Gastrointestinal Bleeding OverviewThe causes of gastrointestinal (GI) bleeding are classified into upper or lower, depending on their locationin the GI tract.Upper gastrointestinal bleeding: Upper GI bleeding originates in the first part of the GI tract-theesophagus, stomach, or duodenum (first part of the small intestine). Most often, upper GI bleeding iscaused by one of the following: Peptic ulcers Gastritis Esophageal varices Mallory-Weiss tears Gastrointestinal cancers Inflammation of the gastrointestinal lining from ingested materialsLower gastrointestinal bleeding: Lower GI bleeding originates in the portions of the GI tract furtherdown the digestive system-such as parts of the small intestine beyond the duodenum, large intestine,rectum, and anus. The most common causes of lower GI bleeding include: Diverticular disease Gastrointestinal cancers Inflammatory bowel disease (IBD) Infectious diarrhea Angiodysplasia Polyps Hemorrhoids and anal fissuresGastrointestinal Bleeding CausesThe causes of gastrointestinal (GI) bleeding are classified into upper or lower, depending on their locationin the GI tract.Upper GI bleeding Peptic ulcer disease: Peptic ulcers are localized erosions of the mucosal lining of the digestive tract. Ulcers usually occur in the stomach or duodenum. Breakdown of the mucosal lining results in damage to blood vessels, causing bleeding. Gastritis: General inflammation of the stomach lining, which can result in bleeding. Gastritis also results from an inability of the gastric lining to protect itself from the acid it produces. NSAIDs (nonsteroidal anti-inflammatory drugs),steroids, alcohol, burns, and trauma can cause gastritis. Esophageal varices: Swelling of the veins of the esophagus or stomach usually resulting from liver disease. Varices most commonly occur in alcoholic liver cirrhosis. When varices bleed, the bleeding can be massive, catastrophic and occur without warning. Mallory-Weiss tear: A tear in the esophageal or stomach lining, often as a result of vomiting or retching. Mucosal tears also can occur after seizures, forceful coughing or laughing, lifting, straining, or childbirth. Physicians often find tears in people who have recently binged on alcohol.
Cancer: One of the earliest signs ofesophageal or stomach cancers may be blood in the vomit or stool. Inflammation: when the mucous membranes break down, they are unable to counteract the harsh effects of stomach acid. Nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, alcohol, and cigarette smoking promote gastric ulcer formation. Helicobacter pylori is a type of bacteria that also promotes formation of ulcers.Lower GI bleeding Diverticulosis: One of the most common causes of lower GI bleeding. Small out-pockets, or diverticula, form in the wall of the colon (large intestine), usually in a weakened area of the bowel wall. The person may develop several pockets, which are more common in people who have constipation and strain during a bowel movement. Cancers: One of the early signs of colon or rectal cancers may be blood in the stool. Inflammatory bowel disease (IBD): Flares of inflammation from IBD often cause mucousy stool that has blood mixed in it. Infectious diarrhea: Some viruses or bacteria can cause damage to the inner lining of the intestines, which can lead to bleeding. Angiodysplasia: Along with diverticulosis, this is one of the most common causes of lower GI bleeding. Angiodysplasia is a malformation of the blood vessels in the wall of the GI tract. These are most commonly in the large intestine and often bleed. The elderly and people with chronic kidney failuredevelop the disease most often. Polyps: Intestinal polyps are noncancerous tumors of the GI tract, occurring mostly in people older than 40 years of age. A small proportion of these polyps may transform into cancer. Colon polyps may bleed rapidly, or they may bleed slowly and go undetected. Hemorrhoids and fissures: Hemorrhoids are swollen veins in and around the anus. Repeated stretching from straining during bowel movements causes them to bleed. Bleeding from hemorrhoids is usually mild, intermittent, and bright red. Anal fissures, or tears in the anal wall, also may trigger small amounts of bright red bleeding from the anus. Forceful straining during passage of hard stool usually causes such tears, which can be very painful and may require surgery.Gastrointestinal Bleeding SymptomsAcute gastrointestinal bleeding first will appear as vomiting of blood, bloody bowel movements, or black,tarry stools. Vomited blood may look like "coffee grounds." Symptoms associated with blood loss caninclude : Fatigue Weakness Shortness of breath Abdominal pain 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 from an upper GI source. Long-term GI bleeding may go unnoticed or may cause fatigue, anemia, black stools, or a positive test for microscopic blood
When to Seek Medical Care Any presence of blood in the stool or from the upper gastrointestinal tract is significant and needs medical attention. Black or dark stools may represent slow bleeding into the GI tract and should be treated by a physician. Any significant bleeding into the GI tract, either vomited blood or blood through the rectum, should be evaluated in the emergency department. Next Page: Gastrointestinal Bleeding DiagGastrointestinal Bleeding Diagnosis A doctor will perform a complete history and physical exam to evaluate the patients problem. The physical will include a digital rectal exam, to test for visible or microscopic blood from the rectum. The doctor may need to perform a procedure called an endoscopy or acolonoscopy. An endoscope is a long tube with a tiny camera at the end. It is passed into the stomach, and the first part of the small intestine. A colonoscopy refers to the passage of a tube with a tiny camera through the rectum into the colon, to directly see the source of bleeding. Both procedures can be diagnostic, finding the source of bleeding; and therapeutic, stopping it. Lab tests also can be helpful to determine the rate or severity of bleeding and to determine factors that may contribute to the problem. Gastrointestinal Bleeding Treatment Gastrointestinal Bleeding Self-Care at Home There is no home care for heavy gastrointestinal bleeding. A person should to a hospitals emergency department if they have heavy gastrointestinal bleeding. For hemorrhoids or anal fissures, a diet high in fiber and fluids to keep stools soft may be helpful. Next Page: Gastrointestinal Bleeding MedGastrointestinal Bleeding Medical Treatment Serious gastrointestinal bleeding can destabilize vital signs. Blood pressure may fall sharply and heart rate may increase. The physician may need to resuscitate the patient with IV fluids and possibly a blood transfusion. In some cases, the patient may need surgery.Next Page:Gastrointestinal BleGastrointestinal Bleeding PreventionPeople can prevent some causes of gastrointestinal bleeding. Avoid foods and triggers, such as alcohol and smoking, that increase gastric secretions. Eat a high-fiber diet to increase the bulk of the stool, which helps prevent diverticulosis and hemorrhoids.Next Page: