Gastrointestinal bleeding

Gastrointestinal bleeding

Definition:

A sign of disease or abnormality within the gastrointestinal tract involving the presence of blood or hemoglobin in the stool. Upper GI bleeding is considered any source located between the mouth and outflow tract of the stomach. Lower GI bleeding is considered any source located from the outflow tract of the stomach to the anus (small and large bowel).

Alternative Names:

Lower GI bleeding; GI bleeding; Upper GI bleeding

Considerations:

Gastrointestinal bleeding can range from microscopic bleeding where the amount of blood is so small that it can only be detected by laboratory testing, to massive bleeding where almost pure blood is passed.

Awareness of gastrointestinal bleeding is important as it may herald many significant diseases and conditions. Prolonged microscopic bleeding can lead to massive losses of iron and subsequent anemia. Acute massive bleeding can lead to hypovolemia, shock, and even death.

Gastrointestinal bleeding can occur at any age from birth on. Gastrointestinal bleeding in children ranges from the simple, such as swallowed blood from a nosebleed to the more complex, such as milk allergies, to life-threatening conditions such as intussusception or Meckel's diverticula. Adolescents and young adults may suffer from bleeding ulcers, Crohn's disease, and colitis; while colon cancer and diverticulitis must be considered as potential causes of gastrointestinal bleeding in middle-aged and senior adults.

Common Causes:

air-contrast barium enema
arterio-venous malformations (fragile blood vessels)
endoscopy or similar tests that involve entering the bowel
intestinal volvulus (twisted bowel)
intussusception
Meckel's diverticula
acquired platelet function defect
anal fissure
cow's milk allergy
diarrhea
diverticulitis
duodenal ulcer
epistaxis (nose bleed)
esophagitis
esophageal varices
foreign bodies
gastric ulcer or duodenal ulcer
gastritis or enteritis
gastrointestinal cancer
hemolytic-uremic syndrome (HUS)
ischemic bowel
Crohn's disease (regional enteritis)
salmonellosis
shigellosis
trauma
ulcerative colitis

Home Care:

Home testing of the stools for microscopic blood (guaiac test) may be recommended for people who have experienced an episode of gastrointestinal bleeding. GI bleeding that is more than just a microscopic amount usually requires hospitalization to determine the cause and to begin treatment.

Call your health care provider if:

you have black, tarry stools (this may be a sign of gastrointestinal bleeding).
you have blood in the stools.
you begin vomiting blood or you vomit material that looks like coffee grounds.

What to expect at your health care provider's office:

GI bleeding can be an emergency condition requiring immediate intervention. Intravenous fluids and medications, blood transfusions, drainage of the stomach through a tube (nasogastric tube), and other measures may be required.

Once the condition is stable, the medical history will be obtained and a physical examination will be performed.

Medical history questions documenting GI bleeding in detail may include:

time pattern
- When did it start?
- Is it off and on or does it continue?
quality
- What did you notice?
- Were there black, tarry stools or was there obvious blood in the stools?
- Were you vomiting blood?
- Did you vomit material that looks like coffee grounds?
family history
- Do you or any family members have a history of peptic ulcer or duodenal ulcer?
- Have you ever had symptoms like this before?
other
- What other symptoms are present?
- Did you notice anything that you think may have caused or been associated with the bleeding?

Note: This finding is diagnosed by the health care provider and the person may or may not have been aware of its presence.

The physical examination will include a detailed abdominal examination.

Diagnostic tests may vary and can include:

After seeing your health care provider:
You may want to add a diagnosis related to GI bleeding to your personal medical record.

Review Date: 12/3/2001
Reviewed By: Steven Angelo, M.D. Department of Internal Medicine, Yale School of Medicine, Hospital of Saint Raphael, New Haven, CT. Review provided by VeriMed Healthcare Network.

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