What are the possible causes of blood in stool? How can one address this issue? Discover the essential steps to take when encountering blood in your stool.

Uncovering the Causes of Blood in Stool

Encountering blood in your stool can be a concerning and unsettling experience. However, it’s crucial to understand that this symptom can stem from a variety of causes, not all of which are indicative of a severe underlying condition. Let’s explore the potential causes of blood in stool:

Hemorrhoids

Hemorrhoids, also known as piles, are swollen blood vessels in the rectum. They often cause itching, burning sensations, and may bleed, resulting in the appearance of bright red blood in the stool.

Gastroenteritis

Gastroenteritis, an infection of the stomach or intestines caused by viruses or bacteria (such as norovirus or food poisoning), can lead to bloody diarrhea. Nausea and vomiting may also be present in cases of gastroenteritis.

Diverticula

Diverticula are small pockets or bulges that can form in the lining of the lower bowel. If these diverticula become infected or rupture, they can cause bleeding, even without the presence of pain.

Polyps in the Bowel

Polyps are clumps of cells that can grow in the lining of the colon and rectum. While they don’t always cause problems, they can potentially bleed during bowel movements and may even develop into cancer if left untreated.

Anal Fissures and Fistulas

Anal fissures are tiny tears in the anal area that can be quite painful and cause bright red bleeding, particularly during and after bowel movements. Anal fistulas, on the other hand, are cracks or creases that form between the anus and the anal canal, which may also result in bleeding.

Angiodysplasia

Angiodysplasia is a condition characterized by abnormal blood vessels in the gastrointestinal tract, leading to rectal bleeding. This tends to occur more frequently in elderly individuals and is not typically associated with pain.

Inflammatory Bowel Diseases (IBD)

Conditions such as Crohn’s disease and ulcerative colitis, which fall under the umbrella of IBD, can cause a range of symptoms, including bloody diarrhea.

Anticoagulant Medications

Certain blood-thinning medications, known as anticoagulants, can sometimes lead to internal bleeding, which may be visible in the stool as a black, tarry appearance.

Responding to Blood in Stool: Essential Steps

If you encounter blood in your stool, it’s crucial to take immediate action and seek medical attention. Do not wait to see if the issue resolves on its own. Here are the essential steps to take:

Contact Your Doctor

As soon as you notice blood in your stool, call your healthcare provider. They will be able to assess your symptoms, determine the underlying cause, and recommend the appropriate course of action.

Schedule a Colonoscopy

If you’re over the age of 50 (or 45 if you’re African American), it’s recommended to schedule a colonoscopy, even if you don’t have any risk factors. This screening procedure can help identify potential issues, such as polyps or colon cancer, in the early stages when they are most treatable.

Provide Detailed Information

When speaking with your doctor, be prepared to provide detailed information about the appearance of the blood in your stool, any accompanying symptoms, and any relevant medical history or family history.

Follow Your Doctor’s Recommendations

Trust your healthcare provider’s expertise and follow their recommended course of action, which may include further testing, dietary changes, or treatment as necessary.

Proactive Approach to Colorectal Health

Maintaining good colorectal health is essential, and taking a proactive approach can make a significant difference. Remember, early detection is key, so don’t hesitate to schedule regular colorectal cancer screenings, even if you don’t have any risk factors.

Importance of Colorectal Cancer Screenings

Colorectal cancer screenings, such as colonoscopies, can help identify precancerous polyps or early-stage cancer, increasing the chances of successful treatment and positive outcomes. Don’t wait until you experience symptoms; make your health a priority.

Risk Factors for Colorectal Cancer

Factors that can increase your risk of colorectal cancer include a family history of the disease, certain inherited genetic syndromes, inflammatory bowel diseases, and lifestyle factors such as a diet high in red meat and processed foods, lack of physical activity, and obesity.

Conclusion

Blood in the stool can be a concerning symptom, but it’s important to understand that it can have various underlying causes, not all of which are necessarily serious. By taking immediate action and seeking medical attention, you can address the issue and take proactive steps to maintain your colorectal health. Remember, early detection and prevention are key, so don’t hesitate to schedule regular screenings and follow your doctor’s recommendations.

Blood In Your Stool | Possible Causes And Steps To Take | Beaumont

It’s a scary thing, seeing blood in your stool (aka “fecal matter” or “poop”). If you see bright red blood on the tissue or in the toilet, that is likely due to rectal bleeding. Blood in your stool usually has what is described as a black and tarry appearance. When there is bleeding higher up in the colon or digestive system, it makes the stool look very dark. 

Any time you notice blood or think there might be blood in your stool, you should contact your doctor. This isn’t always a sign of cancer, but it’s good to get it checked out right away no matter what it’s from. It’s also important to know that not all bleeding in the intestinal tract will lead to blood that’s visible to the naked eye. You may have blood in your stool and not know it. So, if you have any signs or symptoms of colorectal cancer or you’re over age 50 (45 if you’re African American), talk to your doctor about getting a colonoscopy.

Causes of Blood in Stool

Bloody stool and bloody diarrhea are both signs of colorectal cancer, and therefore they should never be ignored. The sooner you are diagnosed, the more effective treatment options will be.

There are other causes of blood in your stool, such as:

• Hemorrhoids – Hemorrhoids, otherwise known as piles, are swollen blood vessels in rectum. They often cause itching or burning sensation, and they may bleed. The blood seen with hemorrhoids is usually bright red.
• Gastroenteritis – Gastroenteritis is an infection in the stomach or intestines caused by a virus or bacteria, such as norovirus or food poisoning. It can lead to bloody diarrhea. Nausea and vomiting may also be present.
• Diverticula – Diverticula are tiny pockets or bulges in the lining of the lower bowel. They can get infected and cause pain, and if they rupture, they can cause bleeding. In some cases, there may be significant bleeding even without pain.
• Polyps in the bowel – Polyps are clumps of cells that can grow in the lining of the colon and rectum. Polyps don’t always cause problems, but they can develop into cancer if not removed. They may also bleed a little during bowel movements.
• Anal fissure – Anal fissures are tiny tears in the anal area that are quite painful. If they bleed, the blood is typically bright red. Pain and bleeding may occur during and after bowel movements.
• Anal fistula – Anal fistula is a crack or crease that forms between the anus and the anal canal. They can be quite painful, and they might bleed. 
• Angiodysplasia – Angiodysplasia is rectal bleeding caused by abnormal blood vessels in the gastrointestinal tract. It usually happens in elderly people, and it doesn’t normally cause pain.
• Inflammatory bowel disease (IBD), such as Crohn’s disease and ulcerative colitis –IBD can cause many symptoms including bloody diarrhea.
• Anal sex and STIs – Damage to the anus from sexually transmitted infections (STIs) or anal sex can cause bleeding in the rectum. This blood is usually bright red.
• Anticoagulant medications – Anticoagulant drugs, also known as blood thinners, can sometimes cause internal bleeding, which may be seen in stool. That blood would normally cause black and tarry stools.

Don’t Wait. Get Screened.

If you have blood in your stool or notice blood in the toilet or on the toilet paper after a bowel movement, call your doctor right away. Do not wait to see if it goes away on its own.

