Gastrointestinal bleeding (patient information): Difference between revisions

	Gastrointestinal bleeding
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Gastrointestinal bleeding ?
Prevention
What to expect (Outlook/Prognosis)?
Possible complications
Gastrointestinal bleeding On the Web
Ongoing Trials at Clinical Trials.gov
Images of Gastrointestinal bleeding
Videos on Gastrointestinal bleeding
FDA on Gastrointestinal bleeding
CDC on Gastrointestinal bleeding
Gastrointestinal bleeding in the news
Blogs on Gastrointestinal bleeding
Directions to Hospitals Treating Gastrointestinal bleeding
Risk calculators and risk factors for Gastrointestinal bleeding

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Latest revision as of 20:11, 5 June 2015

For the WikiDoc page for this topic, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2] Assistant Editor-in-Chief: Meagan E. Doherty

Overview

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.

What are the symptoms of Gastrointestinal bleeding?

The 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.

What causes Gastrointestinal bleeding?

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

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 disease or ulcerative colitis
Esophageal varices
Esophagitis
Gastric (stomach) ulcer
Intussusception (bowel telescoped on itself)
Mallory-Weiss tear
Meckel's diverticulum
Radiation injury to the bowel

Who is at highest risk?

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 blood or you vomit material that looks like coffee grounds

Diagnosis

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

There are home stool tests for microscopic blood that may be recommended for people with anemia or for colon cancer screening.

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

When to seek urgent medical care?

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 blood or you vomit material that looks like coffee grounds

Treatment options

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.

Medications to avoid

Patients diagnosed with Gastrointestinal bleeding should avoid using the following medications:

Abciximab
Metoclopramide
If you have been diagnosed with Gastrointestinal bleeding, consult your physician before starting or stopping any of these medications.

Where to find medical care for Gastrointestinal bleeding?

