Digestive Diseases:
Bleeding in the Digestive Tract
Bleeding
in the digestive tract is a symptom of a problem rather than a
disease itself. Most causes of bleeding are related to
conditions that can be cured or controlled, such as hemorrhoids.
The
cause of bleeding may not be serious, but locating the source of
bleeding is critical. The digestive or gastrointestinal (GI)
tract includes the esophagus, stomach, small intestine, large
intestine, 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 more diffuse problem such as
inflammation of the colon.
Bleeding
can sometimes occur without you even knowing about it. This type
of bleeding is called occult or hidden. Fortunately, simple
tests can detect occult blood in the stool.
Esophagitis and
gastroesophageal reflux. Stomach
acid that refluxes (returns) back into the esophagus from the
stomach can cause damage that may lead to bleeding at the
lower end of the esophagus called esophagitis.
Varices.
Abnormally enlarged veins located at the lower end of the
esophagus, called varices, may rupture and bleed massively.
Cirrhosis of the liver is the most common cause of esophageal
varices.
Mallory-Weiss tear.
This is a tear in the lining of the esophagus that usually is
caused by prolonged vomiting but may also result from other
causes of increased abdominal pressure, such as coughing,
hiccupping, or childbirth.
Bleeding
from the stomach can be caused by:
Gastritis. Alcohol, aspirin,
aspirin-containing medicines, pain medicines --collectively
called NSAIDs (nonsteroidal anti-inflammatory drugs) -- such
as Motrin, Aleve, or ibuprofen and many others can cause
stomach ulcers or inflammation (gastritis).
Stomach ulcers and intestinal ulcers.
Ulcers in the stomach may enlarge and erode through a blood
vessel, causing bleeding. Aside from medication, the most
common cause of a stomach ulcer is an infection with bacteria
called Helicobacter pylori. Also, patients suffering from
burns, shock, head injuries or cancer, as well as those who
have undergone extensive surgery, may develop stress-related
stomach ulcers. Intestinal ulcers are believed to be caused by
excess stomach acid and infection with Helicobacter pylori.
Cancer of the stomach.
Hemorrhoids. These are probably the
most common cause of visible blood in the lower 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.
Anal
fissures.
Tears in the lining of the anus can also cause bleeding.
Colon polyps.These are growths that can occur in the colon. They can be
the precursor of cancer and may cause bleeding.
Colorectal cancer.
Intestinal infections.
Inflammation and bloody diarrhea can result from intestinal
infections.
Ulcerative colitis.
Inflammation and extensive surface bleeding from tiny
ulcerations can be the reason for blood showing up in the
stool.
Crohn's disease.
This condition can result in spotty bleeding.
Diverticular disease.
Caused by diverticula -- outpouchings of the colon wall --
can result in massive bleeding.
Blood
vessel abnormalities.
As one gets older, abnormalities may develop in the blood
vessels of the large intestine, which may result in recurrent
bleeding.
How Is
Bleeding in the Digestive Tract Recognized?
The
signs of bleeding in the digestive tract depend on 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 your 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. Vomit may be bright red or have
a "coffee-grounds" appearance when bleeding is from the
esophagus, stomach or duodenum.
If
bleeding is occult, or hidden, you 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 cramp-like abdominal pain or
diarrhea. Shock may occur, with a rapid pulse, drop in blood
pressure and difficulty in producing urine. You 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 (or
paleness of the skin) from anemia will result. Anemia is a
condition in which the blood's iron-rich substance, hemoglobin,
is diminished.
Note
that iron and some foods, such as beets, can give the stool a
red or black appearance, falsely indicating blood in the stool.
If you
notice any abnormal bleeding, make an appointment to see your
doctor. Your doctor will ask you many questions and perform a
physical examination. Symptoms such as changes in bowel habits,
stool color (black or red), consistency, and the presence of
pain or tenderness may tell your doctor which area of the GI
tract is affected.
The
doctor will test the stool for blood before offering a
diagnosis. A blood count will indicate whether you are anemic
and also will give an idea of the extent of the bleeding and how
chronic it may be.
Your
doctor will likely perform an endoscopy. Endoscopy is a common
procedure that allows your doctor to directly view the site of
the 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 to
allow visualization (and possible tissue sampling or biopsy, or
treatment) of the areas of concern.
Several
other procedures may be used to locate the source of bleeding,
including:
X-rays.During these tests you either drink or have
barium-containing fluid placed through the rectum and then
X-ray is used to look for any abnormalities. Barium lights up
on X-ray.
Angiography.
With this technique, a material that lights up with a special
camera is injected into the veins to highlight blood vessels
so the doctor can look for the site of the bleeding. In
selected situations, angiography allows injection of
medication that may stop the bleeding.
Radionuclide scanning.
This is a noninvasive screening technique used for locating
sites of acute bleeding, especially in the lower digestive
tract. This technique involves injecting small amounts of
radioactive material before pictures of the organs are taken
with a special camera.
Once the
underlying cause of the bleeding has been identified, most
people with digestive tract bleeding can be effectively treated.
The use
of endoscopy has grown and now allows doctors to see not only
bleeding sites but to directly apply therapy as well. A variety
of endoscopic therapies are useful for treating digestive tract
bleeding. Active bleeding from the upper digestive tract can
often be controlled by injecting chemicals directly into a
bleeding site with a needle introduced through the endoscope. A
doctor can also cauterize, or treat with heat, a bleeding site
and surrounding tissue through the endoscope.
Endoscopic techniques do not always control bleeding and
sometimes angiography may be needed. However, surgery is often
required to control active, severe or recurrent bleeding when
endoscopy is not successful.
Once bleeding is controlled, medications are
often prescribed to prevent recurrence of bleeding.
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