And If you’re over 50 (or over 45 if you’re African American), we recommend scheduling a colonoscopy – whether you have risk factors or not. If you do have risk factors, such as a family history or certain inherited colon cancer syndromes, you may need your   colonoscopy earlier. Ask your doctor when the right time is for you to have yours. 

Call (248) 577-9277 to ask for a referral for your colorectal cancer screen, and take control of your bowel health today.

Colon Cancer Symptoms | Johns Hopkins Medicine

Colon and rectal cancers do not usually produce symptoms in the early stages of disease. As the tumor grows, symptoms will depend on the location of the primary tumor within the intestine.

Patients with colon cancer or rectal cancer may experience one or multiple symptoms. These may include the following:

Blood in the Stool

You may notice obvious blood the stool, or darker colored bowel movements, which may indicate that there is bleeding within the intestinal tract or rectum. Sometimes bleeding may be present but not visible. This is called occult (hidden) blood and may not be discovered until a blood test indicates a low red blood cell count.

Rectal Bleeding

Bright red blood in the stool typically indicates that there is bleeding in the rectum or colon, which may be a sign of colon or rectal cancer. Rectal bleeding can also be caused by hemorrhoids. Typically, patients with hemorrhoids experience symptoms that come and go with flare-ups, whereas rectal bleeding caused by cancer usually continues or worsens and is more likely to be accompanied by pain.

Changes in Bowel Habits

Changes in bowel habits that can indicate colon or rectal cancer include the following:

• New-onset constipation or diarrhea

• Changes in frequency or size and caliber of bowel movements

• A bowel that doesn’t seem to empty completely

• Stool that is narrower than normal (even as thin as a pencil)

Occasional bowel changes can be caused by a dietary change, disagreeable food or a viral/bacterial infection. However, if you are experiencing something new and unexplained—and it lasts more than a couple of days—see your doctor.

Abdominal Pain and Bloating

Stomach bloating, distention, cramps or pain in the abdominal or bowel region can be symptoms of colon or rectal cancer. These are common issues that can also be caused by a number of conditions, including diet-related gastrointestinal distress, Crohn’s disease or ulcerative colitis. See your doctor if you experience frequent abdominal pain and bloating that does not have an obvious cause.

Nausea and Vomiting

Nausea and vomiting can occur if a colon or rectal tumor is obstructing the bowel and inhibiting the passage of liquid or solid waste or gas. Bowel blockage can also be accompanied by painful abdominal cramps, bloating and constipation.

Nausea and vomiting are symptoms of a range of conditions, which may be benign or serious. If you experience persistent nausea, signs of dehydration or vomiting that lasts for more than 24 hours, seek immediate medical treatment.

Anemia

Anemia is a blood disorder characterized by a deficiency of red blood cells or hemoglobin. In patients with colon or rectal cancer, intestinal bleeding may cause anemia. Depending on the location of the bleeding within the colon, anemia can be the first sign that blood loss is occurring.

Common symptoms of anemia include skin pallor (paleness), increased heart rate, fatigue, dizziness and irregular menstruation.

Unexplained Weight Loss, Loss of Appetite and Feeling Weak

Losing weight, losing your appetite or feeling weak are all possible signs of colon or rectal cancer along with many other unrelated conditions. In patients with colon or rectal cancer, these symptoms are usually related. Persistent diarrhea can cause weight loss. Stomach pain and nausea can reduce your appetite so that you don’t consume enough food to maintain your weight. All these issues, as well as anemia, can lead to weakness.

Pelvic Pain

Pain in the pelvic area is not common in patients with colon or rectal cancer. If it occurs, it may indicate that the cancer has spread to the pelvic area.

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What Is Rectal Bleeding? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Diverticulosis is the most common cause of rectal bleeding. It is the presence of tiny bulges, called diverticula, in the colon wall. Diverticula are common and typically do not cause problems, but can sometimes protrude through the walls of the bowels, leading to bleeding or infections.

Often called piles, hemorrhoids are swollen veins that appear at the bottom of the large intestine and outside the anus. They are caused by excessive straining, such as while making a bowel movement, sitting on the toilet too long, or, in women, pregnancy and giving birth. People who have persistent hemorrhoids are often constipated, overweight or obese, or eating a very low-fiber diet.

Hemorrhoids can be itchy, painful, and annoying, but they are rarely serious and often go away on their own. In certain cases, treatment may be needed.

Anal fissures, another cause of rectal bleeding, are tiny tears in the anus and anal canal commonly caused by straining with hard stools.

Colitis is the inflammation of the lining of the tissues of the colon. This inflammation can lead to rectal bleeding. Ischemic colitis occurs when blood flow to the colon is reduced, typically as a result of narrowed or blocked arteries. With infectious colitis, the swelling of the colon is caused by bacteria, viruses, or parasites.

Less common causes of rectal bleeding include intestinal polyps, proctitis, colon cancer, inflammatory diseases of the bowel, or rapid bleeding from the stomach or upper GI tract.

Intestinal polyps are masses of tissue that protrude from the bowel wall, sometimes causing minor bleeding. Proctitis is an inflammation of the lining of the rectum. If you have proctitis you may feel rectal pain and the continuous sensation of having to make a bowel movement.

Colon cancer is the most serious cause of rectal bleeding. Anal cancer, which is less common than colorectal cancer, can also cause rectal bleeding.

People with an inflammatory bowel disease such, as Crohn’s disease or ulcerative colitis, may also experience rectal bleeding and related symptoms, such as abdominal pain, diarrhea, constipation, ulcers, and a higher risk for colorectal cancers.

Colon Cancer vs. Hemorrhoid Symptoms Topic Guide

Cancer Fatigue

Cancer fatigue is the most common side effect of cancer treatment. Moreover,
fatigue can be a symptom of cancer. The fatigue experienced with cancer is different
than fatigue experienced by healthy people. People describe it as feeling
worn out, heavy, slow, weak, extremely tired, and in pain. In some people, fatigue can last up to a year or more after treatment stops.
Doctors do not know exactly how cancer treatments cause fatigue, but they do
know what causes it in people who have cancer, or who are undergoing
cancer treatment, for example:

Chemotherapy
Biologic therapy
Surgery
Radiation Therapy
Other cancer drugs
Drugs that cause drowsiness
Anemia
Side effects from diet
Loss of appetite
Not getting enough nutrients and calories daily
Insomnia
Hormone fluctuations
Respiratory problems
Pain
Dehydration due to severe vomiting or diarrhea
Changes in metabolism
Weight loss
Loss of muscle strength
Lack of physical activity
Other health problems
Anxiety and depression
Stress

Fatigue from surgery generally gets better with time, however, it can worsen if
surgery is combined with other cancer treatments. Doctors have studied patients with breast and prostate cancer who suffer from
fatigue and found that the amount of fatigue experienced, and the time it was felt, varied from
patient to patient.Women with breast cancer reported that fatigue was increased by:

Having other health problems or advanced cancer
Being a younger age
Being underweight
Problems sleeping
Anxiety
Depression
Having children at home
Working while receiving radiation treatment

Men with prostate cancer reported that fatigue  increased before radiation
therapy started due to depression and/or poor sleep.
Talk with your doctor or other health care professional about how to treat
and manage your cancer-related fatigue.
REFERENCES:
Bower, JE, Ph.D. Cancer-related fatigue: Mechanisms, risk factors, and treatments. Nat Rev Clin Oncol. 2014 Oct; 11(10): 597–609.
Published online 2014 Aug 12. doi: 10.1038/nrclinonc.2014. 127.
Bower, JE, Ph.D. Behavioral symptoms in breast cancer patients and survivors: Fatigue, insomnia, depression, and cognitive disturbance. J Clin Oncol. 2008 Feb 10; 26(5): 768–777. doi: 10.1200/JCO.2007.14.3248
NIH. National Cancer Institute. “Fatigue (PDQ®)-Patient Version. Updated: June 30,
2017.
NIH. National Cancer Institute. “Facing Forward: Life After Cancer Treatment.” Updated: May 2014.

