteroscopy. Push enteroscopy uses a long endoscope. It examines the upper portion of the small intestine. Double-balloon enteroscopy uses a special endoscope with balloons mounted on the end. The balloons help the endoscope move through the entire small intestine. Capsule enteroscopy uses a small capsule swallowed by the patient. The small capsule contains a tiny camera. The camera transmits images of the digestive tract to a video monitor. Barium x-rays may also be used to diagnose the cause of gastrointestinal bleeding. A liquid containing barium is either swallowed or inserted into the rectum for this test. The barium makes the digestive tract visible in the x-rays. 6

7 Another test used to find gastrointestinal bleeding is radionuclide scanning. This test requires injecting a small and safe amount of radioactive material into the patient s vein. A special camera creates images of the blood flow in the digestive tract. It can detect very slow bleeding. An angiography may also help detect the exact source of bleeding. An angiography uses a dye injected into the patient s blood vessels. The dye makes blood vessels visible in x-ray or CT scans. CT scan is an x- ray machine linked to a computer. CT stands for computerized tomography. An exploratory laparotomy may be done if other tests can t find the source of the bleeding. An exploratory laparotomy is a surgical procedure that examines the digestive tract. Treatment Treatment of gastrointestinal bleeding depends on the cause of the bleeding. Gastrointestinal bleeding is a symptom and not a disease or medical condition. During an endoscopy, the doctor may be able to stop a discovered gastrointestinal bleeding. A doctor can insert tools through the endoscope to: Inject chemicals into the bleeding site Treat the bleeding site with a heat probe, electric current, or laser Close affected blood vessels with a band or clip Endoscope If an endoscopy doesn t work, an angiography may be used to inject medicine or other materials. This may control some types of bleeding. Surgery or other treatments may be needed to stop the bleeding. 7

8 To prevent bleeding in the future, doctors treat the disease or medical conditions that cause bleeding. Diseases that can be treated include: H. pylori and other infections GERD Ulcers Hemorrhoids Polyps Inflammatory bowel disease If the bleeding is caused by cancer, then surgery is needed to take the cancer out and stop the bleeding. If the patient is severely anemic, blood transfusions may be needed. When bleeding is caused by inflammation of the lining of the intestines, medications are given to decrease the inflammation. At times, the source of bleeding is not discovered. This is especially true in slow bleeders. Patients with such a condition have to be followed up very closely by their healthcare providers. Summary Gastrointestinal bleeding is a symptom of a disease rather than a disease itself. A number of different diseases and medical conditions can cause gastrointestinal bleeding. The test used most often to look for the cause of GI bleeding is called endoscopy. It uses a flexible instrument inserted through the mouth or rectum to view the inside of the GI tract. Locating the source of bleeding is important. Knowing if the bleeding is coming from the upper or lower digestive tract can help your doctor make a diagnosis. Some causes of gastrointestinal bleeding may be life-threatening. However, most causes of bleeding are related to conditions that can be healed or managed. 8

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