Gastrointestinal bleeding

Answer 1

Definition

Gastrointestinal (GI) bleeding refers to any bleeding that starts in the gastrointestinal tract, which extends from the mouth to the anus.

The amount of bleeding can range from nearly undetectable to acute, massive, and life threatening.

Bleeding may come from any site along the GI tract, but is often divided into:

• Upper GI bleeding: The upper GI tract is located between the mouth and the upper part of the small intestine.
• Lower GI bleeding: The lower GI tract is located between the upper part of the small intestine and the anus. The lower GI tract includes the small and large bowels.

Alternative Names

Lower GI bleeding; GI bleeding; Upper GI bleeding

Considerations

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

GI 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 GI bleeding include:

• Anal fissure
• Aorto-enteric fistula
• Arterio-venous malformations (also called angiodysplasias)
• Bleeding diverticulum
• Cancer of the small intestine
• Celiac sprue
• Colon cancer
• Cow's milk allergy
• Crohn's disease
• Dieulafoy's lesion
• Duodenal ulcer
• Dysentery (infectious diarrhea that causes bleeding)
• Esophageal varices
• Esophagitis
• Gastric (stomach) ulcer
• Hemorrhoids
• Ischemic bowel
• Intestinal polyps
• Intestinal obstruction (twisted bowel)
• Intestinal vasculitis
• Intussusception(bowel telescoped on itself)
• Mallory-Weiss tear
• Meckel's diverticulum
• Nosebleed
• Portal hypertensive gastropathy
• Radiation injury to the bowel
• Stomach cancer
• Ulcerative colitis

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

Call for an appointment with your doctor if:

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

What to expect at your health care provider's office

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

GI bleeding can be an emergency condition requiring immediate medical attention. Treatment may involve:

• Blood transfusions
• Fluids and medicines through a vein
• Tube through the mouth into the stomach to drain the stomach contents (gastric lavage)

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

You will also be asked questions about your symptoms, including:

• When did you first notice symptoms?
• Did you have black, tarry stools or red blood in the stools?
• Have you vomited blood?
• Did you vomit material that looks like coffee grounds?
• Do you have a history of peptic or duodenal ulcers?
• Have you ever had symptoms like this before?
• What other symptoms do you have?

Tests that may be done include:

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

References

Bjorkman D. GI hemorrhage and occult GI bleeding. In: Goldman L, Ausiello D. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 137.

Answer 2

Definition

Gastrointestinal (GI) bleeding refers to any bleeding that starts in the gastrointestinal tract.

Bleeding may come from any site along the GI tract, but is often divided into:

• Upper GI bleeding: The upper GI tract includes the esophagus (the tube from the mouth to the stomach), stomach, and first part of the small intestine.
• Lower GI bleeding: The lower GI tract includes much of the small intestine, large intestine or bowels, rectum, and anus.

Alternative Names

Lower GI bleeding; GI bleeding; Upper GI bleeding

ConsiderationsThe amount of GI bleeding may be so small that it can only be detected on a lab test such as the fecal occult blood test. Other signs of GI bleeding include:

• Dark, tarry stools
• Larger amounts of blood passed from the rectum
• Small amounts of blood in the toilet bowl, on toilet paper, or in streaks on stool (feces)
• Vomiting blood

Massive bleeding from the GI tract can be dangerous. However, even very small amounts of bleeding that occur over a long period of time can lead to problems such as anemia or low blood counts.

Once a bleeding site is found, many therapies are available to stop the bleeding or treat the cause.

Common Causes

GI bleeding may be due to conditions that are not serious, including:

• Anal fissure
• Hemorrhoids

However, GI bleeding may also be a sign of more serious diseases and conditions, such as the following cancers of the GI tract:

• Cancer of the colon
• Cancer of the small intestine
• Cancer of the stomach
• Intestinal polyps (a pre-cancerous condition)

Other possible causes of GI bleeding include:

• Abnormal blood vessels in the lining of the intestines (also called angiodysplasias)
• Bleeding diverticulum, or diverticulosis
• Crohn's diseaseorulcerative colitis
• Esophageal varices
• Esophagitis
• Gastric (stomach) ulcer
• Intussusception(bowel telescoped on itself)
• Mallory-Weiss tear
• Meckel's diverticulum
• Radiation injury to the bowel

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

Call for an appointment with your doctor if:

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

What to expect at your health care provider's office

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

GI bleeding can be an emergency condition requiring immediate medical attention. Treatment may involve:

• Blood transfusions
• Fluids and medicines through a vein
• Esophagogastroduodenoscopy(EGD) - a thin tube with a camera on the end is passed through your mouth into your esophagus, stomach, and small intestine
• A tube is placed through your mouth into the stomach to drain the stomach contents (gastric lavage)

Once your condition is stable, you will have a physical examination, including a detailed abdominal examination.

You will also be asked questions about your symptoms, including:

• When did you first notice symptoms?
• Did you have black, tarry stools or red blood in the stools?
• Have you vomited blood?
• Did you vomit material that looks like coffee grounds?
• Do you have a history of peptic or duodenal ulcers?
• Have you ever had symptoms like this before?
• What other symptoms do you have?

Tests that may be done to find the source of the bleeding include:

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

References

Bjorkman D. GI hemorrhage and occult GI bleeding. In: Goldman L, Ausiello D. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 137.

Savides TJ, Jensen DM. Gastrointestinal bleeding. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010:chap 19.

Reviewed By

Review Date: 01/31/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.