IH. National Cancer Institute. “Fatigue.” Updated: Apr 29, 2015.
NIH. National Cancer Institute. “Managing Radiation Therapy Side Effects.” April 2010.

Gastrointestinal Bleeding: An Alarming Sign

US Pharm. 2009;34(12):HS12-HS16. 

Gastrointestinal (GI) bleeding can originate anywhere from the pharynx to the rectum and can be occult or overt. It differs from internal bleeding, where blood leaks from the blood vessels in such a way that the bleeding cannot be seen outside of the body. GI bleeding has a variety of causes, and a review of patient medical history and a physical examination can distinguish between the macroscopic and microscopic forms. The manifestations depend on the location and rate of bleeding, from nearly undetectable to acute and life-threatening. Upper endoscopy or colonoscopy are generally considered the best methods to identify the source of bleeding.¹ 

History of present illness should be reviewed to ascertain quantity and frequency of blood passage. However, quantity can be difficult to assess because even small amounts (5-10 mL) of rectal bleeding or modest amounts of vomited blood are alarming to a patient. Whether blood was passed with initial emesis or only after several nonbloody vomiting episodes could indicate different causes.¹ 

To evaluate the patient, there are a number of symptoms that need to be reviewed after GI bleeding. These include presence of abdominal discomfort, weight loss, easy bleeding or bruising, previous colonoscopy results, and symptoms of anemia (weakness, fatigue, dizziness). Past medical history should also inquire about previously diagnosed or undiagnosed GI bleeding, inflammatory bowel disease (IBD), bleeding diatheses, and liver disease.  

Several drugs increase the likelihood of bleeding, including nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, and heparin. Chronic liver disease due to excessive use of alcohol can also cause bleeding. GI bleeding may also precipitate hepatic encephalopathy (brain and nervous system damage caused by liver failure) or hepatorenal syndrome (kidney failure secondary to liver disease).² 

Types of GI Bleeding

Upper GI Bleeding: Hematemesis is vomiting of red-colored blood and indicates upper GI bleeding, usually from an arterial source or varix. It is considered a medical emergency, and the most vital distinction is whether there is blood loss sufficient to cause shock. The bleeding is similar to dark brown emesis, with granular material that resembles coffee grounds. This results from upper GI bleeding that has slowed or stopped, with conversion of red hemoglobin to brown hematin by gastric acid. ³ 

There are many causes for hematemesis, including irritation or erosion of the lining of the esophagus or stomach; bleeding ulcer located in the stomach, duodenum, or esophagus; vomiting of ingested blood after hemorrhage in the oral cavity, nose, or throat; vascular malfunctions of the GI tract; and tumors of the stomach or esophagus. 

Minimal Blood Loss: In this case, the patient is administered a proton pump inhibitor such as omeprazole, given a blood transfusion, and kept nil per os (Latin, “nothing by mouth”) until endoscopy can be arranged for further investigation. 

Significant Blood Loss: In a hemodynamically significant case of hematemesis (e.g., hypovolemic shock), resuscitation is an immediate priority to prevent cardiac arrest. Fluids and/or blood are administered, preferably by central venous catheter, and the patient is prepared for emergency endoscopy. If the source of bleeding cannot be identified endoscopically, a surgical option is usually sought for laparotomy. ³ 

Lower GI Bleeding: Hematochezia is the passage of gross blood from the rectum and usually indicates lower GI bleeding. It is distinguished from melena, which is stool with blood that has been altered by the gut flora and appears “tarry” black. It is also different from bright red blood per rectum, which is caused by hemorrhoidal or fissure problems and is a local rectal bleeding. Hematochezia might also result from vigorous upper GI bleeding with rapid transit of blood through the intestines. Most common causes in adults are diverticulosis and hemorrhoids, both relatively benign, although this bleeding might be a warning sign for colorectal cancer. 

Hematochezia in newborn infants may be due to swallowed maternal blood at the time of delivery. In the most serious cases, it can also be an initial symptom of necrotizing enterocolitis, a serious condition affecting premature infants. In young adults, IBD, particularly ulcerative colitis, is a serious cause of hematochezia that must be further investigated for rapid treatment. ^1-3 

Melena: Melena is a black, tarry stool that is caused by GI bleeding. The black color is due to the oxidation of blood hemoglobin during the bleeding in the ileum and colon. Melena also refers to stools or vomit stained black by blood pigment or dark blood products and may indicate upper GI bleeding. Bleeding from a lower source that occurs slowly enough to allow for oxidation is also associated with melena. About 100 to 200 mL of blood in the upper GI tract is required to cause melena, which can remain for several days after bleeding has stopped.⁴ 

Black stool that does not contain occult blood may result from ingestion of iron, bismuth, or various foods and should not be mistaken for melena. Peptic ulcer disease is the main cause of melena, but secondary causes include bleeding from the upper GI tract as in gastritis or esophageal varices or even from the ascending colon. Overdosing of certain drugs (e.g., warfarin, clopidogrel, or long-term use of NSAIDS) may also be a cause. Melena is not considered a medical emergency, but patients should be carefully monitored to find the cause and assessed for further treatment.³ 

Etiology

GI bleeding of any cause is more likely and severe in patients with chronic liver disease from alcohol abuse or hepatitis. It also occurs more commonly in patients with hereditary coagulation disorders or in those taking certain drugs. Drugs associated with GI bleeding include heparin, warfarin, aspirin, certain NSAIDs, clopidogrel, and selective serotonin reuptake inhibitors, which cause platelet depletion and reduce the ability to form clots. About 20% to 30% of GI bleeding is due to duodenal ulcers and gastric or duodenal erosions.⁴ 

Varices and erosive esophagitis are responsible for 10% to 20% of upper GI bleeds. For the lower GI, the bleeding depends on the age group, but it is mainly due to anal fissures, diverticulitis, irritable bowel syndrome, colitis, Crohn’s disease, and colonic polyps or carcinoma. ⁵ 

Evaluation and Diagnosis

The first step in the diagnosis of GI bleeding is to stabilize the patient’s airways and administer IV fluids or transfuse blood. Bloody nasogastric aspirate indicates active upper GI bleeding, but about 10% of patients have no blood in the nasogastric aspirate.⁴ Then the focus should be on vital signs and any indication for hypovolemia (e.g., tachycardia, tachypnea, oliguria, confusion) or anemia (e.g., fatigue, pale skin, headache, coldness in the hands and feet, diaphoresis). In cases of lesser bleedings, the tachycardia and orthostatic changes (i.e., pulse, blood pressure) are milder but need immediate attention, especially in the elderly.⁶ 

When the patient is stable, the signs and symptoms of external bleeding disorders, such as black and blue spots on the skin (petechiae, ecchymoses), are sought. Other signs to look for are ascites and erythema (chronic liver disease) and splenomegaly and dilated abdominal wall veins (portal hypertension).  

