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Gastrointestinal Bleeding
Gastrointestinal bleeding is a symptom that can be caused by a number of different conditions. It can vary in degrees from massive life-threatening hemorrhage to slow, subtle chronic blood loss. While most causes of bleeding are related to conditions that can be cured or controlled, such as ulcers or hemorrhoids, other causes can be more serious. Locating the source of the bleeding is necessary to determine an exact diagnosis.
The digestive, or gastrointestinal (GI), tract includes the esophagus, stomach, small intestine, large intestine or colon, rectum, and anus. Bleeding can come from one or more of these areas. Sometimes bleeding can occur without being noticeable. This type of bleeding is called occult or hidden. Fortunately, simple tests can detect occult blood in the stool.
The most common cause of an upper GI bleed is an ulceration that could occur in the duodenum (the upper small intestine), the stomach lining itself, or the esophagus. Duodenal ulcers are most commonly caused by infection. Esophageal varices (enlarged veins) at the lower end of the esophagus may rupture and bleed massively. Cirrhosis of the liver is the most common cause of esophageal varices. Esophageal bleeding can also be caused by a tear in the lining of the esophagus (Mallory-Weiss syndrome). Mallory-Weiss syndrome usually results from vomiting or retching, but may also be caused by increased pressure in the abdomen from coughing, hiatal hernia or childbirth. Stomach acid can cause inflammation that may lead to bleeding at the lower end of the esophagus. This condition, usually associated with the symptom of heartburn, is called esophagitis or inflammation of the esophagus. Tumors or cancers of the esophagus or stomach may also cause bleeding.
Factors that may aggravate upper GI bleeding include the use of anti-inflammatory medications, particularly aspirin, arthritis drugs, blood thinning medications (such as Coumadin), or underlying medical problems like chronic liver disease, renal, cardiac or pulmonary diseases.
In the lower digestive tract, the large intestine and rectum are frequent sites of bleeding. Hemorrhoids are the most common cause of visible blood in the digestive tract, especially blood that appears bright red. Hemorrhoids are enlarged veins in the anal area that can rupture and produce bright red blood, which can show up in the toilet or on toilet paper. However, if red blood is seen it is essential to exclude other causes of bleeding since the anal area may also be the site of cuts (fissures), inflammation, or cancer.
Another common cause of bleeding in the lower GI tract or colon is diverticulosis.
Benign growths or polyps of the colon are very common and are thought to be forerunners of cancer. These growths can cause either bright red blood or occult bleeding. Colorectal cancer is the third most frequent of all cancers in the United States and often causes occult bleeding at some time, but not necessarily visible bleeding.
Inflammation from various causes can produce extensive bleeding from the colon. Different intestinal infections can cause inflammation and bloody diarrhea. Ulcerative colitis can produce inflammation and extensive surface bleeding from tiny ulcerations. Crohn's disease of the large intestine can also produce bleeding.
Acute gastrointestinal bleeding first will appear as vomiting of blood, bloody bowel movements, or black, tarry stools. Blood may look like “coffee grounds.” Symptoms associated with blood loss can include the following:
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Fatigue |
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Weakness |
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Shortness of breath |
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Abdominal pain |
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Pale appearance |
Vomiting of blood usually originates from an upper GI source. Bright red or maroon stool can be from either a lower GI source or from brisk bleeding at an upper GI source.
Any presence of blood in the stool or the upper GI tract is significant and needs medical attention. To determine the cause of bleeding, a physician may need to use an endoscope to visualize the GI tract and indentify the source of the bleeding. An endoscope is a long, slender tube with a tiny camera on the end. It may be passed through the mouth into the stomach, or through the rectum into the colon. Endoscopy can be both diagnostic (finding the source of bleeding) and therapeutic (stopping it). Once the cause for the bleeding is determined, appropriate treatment, management and recommendations can be made.
Information
Courtesy of
The American College of Gastroenterology |