Directions to Hospitals Treating Gastrointestinal bleeding

Sources

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 __NOTOC__
+{{Gastrointestinal bleeding (patient information)}}
 '''For the WikiDoc page for this topic, click [[Gastrointestinal bleeding|here]]'''
-{{SI}}
-{{CMG}}; '''Assistant Editor-in-Chief:''' Meagan E. Doherty
+{{CMG}}; {{AE}} {{KD}} '''Assistant Editor-in-Chief:''' Meagan E. Doherty
 ==Overview==
-Gastrointestinal (GI) bleeding refers to any bleeding that starts in the [[gastrointestinal tract]], which extends from the [[mouth]] to the [[anus]].
+Gastrointestinal (GI) bleeding refers to any bleeding that starts in the [[gastrointestinal tract]].
-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:
-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]].
-* 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 includes much of the [[small intestine]], [[large intestine]] or bowels, [[rectum]], and [[anus]].
-* 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.
 ==What are the symptoms of Gastrointestinal bleeding?==
-The signs of bleeding in the digestive tract depend upon the site and severity of bleeding. If blood is coming from the [[rectum]] or the lower [[colon]], bright red blood will coat or mix with the stool. The stool may be mixed with darker blood if the bleeding is higher up in the colon or at the far end of the [[small intestine]]. When there is bleeding in the [[esophagus]], [[stomach]], or [[duodenum]], the stool is usually black or tarry. Vomited material may be bright red or have a coffee-grounds appearance when one is bleeding from those sites. If bleeding is occult, the patient might not notice any changes in stool color.
+The 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:
-If sudden massive bleeding occurs, a person may feel weak, [[dizzy]], faint, short of breath, or have crampy [[abdominal pain]] or [[diarrhea]]. Shock may occur, with a rapid pulse, drop in blood pressure, and difficulty in producing urine. The patient may become very pale. If bleeding is slow and occurs over a long period of time, a gradual onset of fatigue, lethargy, shortness of breath, and pallor from the [[anemia]] will result. [[Anemia]] is a condition in which the blood's iron-rich substance, [[hemoglobin]], is diminished.
+* 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
-==What are the causes of Gastrointestinal bleeding?==
+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.
-[[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. Sometimes a muscle between the esophagus and stomach fails to close properly and allows the return of food and stomach juices into the esophagus, which can lead to [[esophagitis]]. In another, unrelated condition, enlarged veins ([[varices]]) 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 be caused by a tear in the lining of the esophagus ([[Mallory-Weiss syndrome]]). Mallory-Weiss syndrome usually results from vomiting but may also be caused by increased pressure in the abdomen from coughing, [[hiatal hernia]], or childbirth. [[Esophageal cancer]] can cause bleeding.
-The stomach is a frequent site of bleeding. Infections with [[Helicobacter pylori]] (H. pylori), alcohol, [[aspirin]], aspirin-containing medicines, and various other medicines ([[NSAIDs]], particularly those used for [[arthritis]]) can cause stomach ulcers or inflammation ([[gastritis]]). The stomach is often the site of [[ulcer disease]]. Acute or chronic ulcers may enlarge and erode through a blood vessel, causing bleeding. Also, patients suffering from burns, shock, head injuries, cancer, or those who have undergone extensive surgery may develop stress ulcers. Bleeding can also occur from benign tumors or cancer of the stomach, although these disorders usually do not cause massive bleeding.
+Once a bleeding site is found, many therapies are available to stop the bleeding or treat the cause.
+==What causes Gastrointestinal bleeding?==
+GI bleeding may be due to conditions that are not serious, including:
-A common source of bleeding from the upper digestive tract is ulcers in the [[duodenum]] (the upper small intestine). Duodenal ulcers are most commonly caused by infection with H. pylori bacteria or drugs such as aspirin or NSAIDs.
+* [[Anal fissure]]
+* [[Hemorrhoids]]
-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. If red blood is seen, however, it is essential to exclude other causes of bleeding since the anal area may also be the site of cuts (fissures), inflammation, or cancer.
+However, GI bleeding may also be a sign of more serious diseases and conditions, such as the following cancers of the GI tract:
-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.
+* [[Cancer of the colon]]
+* Cancer of the small intestine
+* [[Cancer of the stomach]]
+* Intestinal polyps (a pre-cancerous condition)
-[[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.
+Other possible causes of GI bleeding include:
-[[Diverticular disease]] caused by [[diverticula]]—pouches in the colon wall—can result in massive bleeding. Finally, as one gets older, abnormalities may develop in the blood vessels of the large intestine, which may result in recurrent bleeding.
+* Abnormal blood vessels in the lining of the intestines (also called [[angiodysplasia]]s)
+* Bleeding [[diverticulum]], or [[diverticulosis]]
+* [[Crohn's disease]] or [[ulcerative colitis]]
+* [[Esophageal varices]]
+* [[Esophagitis]]
+* Gastric (stomach) ulcer
+* [[Intussusception]] (bowel telescoped on itself)
+* [[Mallory-Weiss tear]]
+* [[Meckel's diverticulum]]
+* [[Radiation injury]] to the bowel
-Patients taking blood thinning medications ([[warfarin]]) may have bleeding from the GI tract, especially if they take drugs like aspirin.
+==Who is at highest risk?==
+Call for an appointment with your doctor if:
-==How to know you have Gastrointestinal bleeding?==
+* You have black, tarry stools (this may be a sign of GI bleeding)
-he site of the bleeding must be located. A complete history and physical examination are essential. Symptoms such as changes in bowel habits, stool color (to black or red) and consistency, and the presence of pain or tenderness may tell the doctor which area of the GI tract is affected. Because the intake of iron, bismuth (Pepto Bismol), or foods such as beets can give the stool the same appearance as bleeding from the digestive tract, a doctor must test the stool for blood before offering a diagnosis. A blood count will indicate whether the patient is anemic and also will give an idea of the extent of the bleeding and how chronic it may be.
+* You have blood in your [[stool]]