In all patients with GI bleeding, a digital rectal examination is necessary to search for stool color, masses, and fissures. Anoscopy is done to diagnose hemorrhoids. Chemical testing of a stool specimen for occult blood completes the examination if gross blood is not present. In about 50% of patients, peptic ulcer can be the cause of GI bleeding.⁴ Epigastric abdominal discomfort that is relieved by food or antacids suggests peptic ulcer disease. These patients may or may not have pain.⁶ 

Bloody diarrhea, fever, and abdominal pain suggest ischemic colitis, ulcerative colitis, Crohn’s disease, or an infectious colitis. Fresh blood only on stools suggests rectal hemorrhoids or fissures, whereas blood mixed with the stool indicates bleeding from a distal or farthest area of the colon. Occult blood in the stool may be the first sign of a polyp, particularly in middle-aged patients. A CBC should be obtained in patients with occult blood loss.⁶ 

With more significant bleeding, coagulation monitoring such as platelet count, prothrombin time (PT), and partial thromboplastin time (PTT), and liver function tests such as aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin, alkaline phosphatase (ALP), and albumin, are done in certain patients. In most cases, one or more diagnostic procedures are required. 

Although endoscopy is therapeutic as well as diagnostic, it should be done rapidly for significant upper GI bleeding. Angiography is useful in the diagnosis of upper GI bleeding and permits certain therapeutic maneuvers (e.g., embolization, vasoconstrictor infusion). 

Flexible sigmoidoscopy and ano-scopy may be all that is required acutely for patients with symptoms typical of hemorrhoidal bleeding. All other patients with hematochezia should have a colonoscopy, which can be done electively after routine preparation unless there is significant ongoing bleeding. If colonoscopy cannot visualize the source and ongoing bleeding is sufficiently rapid (>0.5 to 1 mL/min), angiography may localize the source.^5,6 

Endoscopy is the preferred choice for occult bleeding, because diagnosis of this type of bleeding may be difficult, due to heme-positive stools from bleeding anywhere in the GI tract. Double-contrast barium enema and sigmoidoscopy can also be used for the lower tract when colonoscopy is unavailable or the patient refuses the procedure.⁴ 

Both hematemesis and hematochezia should be considered an emergency. Admission to an intensive care unit, with consultation by a gastroenterologist and a surgeon, is recommended for all patients with severe GI bleeding. General treatment is directed at maintenance of the airway and restoration of circulating volume. Hemostasis and other treatments depend on the cause of the bleeding.^7,8 

Airway: A major cause of morbidity and mortality in patients with active upper GI bleeding is aspiration of blood with subsequent respiratory problems. To prevent these issues, endotracheal intubation should be considered in patients who have inadequate gag reflexes or are obtunded or unconscious—particularly if they will be undergoing upper endoscopy.⁴ 

Fluid Replacement: IV fluids are initiated for any patient with hypovolemia or hemorrhagic shock. Patients requiring further resuscitation should receive transfusion with packed red blood cells (RBCs). Transfusions continue until intravascular volume is restored and then are given as needed to replace ongoing blood loss. Platelet count should be monitored closely, since platelet transfusion may be required with severe bleeding. Patients who are taking antiplatelet drugs (e.g., clopid-ogrel) and aspirin may have platelet dysfunction, often resulting in increased bleeding. Platelet transfusion should be considered when patients taking these drugs have severe, ongoing bleeding. Fresh frozen plasma should be transfused after every 4 units of packed RBCs.⁴ 

Hemostasis: Early intervention to control bleeding is important in order to minimize mortality, particularly in elderly patients. Specific therapy depends on the bleeding site. For peptic ulcer, ongoing bleeding or rebleeding is treated with endoscopic coagulation. Nonbleeding vessels that are visible within an ulcer crater are also treated. If endoscopy does not stop the bleeding and medical management does not control gastric acid secretion, then surgery is performed.⁴ 

Severe, ongoing hematochezia from diverticula or angiomas can sometimes be controlled colonoscopically by electrocautery, coagulation with a heater probe, or injection with dilute epinephrine. Polyps can be removed by snare or cautery. If these methods are ineffective or unfeasible, angiography with embolization or vasopressin infusion may be successful.⁴ Angiography can also be used to localize the source of bleeding more accurately. Surgery may be used in patients with continued bleeding, but localization of the bleeding site is very important. Acute or chronic bleeding of internal hemorrhoids stops spontaneously in most cases. Patients with refractory bleeding are treated via anoscopy with rubber band ligation, injection, coagulation, or surgery.⁸ 

Typically, a healthy person can endure a loss of 10% to 15% of the total blood volume without serious medical difficulties, and blood donation typically takes 8% to 10% of the donor’s blood volume.⁴ 

GI Bleeding in the Elderly

In the elderly (age ≥65 years), hemorrhoids and colorectal cancer are the most common causes of minor bleeding. Peptic ulcer, diverticular disease, and angiodysplasia are the most common causes of major bleeding. Approximately 35% to 45% of all cases of acute upper GI hemorrhage occur in elderly persons. These patients increasingly account for the 10% of deaths that result from a bleeding episode each year.⁴ 

Elderly patients tolerate massive GI bleeding poorly. Diagnosis must be made quickly, and treatment must be started sooner than in younger patients, who can better tolerate repeated episodes of bleeding.⁹ 

Endoscopic Safety

Although upper endoscopy and colonoscopy are generally considered to be safe in the elderly, the risk of complications (including hemorrhage, aspiration pneumonia, myocardial infarction, and perforation) is greater than that with younger patients. Approximately 30% to 40% of patients who undergo GI endoscopy are older than 70 years.⁴ 

On an emergency basis, therapeutic endoscopy is generally riskier than diagnostic endoscopy. Therefore, elderly patients—especially those with such comorbidities as obesity and cardiovascular, pulmonary, renal, hepatic, metabolic, or neurologic disorders—require careful evaluation before, and intensive monitoring during, the procedure. Endoscopy can be done in patients taking aspirin or NSAIDs who do not have a preexisting bleeding disorder. 

REFERENCES

1. Ghosh S, Watts D, Kinnear M. Management of gastrointestinal haemorrhage. Postgrad Med J.

2. Rockey DC, Auslander A, Greenberg PD. Detection of upper gastrointestinal blood with fecal occult blood tests. Am J Gastroenterol. 1999;94:344-350.

3. Marignani M, Angeletti S, Filippi L, et al. Occult and obscure bleeding, iron deficiency anemia, and other gastrointestinal stories. Int J Mol Med. 2005;15:129-135.

