Bleeding in the Digestive Tract
Bleeding in the digestive tract is a symptom of a disease rather than a disease
itself. Bleeding can occur as the result of a number of different conditions,
some of which are life threatening. Most causes of bleeding are related to
conditions that can be cured or controlled, such as ulcers or hemorrhoids. The
cause of bleeding may not be serious, but locating the source of bleeding is
important.
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, that is, from a small area such as an ulcer on
the lining of the stomach or from a large surface such as an inflammation of
the colon. Bleeding can sometimes occur without the person noticing it. This
type of bleeding is called occult or hidden. Fortunately, simple tests can
detect occult blood in the stool.
[Top] What causes bleeding in the digestive tract?
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.
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.
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.
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.
Diverticular disease caused by diverticulapouches in the colon wallcan 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.
Patients taking blood thinning medications (warfarin) may have bleeding from
the GI tract, especially if they take drugs like aspirin.
What are the common causes of bleeding in the digestive tract?
Esophagus
inflammation (esophagitis)
enlarged veins (varices)
tear (Mallory-Weiss syndrome)
cancer
liver disease
Stomach
ulcers
inflammation (gastritis)
cancer
Small intestine
duodenal ulcer
inflammation (irritable bowel disease)
cancer
Large intestine and rectum
hemorrhoids
infections
inflammation (ulcerative colitis)
colorectal polyps
colorectal cancer
diverticular disease
[Top] How is bleeding in the digestive tract recognized?
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.
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.
[Top] How is bleeding in the digestive tract diagnosed?
The 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.
Endoscopy
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.
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.
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.
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.
Other Procedures
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.
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.
[Top] How is bleeding in the digestive tract treated?
Endoscopy is the primary diagnostic and therapeutic procedure for most causes
of GI bleeding.
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.
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.
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.
How do you recognize blood in the stool and vomit?
bright red blood coating the stool
dark blood mixed with the stool
black or tarry stool
bright red blood in vomit
coffee-grounds appearance of vomit
What are the symptoms of acute bleeding?
any of bleeding symptoms above
weakness
shortness of breath
dizziness
crampy abdominal pain
faintness
diarrhea
What are the symptoms of chronic bleeding?
any of bleeding symptoms above
weakness
fatigue
shortness of breath
lethargy
faintness
>From : NDDIC
Dr. Abd Hamid Mat Sain
AM(MAL), MBBS(Adelaide, Aust.), MS(UKM)
FRCS(Edinburgh,UK), FICS (USA)
Consultant Surgeon
ColumbiaAsia Medical Centre
292 Jalan Haruan 2,Oakland Commercial Centre
70300 Seremban,Negeri Sembilan
Malaysia
Ph :+606-6011988
Fax:+606-6011848
Mobile:+6012-2071913
Email :[EMAIL PROTECTED]
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