+* You vomit blood or you vomit material that looks like coffee grounds
-===Endoscopy===
+==Diagnosis==
-[[Endoscopy]] is a common diagnostic technique that allows direct viewing of the bleeding site. Because the endoscope can detect lesions and confirm the presence or absence of bleeding, doctors often choose this method to diagnose patients with acute bleeding. In many cases, the doctor can use the endoscope to treat the cause of bleeding as well.
+GI bleeding is diagnosed by a doctor -- you may or may not be aware of its presence.
-The [[endoscope]] is a flexible instrument that can be inserted through the mouth or [[rectum]]. The instrument allows the doctor to see into the [[esophagus]], [[stomach]], [[duodenum]] ([[esophago-duodenoscopy]]), [[colon]] ([[colonoscopy]]), and [[rectum]] ([[sigmoidoscopy]]); to collect small samples of tissue ([[biopsies]]); to take photographs; and to stop the bleeding.
+There are home stool tests for microscopic blood that may be recommended for people with anemia or for [[colon cancer]] screening.
-Small bowel endoscopy, or [[enteroscopy]], is a procedure using a long endoscope. This endoscope may be used to localize unidentified sources of bleeding in the small intestine.
+You will also be asked questions about your symptoms, including:
-A new diagnostic instrument called a capsule endoscope is swallowed by the patient. The capsule contains a tiny camera that transmits images to a video monitor. It is used most often to find bleeding in portions of the small intestine that are hard to reach with a conventional endoscope.
+* When did you first notice symptoms?
+* Did you have black, tarry stools or red blood in the [[stool]]s?
+* Have you vomited blood?
+* Did you vomit material that looks like coffee grounds?
+* Do you have a history of peptic or [[duodenal ulcer]]s?
+* Have you ever had symptoms like this before?
+* What other symptoms do you have?
-===Other Procedures===
+Tests that may be done to find the source of the bleeding include:
-Several other methods are available to locate the source of bleeding. [[Barium x rays]], in general, are less accurate than endoscopy in locating bleeding sites. Some drawbacks of barium x rays are that they may interfere with other diagnostic techniques if used for detecting acute bleeding, they expose the patient to x rays, and they do not offer the capabilities of biopsy or treatment. Another type of x ray is CT scan, particularly useful for inflammatory conditions and cancer.
-[[Angiography]] is a technique that uses dye to highlight blood vessels. This procedure is most useful in situations when the patient is acutely bleeding such that dye leaks out of the blood vessel and identifies the site of bleeding. In selected situations, angiography allows injection of medicine into arteries that may stop the bleeding.
+* 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]]
-[[Radionuclide scanning]] is a noninvasive screening technique used for locating sites of acute bleeding, especially in the lower GI tract. This technique involves injection of small amounts of radioactive material. Then, a special camera produces pictures of organs, allowing the doctor to detect a bleeding site.
+==When to seek urgent medical care?==
+Call for an appointment with your doctor if:
-==When to seek urgent medical care==
+* You have black, tarry stools (this may be a sign of GI bleeding)
-Call for an appointment with your doctor if:
+* You have blood in your stool
-* You have black, tarry stools (this may be a sign of upper GI bleeding)
-* You have blood in your stool
 * You vomit blood or you vomit material that looks like coffee grounds
 ==Treatment options==
-Endoscopy is the primary diagnostic and therapeutic procedure for most causes of GI bleeding.
+GI bleeding can be an emergency condition requiring immediate medical attention. Treatment may involve:
-Active bleeding from the upper GI tract can often be controlled by injecting chemicals directly into a bleeding site with a needle introduced through the endoscope. A physician can also [[cauterize]], or heat treat, a bleeding site and surrounding tissue with a heater probe or [[electrocoagulation device]] passed through the endoscope. [[Laser therapy]] is useful in certain specialized situations.
-Once bleeding is controlled, medicines are often prescribed to prevent recurrence of bleeding. Medicines are useful primarily for [[H. pylori]], [[esophagitis]], [[ulcer]], [[infections]], and [[irritable bowel disease]]. Medical treatment of [[ulcers]], including the elimination of [[H. pylori]], to ensure healing and maintenance therapy to prevent ulcer recurrence can also lessen the chance of recurrent bleeding.
+* [[Blood transfusion]]s
+* [[Fluid]]s and [[medicine]]s 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)
-Removal of [[polyps]] with an endoscope can control bleeding from colon polyps. Removal of [[hemorrhoids]] by banding or various heat or electrical devices is effective in patients who suffer [[hemorrhoidal bleeding]] on a recurrent basis. Endoscopic injection or cautery can be used to treat bleeding sites throughout the lower intestinal tract.
+Once your condition is stable, you will have a physical examination, including a detailed abdominal examination.
-Endoscopic techniques do not always control bleeding. Sometimes [[angiography]] may be used. However, surgery is often needed to control active, severe, or recurrent bleeding when endoscopy is not successful.
+===Medications to avoid===
+{{MedCondContrPI
-==Where to find medical care for Gastrointestinal bleeding==
+|MedCond =Gastrointestinal bleeding|Abciximab|Metoclopramide}}
-[http://maps.google.com/maps?f=q&amp;hl=en&amp;geocode=&amp;q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|yourdisease}}}}&amp;sll=37.0625,-95.677068&amp;sspn=65.008093,112.148438&amp;ie=UTF8&amp;ll=37.0625,-95.677068&amp;spn=91.690419,149.414063&amp;z=2&amp;source=embed Directions to Hospitals Treating Gastrointestinal bleeding]
-==What to expect (Outlook/Prognosis)==
+==Where to find medical care for Gastrointestinal bleeding?==
-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.
+[http://maps.google.com/maps?q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|map+top+hospital+Condition}}}}&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&ie=UTF-8&sa=N&hl=en&tab=wl Directions to Hospitals Treating Gastrointestinal bleeding]
 ==Sources==
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 [[Category:Gastroenterology]]
 [[Category:Conditions diagnosed by stool test]]
-[[Category:Signs and symptoms]]
 [[Category:Emergency medicine]]