4. Gastrointestinal bleeding. MedlinePlus. www.nlm.nih.gov/medlineplus/ 2002;78:4-14.gastrointestinalbleeding.html. Accessed November 4, 2009.

5. Raju GS, Nath SK. Capsule endoscopy. Curr Gastroenterol Rep. 2005;7:358-364.

6. Triester SL, Leighton JA, Leontiadis GI, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. Am J Gastroenterol. 2005;100:2407-2418.

7. Carey EJ, Fleischer DE. Investigation of the small bowel in gastrointestinal bleeding—enteroscopy and capsule endoscopy. Gastroenterol Clin North Am. 2005;34:719-734.

8. Gastrointestinal bleeding. Mayo Clinic. www.mayoclinic.org/gastrointestinal-bleeding. Accessed November 2, 2009.

9. Allison JE, Tekawa IS, Ransom LJ, Adrain AL. A comparison of fecal occult-blood tests for colorectal-cancer screening. N Engl J Med. 1996;334:155-159. 

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Colon and Rectal Conditions | Diverticulitis

If you have diverticulosis, you know how debilitating diverticulitis flare-ups can be. To prevent these, your doctor may suggest that you eat more fiber, drink plenty of fluids, and exercise regularly. 

When lifestyle changes aren’t enough, you have other options to getting you back on the road to health.

Learn more about diverticulum, what the symptoms are, your surgical options and more.

What is diverticulitis?

Diverticulosis is the medical name for the presence of diverticulum, or small pouches formed in the colon wall. The cause for development of these is not well understood. It is possible the development is a side effect of having too low amount of fiber in your diet. Without fiber to add bulk to the stool, the colon has to work harder than normal to push the stool forward. The pressure from this may cause pouches to form in weak spots along the colon. There also seems to be a genetic component, so it can run in families.

When the diverticulum are present but not causing problems, we call it Diverticulosis. We find diverticulum when we conduct a test for other reasons, like a colonoscopy or barium enema. Many people with diverticulosis have no symptoms. They will remain symptom free for the rest of their lives.

Diverticulum

Diverticulitis happens when the diverticulum become inflamed. Particles of stool or undigested food become stuck in these pouches. This creates both inflammation and infection in the wall of the colon. The infection is due in part to the bacteria that naturally live in the colon. The inflammation causes increased pressure in the diverticulum and discomfort for you.

In severe cases, the pressure can cause the diverticulum to burst. Then stool and bacteria flood your lower abdomen causing a severe wide-spread infection.

Symptoms of diverticulitis

The symptoms of diverticulitis depend upon the degree of inflammation and infection present. Symptoms can include:

• Abdominal pain, many times in the lower abdomen, more often on the left side, but can be present on the right side as well
• Fever and chills
• Diarrhea or constipation, can have blood or mucous in the stool
• Nausea with decreased appetite, sometimes with vomiting
• Blood from the rectum
• Pain in the pelvis area with urination (this is due to inflammation around your bladder and its proximity to the colon)

You should seek medical attention if you have any of these symptoms. Diverticulitis can progress into a severe, wide-spread infection if left untreated.

Testing for diverticulitis

Your doctor will assess your symptoms and do an examination of your abdomen, as well as the rest of your body. You will need tests to determine if you have diverticulitis.

• Blood tests to look for signs of infection, check your kidney and liver functions
• Urine test to look for infection in the urinary tract
• A CT scan, or an image of your abdominal organs

Complications associated with diverticulitis

Simple diverticulitis accounts for 75 percent of cases. Treatments take place at home using antibiotics and lifestyle changes.

Complicated diverticulitis is more severe and accounts for 25 percent of cases. In most cases, you will need hospitalization and surgery. Complications associated with diverticulitis can include the following:

• Abscess — This is a localized collection of infection next to the inflamed colon. This is usually caused by a “microperforation,” or a very small hole in the diverticulum. The hole allows bacteria to escape from the colon into the abdomen. The body is able to contain the infection to a small area by “walling off” the pus.
• Recurrence — After you have one episode of diverticulitis, you are at higher risk of having another. Each flare up can become more severe. About 1/3 of patients that have one episode of diverticulitis will have future episode(s).
• Fistula — This is a hole created between two areas not normally connected. For example, a hole forms between the colon and the bladder.
• Obstruction — A blockage of the colon is due to inflammation of the colon. The colon wall thickens and stool is not able to pass through.
• Peritonitis — If your colon develops a hole, the contents of your intestines spill into your abdomen. This wide-spread infection of the abdominal cavity has the diagnosis of peritonitis.
• Sepsis — An overwhelming body-wide infection that can lead to failure of many organs.
• Diverticular bleeding — When a small artery located within the diverticulum breaks through the colon lining and bleeds into the colon. This can happen with diverticulosis and diverticulitis. Diverticular bleeding usually causes painless bleeding from the rectum. In about 50 percent of cases, the person will see maroon or bright red blood with bowel movements. Bleeding with bowel movements is not normal and you should immediately seek medical attention. Most cases of diverticular bleeding resolve on their own. Some people will need further testing or treatment to stop bleeding. Testing may include a colonoscopy, angiography (blocking off the bleeding artery) or surgery.

Treatment for diverticulitis

Treatment of diverticulitis depends upon how severe your symptoms and disease are. People with diverticulosis who do not have symptoms do not need treatment.

• Increase fiber to add bulk to the stool — Fiber can help to bulk up your stool. A high-fiber diet might prevent new diverticula, diverticulitis or diverticular bleeding. Fiber has not proven to prevent these conditions or get rid of current diverticuli. Fruits and vegetables are a good source of fiber. You calculate fiber content of packaged foods by reading the nutrition label.
• Take fiber supplements — You can take fiber supplements like Metamucil, Citrucel or Benefiber to bulk up your stool.
• Seeds and nuts — In the past we advised diverticulitis patients to avoid whole pieces of fiber, like seeds, corn and nuts. There was concern that these foods could cause an episode of diverticulitis. This belief is completely unproven. So we no longer recommend avoiding these high fiber foods.

After diverticulitis resolves

At the end of a diverticulitis episode, you should have the entire length of your colon examined. We usually perform this exam with a colonoscopy. This colon exam gives us the opportunity to determine the extent of your disease. We also can rule out the presence of abnormal lesions such as polyps or cancer.

In rare cases, people can present with what appears to be diverticulitis, but can turn out to be colon cancer.

My dog has bloody stool and vomit, what should I do? | CVS

Spotting blood in your dog’s stool, diarrhea or vomit is bound to cause both concern and alarm. Today our Veterinary Internal Medicine Specialists at Carolina Veterinary Specialists in Winston-Salem NC share some of the causes, symptoms and treatment for bloody diarrhea and vomit in dogs.

Why does my dog have blood in their stool?

Noticing any type of blood in your dog’s stool, diarrhea or vomit merits a call to your veterinarian. Being able to describe and identify the type of blood in your dog’s stool or vomit can help your veterinarian to determine the source of the blood, and will ultimately play a roll in diagnosing your dog’s condition.

Not Actually Blood

• First it’s important to determine whether what you see is actually blood, since ingesting red foods, Pepto-Bismol or red items such as a lipstick or crayon can cause your dog’s stool or vomit to appear as if it is blood streaked. Take a really analytical look at your dog’s vomit or stool, and be prepared to provide your vet with a detailed description.

