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What is gastrointestinal bleeding?

Gastrointestinal bleeding is bleeding that occurs anywhere in the digestive tract, also called the gastrointestinal tract, which runs from the mouth to the anus. Blood may be present in vomit or stool. Depending on where the bleeding originates, the blood may be visible or occult, which means that it can be detected only by laboratory testing. The severity of gastrointestinal bleeding varies among individuals depending on the cause. Typically, bleeding from the upper gastrointestinal tract manifests as black or tarry stool known as melena. The black color develops because of chemical changes that occur as the blood passes through the digestive tract. The passage of bright red blood from the anus is known as hematochezia and usually results from bleeding from sources that are closer to the anus and rectum. Common causes of gastrointestinal bleeding are inflammation and infections in the digestive tract, such as gastritis. Mild gastrointestinal bleeding is common with viral infections, and this bleeding will go away as the infection resolves. People with an anal fissure or hemorrhoids may also have mild bleeding that resolves on its own. If severe bleeding occurs, it can result in significant blood loss, leading to symptoms such as lightheadedness, dizziness, fainting, or difficulty breathing. While gastrointestinal bleeding can be minor, it can also result from severe conditions that are characterized by prolonged bleeding. In these cases, serious complications such as shock can develop. Gastrointestinal bleeding can also occur from cancers in the digestive tract.

Left untreated, severe gastrointestinal bleeding can result in a life-threatening loss of blood. Seek immediate medical care (call 911) for serious symptoms, pale skin or pallor and difficulty breathing, severe abdominal pain, vomiting blood or black material, or change in level of consciousness. SYMPTOMS

What other symptoms might occur with gastrointestinal bleeding? Gastrointestinal bleeding may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the digestive tract may also involve other body systems.... Read More About Gastrointestinal Bleeding Symptoms

What causes gastrointestinal bleeding? Gastrointestinal bleeding can result from any condition occurring in the digestive tract, either in the upper part (including the esophagus, stomach, and part of the small intestine) or in the lower part (including the rest of the small intestine and the large intestine, colon, rectum, and anus). Common causes of gastrointestinal bleeding include inflammation, infection, and underlying disease processes such as Crohns disease, diverticular disease, or malignancy. Hemorrhoids and anal fissures are common and usually mild sources of bleeding. Gastrointestinal bleeding may also be the result of internal injuries caused by trauma.

Common causes of gastrointestinal bleeding Common causes of gastrointestinal bleeding include: Anal fissures

Angiodysplasia (abnormalities in the intestinal blood vessels) Colon polyps or tumors Diverticulitis (inflammation of an abnormal pocket in the colon) Esophagitis (inflammation of the esophagus) Gastritis (inflammation of the stomach lining) Hemorrhoids Peptic ulcer

Other causes of gastrointestinal bleeding Other causes of gastrointestinal bleeding include: Angiodysplasia (abnormalities in the intestinal blood vessels) Bleeding disorders, such as hemophilia or von Willebrands disease Bleeding diverticulum (pouch formed by weakening in the intestinal wall) Celiac disease (severe sensitivity to gluten from wheat and other grains that causes intestinal damage) Dysentery (infectious inflammation of the colon causing severe bloody diarrhea) Inflammatory bowel disease (includes Crohns disease and ulcerative colitis) Medication effects (caused by medications such as warfarin, clopidogrel) Nosebleed

Serious or life-threatening causes of gastrointestinal bleeding In some cases, gastrointestinal bleeding may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include: Colorectal or anal cancer

Esophageal cancer Esophageal varices Internal injury from trauma Intestinal obstruction Perforated peptic ulcer (bleeding stomach or intestinal ulcer) Stomach cancer

Questions for diagnosing the cause of gastrointestinal bleeding To diagnose your condition, your doctor or licensed health care practitioner will ask you several questions related to your gastrointestinal bleeding including: When did you first notice your gastrointestinal bleeding? Can you tell where the bleeding is coming from? Do you have any other symptoms? What medications are you taking?

What are the potential complications of gastrointestinal bleeding? Because gastrointestinal bleeding can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including: Anemia (low red blood cell count) Need for blood transfusion Shock Spread of cancer

Spread of infection

References: Gastrointestinal bleeding. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/003133.htm. Accessed May 11, 2011. Bleeding in the digestive tract. National Digestive Diseases Information Clearinghouse (NDDIC).http://digestive.niddk.nih.gov/ddiseases/pubs/bleeding/. Accessed May 11, 2011.

What other symptoms might occur with gastrointestinal bleeding? Gastrointestinal bleeding may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the digestive tract may also involve other body systems.

Gastrointestinal symptoms that may occur along with gastrointestinal bleeding Gastrointestinal bleeding may accompany other symptoms affecting the gastrointestinal system including: Abdominal pain or cramping Abdominal swelling, distension or bloating Blood-streaked stools Bloody stool (the blood may be red, black, or tarry in texture) Constipation Diarrhea

Rectal bleeding or blood in the stool (melena) Vomiting blood or black material resembling coffee grounds

Other symptoms that may occur along with gastrointestinal bleeding Gastrointestinal bleeding may accompany symptoms related to other body systems including: Dizziness Fainting or change in level of consciousness or lethargy Fatigue Fever Pale skin or pallor Weakness (loss of strength)

Serious symptoms that might indicate a life-threatening condition In some cases, gastrointestinal bleeding can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including: Change in level of consciousness or alertness such as passing out or unresponsiveness Dizziness Respiratory or breathing problems such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking Severe abdominal pain Vomiting blood or black material resembling coffee grounds Weakness (loss of strength)

Hematemesis is vomiting of red blood and indicates upper GI bleeding, usually from an arterial source or varix. Coffee-ground emesis is vomiting of dark brown, granular material that resembles coffee grounds. It results from upper GI bleeding that has slowed or stopped, with conversion of red Hb to brown hematin by gastric acid. Hematochezia is the passage of gross blood from the rectum and usually indicates lower GI bleeding but may result from vigorous upper GI bleeding with rapid transit of blood through the intestines. Melena is black, tarry stool and typically indicates upper GI bleeding, but bleeding from a source in the small bowel or right colon may also be the cause. About 100 to 200 mL of blood in the upper GI tract is required to cause melena, which may persist for several days after bleeding has ceased. Black stool that does not contain occult blood may result from ingestion of iron, bismuth, or various foods and should not be mistaken for melena. Chronic occult bleeding can occur from anywhere in the GI tract and is detectable by chemical testing of a stool specimen. Acute, severe bleeding also can occur from anywhere in the GI tract. Patients may present with signs of shock. Those with underlying ischemic heart disease may develop angina or MI because of hypoperfusion. GI bleeding may precipitate portal-systemic encephalopathy (see Approach to the Patient with Liver Disease:
Portal-Systemic Encephalopathy) or hepatorenal syndrome (kidney failure secondary to liver failure

see Approach to the Patient with Liver Disease: Renal and Electrolyte Abnormalities).

GASTROINTESTINAL SYSTEM

Elderly Coagulopathy: o An abnormality that affects blood coagulation Liver disease Treatment with blood thinner medication: o Coumadin (Warfarin) o Heparin Daily aspirin use Regular or heavy use of nonsteroidal antiinflammatory medications: o Ibuprofen ( Motrin, Advil) o Naproxen (

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