Hematochezia in Dog’s Stool

• If the blood in your pet’s stool is bright red, then it’s Hematochezia. Typically, hematochezia stems from bleeding in the lower digestive tract, rectum or colon. Bleeding in this area will point your vet to investigate a particular set of conditions such as parvovirus, hemorrhagic gastroenteritis, cancer, viral and bacterial infections, parasites, digestion of something inappropriate, sudden change in pet’s diet, rectal injury, or colitis.

Melena in Dog’s Stool

• If the blood in your dog’s stool is darker, sticky and tar-like then it’s Melena. Melena is blood that has either been swallowed or digested which points to issues in your pet’s upper digestive tract, esophagus, stomach, or upper small intestine such as parasites, liver cancer. Other common causes of melena in stool include ulcers caused by medications, blood clotting disorders, post-surgery complications, tumors, polyps, or ingestion of blood (licking a bleeding wound, a mouth injury or a bloody nose).

Other Causes of Bloody Stool in Dogs

• Some other causes for blood in your dog’s stool include intestinal blockages, trauma, bacterial infections, or fissures.

Why does my dog have blood in their vomit?

While taking a close look a vomit is never pleasant, in order to determine the cause of the blood in your dog’s vomit you will need to provide your vet with a detailed description of the blood. Does your dog’s vomit have a couple of streaks of red blood through it, or is all of the vomit tinged pink or red? Does the vomit contain a black or dark substance that looks a bit like coffee grinds? Dark coffee grind-like blood can indicates that the blood has been partially digested and as such means that the bleeding has been occurring over a longer period of time and is certainly cause for concern.

As with the appearance of blood in your dog’s stool, when you see blood in your dog’s vomit it can be caused by something minor such as swallowing blood from a wound or nose bleed, but could also be due to more serious issues such as internal bleeding.

What should I do if I see blood in my dog’s stool or vomit?

Regardless of the type of blood you see in your dog’s stool or vomit it is important to contact your vet, or your nearest emergency vet right away. Bloody diarrhea or vomiting can be a veterinary emergency requiring immediate care. Some causes of blood in stool or vomit are potentially fatal if left untreated, so it’s always wise to err on the side of caution.

At Carolina Veterinary Specialists, our board-certified Veterinary Internal Medicine Specialist is equipped to offer advanced diagnostics and care for pets with internal health conditions. Our emergency veterinary team treats animals in circumstances requiring urgent medical care, including life-threatening emergencies.

How is bloody stool or vomit in dogs diagnosed?

Diagnosing the underlying cause of bloody vomit or diarrhea can be challenging. If routine diagnostic procedures are unsuccessful, more invasive procedures may be needed to diagnose the issue. The diagnostic procedure may include the following:

A Detailed Medical History

The more detailed information you can provide to your the vet, the better.  Some of the valuable information in your dog’s medical history may include:

• Whether your dog has experienced intestinal blockages, physical obstructions, ulcers or tumors in the past
• Your pet’s vaccination record (to rule out parvovirus)
• How severe the diarrhea or vomiting has been.
• Has it become worse since the vomiting or diarrhea first began?

Physical Examination of Your Pet & Samples

• Examination of the stool or vomit sample to see if blood is present
• Palpitation of the abdomen to check for abdominal obstruction or pain
• Heart function to look for symptoms of blood loss or dehydration
• Skin test to find out if your dog is dehydrated

Blood tests

• Biochemical tests to check for liver function and blood sugar
• Packed cell volume (hematocrit) to confirm whether hemorrhagic gastroenteritis could be the cause

Endoscopy & X-rays

• To look for intestinal blockages, ulcers, tumors, or physical obstructions

Fecal

• Fecal exams help to detect parasites or microbiological organisms

What is the treatment for blood in dog’s stool or vomit?

The treatment for your dog’s symptoms will depend on the underlying cause, and your pet’s overall health. With the right treatment most dogs respond very well and recover quickly. Treatment may include:

• Medications to soothe intestines
• Electrolyte and fluid therapies in the case of hemorrhagic gastroenteritis
• Antibiotic therapy if an infection is at the root of the problem
• Surgical remedies for tumors, ulcers or physical obstructions
• Corticosteroid therapy in cases of severe blood loss causing hypovolemic shock
• Anthelmintics (anti-parasitic drugs) to expel parasitic worms and other internal parasites

How can I help my dog to feel better?

Once your dog’s underlying issue is being treated, the main priority is allowing your pet’s inflamed intestines the time they need to recover. Your vet will be sure to provide you with detailed instructions on how to care for your dog as they recover which may include,

• No food or water for 24 hours to allow your pet’s intestines to rest
• Following the rest period, feeding a prescription or bland diet for a week or so before gradually returning your dog to their normal diet
• Monitoring your dog for other symptoms or recurring symptoms. If the problem quickly returns a prescription hypoallergenic medical diet may be recommended for your pet
• Restoring intestinal microflora by introducing food supplements (such as probiotics and probiotics) to help prevent the issue from recurring

City Clinical Hospital # 31 – IBD: Ulcerative colitis. What does the patient need to know? (page 8)

Page 8 of 10

Treatment of ulcerative colitis

The tasks of treating a patient with UC are:

• achieving and maintaining remission (clinical, endoscopic, histological),
• minimization of indications for surgical treatment,
• reducing the incidence of complications and side effects of drug therapy,
• reduction in hospital stay and cost of treatment,
• improvement of the patient’s quality of life.

The results of treatment largely depend not only on the efforts and qualifications of the doctor, but also on the willpower of the patient, who clearly follows the medical recommendations. The modern medicines available in the doctor’s arsenal allow many patients to return to normal life.

Complex of therapeutic measures includes:

• dieting (diet therapy)
• taking medications (drug therapy)
• surgery (surgical treatment)
• lifestyle change.

Diet therapy. Usually, in the period of exacerbation, patients with UC are recommended a variant of a slag-free (with a sharp restriction of fiber) diet, the purpose of which is mechanical, thermal and chemical sparing of the inflamed intestinal mucosa. Fiber is limited by excluding fresh vegetables and fruits, legumes, mushrooms, tough, stringy meat, nuts, seeds, sesame, poppy from the diet. With good tolerance, juices without pulp, canned (preferably at home) vegetables and fruits without seeds, ripe bananas are acceptable.Only refined flour baked goods and baked goods are allowed. For diarrhea, meals are served warm, pureed, limit foods with a high sugar content. The use of alcohol, spicy, salty, foods, dishes with the addition of spices is highly undesirable. In case of intolerance to whole milk and lactic acid products, they are also excluded from the patient’s diet.

In a severe course of the disease with loss of body weight, a decrease in the level of protein in the blood, the daily amount of protein in the diet is increased, recommending lean meat of animals and poultry (beef, veal, chicken, turkey, rabbit), lean fish (pike perch, pike, pollock) , buckwheat and oatmeal, chicken egg white.In order to replenish protein losses, artificial nutrition is also prescribed: special nutrient solutions are injected through a vein (usually in a hospital) or through the mouth or a tube special nutritional mixtures in which the main food ingredients have been specially processed for their better digestibility (the body does not need to waste its forces for the processing of these substances). Such solutions or mixtures can complement or replace natural nutrition. Currently, special nutritional mixtures have already been created for patients with inflammatory bowel diseases, which also contain anti-inflammatory substances.

Failure to comply with the principles of medical nutrition during an exacerbation can lead to an aggravation of clinical symptoms (diarrhea, abdominal pain, the presence of pathological impurities in the stool) and even provoke the development of complications. In addition, it should be remembered that the reaction to various foods in different patients is individual. If attention is drawn to the deterioration of health after eating any product, then after consultation with the attending physician, he should also be eliminated from the diet (at least during an exacerbation).

Drug therapy defined by:

• the prevalence of colon lesions;
• by the severity of UC, the presence of complications of the disease;
• the effectiveness of the previous course of treatment;
• individual patient tolerance of drugs.

Treatment for mild and moderate forms of the disease can be carried out on an outpatient basis. Patients with severe UC require hospitalization.The choice of the necessary medicines by the attending physician is carried out step by step.

In mild to moderate disease, treatment is usually started with the appointment of 5-aminosalicylates (5-ASA) . These include sulfasalazine and mesalazine. Depending on the duration of the inflammatory process in UC, these drugs are recommended in the form of suppositories, enemas, foams, which are injected through the anus, tablets or a combination of local and tablet forms. The drugs reduce inflammation in the colon during an exacerbation, are used to maintain remission, and are also proven to prevent the development of colon cancer when taken long-term.Side effects more often occur while taking sulfasalazine in the form of nausea, headache, increased diarrhea and abdominal pain, and renal dysfunction.

If there is no improvement or the disease has a more severe course, then the patient with UC is prescribed hormonal drugs – systemic glucocorticoids (prednisolone, methylprednisolone, dexamethasone). These drugs faster and more effectively cope with the inflammatory process in the intestine. In severe UC, glucocorticoids are administered intravenously.Due to serious side effects (edema, increased blood pressure, osteoporosis, increased blood glucose levels, etc.), they should be taken according to a specific scheme (with a gradual decrease in the daily dose of the drug to a minimum or up to complete cancellation) under the strict guidance and supervision of the attending physician doctor. In some patients, there are phenomena of steroid refractoriness (lack of response to treatment with glucocorticoids) or steroid dependence (resumption of clinical symptoms of exacerbation of UC when trying to reduce the dose or soon after hormone withdrawal).It should be noted that during the period of remission, hormonal drugs are not a means of preventing new exacerbations of UC, therefore, one of the goals should be to maintain remission without glucocorticoids.

With the development of steroid dependence or steroid refractoriness, severe or often recurrent course of the disease, the appointment of immunosuppressants is indicated (cyclosporine, tacrolimus, methotrexate, azathioprine, 6-mercaptopurine). Drugs in this group suppress the activity of the immune system, thereby blocking inflammation.Along with this, influencing the immune system, they reduce the resistance of the human body to various infections, and have a toxic effect on the bone marrow.

Cyclosporine, tacrolimus are fast-acting drugs (the result is evident in 1-2 weeks). Their timely use in 40-50% of patients with severe UC avoids surgical treatment (removal of the large intestine). The drugs are given intravenously or given in pill form. However, their use is limited by their high cost and significant side effects (convulsions, kidney and liver damage, increased blood pressure, gastrointestinal disorders, headache, etc.)).

Methotrexate is a drug for intramuscular or subcutaneous administration. Its action unfolds after 8 to 10 weeks. When using methotrexate, one also has to reckon with its high toxicity. The drug is prohibited for use in pregnant women, as it causes malformations and fetal death. The effectiveness of the use in patients with UC is being specified.

Azathioprine, 6-mercaptopurine are slow-acting drugs.The effect of taking them develops no earlier than 2-3 months later. The drugs are able not only to induce, but also to maintain remission with prolonged use. In addition, the appointment of azathioprine or 6-mercaptopurine allows you to gradually stop taking hormonal drugs. They have fewer side effects compared to other immunosuppressants, and are well combined with 5-ASA drugs and glucocorticoids. However, due to the fact that in some patients thiopurines have a toxic effect on the bone marrow, patients should definitely undergo a CBC periodically to monitor this side effect and take timely treatment.

At the end of the 20th century, a revolution in the treatment of patients with inflammatory bowel diseases (Crohn’s disease, UC) was the use of fundamentally new drugs – biological (anticytokine) drugs. Biologicals are proteins that selectively block the work of certain cytokines – key participants in the inflammatory process. This selective action contributes to a more rapid onset of the positive effect and causes fewer side effects compared to other anti-inflammatory drugs.Currently, active work is underway all over the world to create and improve new and existing biological drugs (adalimumab, certolizumab, etc.), and large-scale clinical trials are being carried out.

In Russia, for the treatment of patients with inflammatory bowel diseases (UC and Crohn’s disease), the only drug in this group has been registered so far – infliximab (trade name – Remicade) . Its mechanism of action is to block the multiple effects of the central pro-inflammatory (supportive of inflammation) cytokine, tumor necrosis factor α.First, in 1998, the drug was licensed in the United States and Europe as a backup drug for the treatment of refractory and fistulous forms of Crohn’s disease. In October 2005, based on the accumulated experience of the high clinical efficacy and safety of infliximab in the treatment of UC patients, a round table dedicated to the development of new treatment standards for UC and CD in the EU and the USA decided to include in the list of indications for treatment with infliximab and UC. Since April 2006, infliximab (remicade) has been recommended for the treatment of patients with severe ulcerative colitis in Russia.

Infliximab has become a real breakthrough in modern medicine and is considered the “gold standard” with which most of the new drugs (adalimumab, certolizumab, etc.) currently undergoing clinical trials are being compared.

For UC infliximab (Remicade) is prescribed:

90 014 90 015 patients in whom conventional therapy (hormones, immunosuppressants) is ineffective

90,015 patients dependent on hormonal drugs (withdrawal of prednisone is impossible without resumption of exacerbation of UC)

90,015 patients with moderate and severe course of the disease, which is accompanied by damage to other organs (extraintestinal manifestations of UC)

90,015 patients who would otherwise need surgical treatment

90,015 patients in whom successful treatment with infliximab caused remission (to maintain it).

Infliximab is administered as an intravenous infusion in a treatment room or at an anti-cytokine therapy center. Side effects are rare and include fever, joint or muscle pain, and nausea.

Infliximab is faster than prednisone in terms of symptom relief. So, in some patients, already within the first 24 hours after the administration of the drug, an improvement in well-being occurs. Reduced abdominal pain, diarrhea, bleeding from the anus.Physical activity is restored, appetite increases. For some patients, for the first time, it becomes possible to withdraw hormones, in others, saving the colon from surgical removal. Due to the positive effect of infliximab on the course of severe forms of UC, the risk of complications and deaths decreases.

This drug is indicated not only for achieving remission of UC, but can also be administered as intravenous infusions over a long period of time as maintenance therapy.

Infliximab (Remicade) is currently one of the most studied drugs with an optimal benefit / risk profile. Infliximab (Remicade) is even approved for use in children over 6 years old.

However, biologics are not without side effects. By suppressing the activity of the immune system, as well as other immunosuppressants, they can lead to an increase in infectious processes, in particular tuberculosis. Therefore, before prescribing infliximab, patients need to undergo chest x-ray and other studies for the timely diagnosis of tuberculosis (for example, the quantiferon test is the “gold standard” for detecting latent tuberculosis abroad).

A patient receiving infliximab therapy, like any other new agent, should be monitored continuously by his or her physician or anti-cytokine specialist.

Before the first infusion of infliximab (Remicade), patients undergo the following tests:

• chest X-ray
• Mantoux skin test
• blood test.

Chest X-ray and Mantoux skin test are done to exclude latent tuberculosis.A blood test is necessary to assess the general condition of the patient and to rule out liver disease. If an active, severe infection (eg, sepsis) is suspected, other tests may be needed.

Infliximab (Remicade) is injected directly into a vein, drip, as an intravenous infusion, slowly. The procedure takes approximately 2 hours and requires constant monitoring by medical personnel.

The standard recommended single dose of infliximab in patients with UC is 5 mg per kg of body weight.

An example of calculating a single dose of infliximab required for a single infusion. With a patient weighing 60 kg, a single dose of infliximab is: 5 mg x 60 kg = 300 mg (3 Remicade 100 mg vials).

Infliximab (Remicade), in addition to its therapeutic efficacy, provides patients with a gentle therapy regimen. In the first 1.5 months at the initial, so-called induction stage of therapy, the drug is administered intravenously only 3 times with a gradually increasing interval between subsequent injections carried out under the supervision of a physician.At the end of the induction period, the doctor evaluates the effectiveness of treatment in this patient and, if there is a positive effect, recommends continuing therapy with infliximab (Remicade), usually according to the scheme once every 2 months (or every 8 weeks). It is possible to adjust the dose and mode of administration of the drug, depending on the individual course of the disease in a particular patient. Infliximab is recommended to be used throughout the year, and, if necessary, for a longer period.

The future in the treatment of inflammatory bowel disease (UC and Crohn’s disease) looks very promising.The fact that infliximab (Remicade) is included in the public care scheme for patients with UC and Crohn’s disease means that more patients can access the most modern treatment.

In case of ineffectiveness of conservative (drug) therapy, the question of the need for surgical intervention is being resolved.

90,000 Blood in the stool: causes, symptoms, diagnosis, treatment

For a number of features, the doctor is able to identify a possible source of bleeding and determine its causes.In terms of diagnostics, the rule is relevant: the brighter the blood in the feces, the lower the bleeding area is. This phenomenon is explained by the presence of hemoglobin, which, passing considerable distances along the gastrointestinal tract, becomes oxidized, changing the color of the blood to brown or black.

At first, it is important for a specialist to clarify the source of bleeding and assess the severity of blood loss, since further tactics will depend on this moment. The simplest method is a complete blood count. The main indicators are hemoglobin, hematocrit and erythrocytes.In the future, the doctor prescribes more specific diagnostic methods.

Therapy is based on eliminating bleeding and eliminating its consequences. In simple cases, doctors manage to cope with conservative methods, but sometimes they have to resort to surgical treatment.

Symptoms

Bleeding from the gastrointestinal tract can not always be determined visually, but it is possible to learn about regular blood loss by a number of signs:

• deterioration of the general condition;

90,015 fatigue;

• pallor of the skin;
• dizziness, tinnitus, fainting;
• high heart rate;
• heart pain;
• low pressure;
• brittle nails;
• hair loss.

The described symptoms are often overlooked, as patients associate them with ordinary fatigue. Acute bleeding from the gastrointestinal tract manifests itself in a stormy clinic, which develops much faster, while new symptoms appear:

• vomiting of blood;
• weakness, trembling, fainting;
• decrease in the volume of urine, or its complete absence.

Symptoms of the main disease that led to blood loss may come to the fore.Pain syndrome may indicate ischemic processes, intussusception of intestinal loops. At the time of defecation, pain is characteristic of anal fissure or hemorrhoids, while an important sign is the presence of bright blood in the stool.

Reasons

A bleeding vessel can be localized in any part of the gastrointestinal tract and the exact localization can be detected using special diagnostic methods. Nevertheless, it is possible to identify the main diseases in the clinic of which blood loss is possible:

• gastric and duodenal ulcer;
• infectious diseases of the intestine;
• diverticula of the esophagus and intestines;
• mesenteric thrombosis;
• Crohn’s disease;
• ulcerative colitis;
• tumors in decay stage;

90,015 polyps;

• hemangiomas;
• hemorrhoids;
• anal fissure.

In some cases, other diseases of a systemic nature can become the cause of blood in the stool: hemorrhagic vasculitis, hemostasis disorder.

Diagnostics

The very first thing that the proctologist specifies is the type of blood in the feces. This moment can prompt a specialist to make assumptions about the source and causes of blood loss. The detected signs may be specific for a number of diseases:

• bright scarlet blood that comes out from the anus in the form of drops or trickles – a characteristic sign of hemorrhoidal bleeding;
• blood in the feces in the form of scarlet veins – a symptom of a lesion of the sigmoid colon;
• dark brown blood, evenly mixed with feces, is characteristic of pathological processes localized in the initial section of the large intestine;
• black loose stools – a sign of massive bleeding from the esophagus, stomach or small intestine.

After clarifying the anamnesis, the doctor proceeds to a visual examination and identifying areas of pain. With the help of palpation, you can find painful areas and, accordingly, the localization of the source of bleeding.

The first method of laboratory diagnostics is a blood test, which can be used to track the severity of bleeding and suggest its probable duration.

Instrumental methods are required to help visualize the pathological focus and eliminate it.Based on the available data, the doctor prescribes diagnostic methods that will be informative in each specific case:

• contrast-enhanced abdominal X-ray – effective for the diagnosis of ulcers, polyps, tumors, diverticula and intussusception;
• sigmoidoscopy – a method that helps to detect pathologies of the rectum;
• colonoscopy is an endoscopic diagnostic method used to visualize the colon.

The peculiarity of endoscopic approaches is the ability to examine the bleeding focus, take histological material and try to stop bleeding with conservative approaches.

Treatment

In the treatment of bleeding, doctors strive to fulfill 2 goals:

• stop bleeding;
• to correct the developed anemia.

It is most often possible to perform hemostasis with the help of drugs that increase coagulation, gastric lavage with cold water, coagulation through an endoscope. In some cases, the bleeding area cannot be treated with non-invasive methods, then doctors begin surgical treatment.

In the postoperative period, it is very important to eliminate the main causes of the development of pathology and prevent relapses. In case of an ulcer, it is necessary to eradicate H. pylori, suppress the secretion of gastric juice. Early hemorrhoids and anal fissure can also be treated conservatively. But some diseases – polyps, intussusception or diverticula – are eliminated only by surgery.

Chronic bleeding is always accompanied by anemia, therefore it is necessary to correct the loss of hemoglobin, which is achieved by using iron preparations.When shock develops, transfusion of plasma or blood components is considered an indispensable approach.

90,000 Rectal bleeding – Tartu Ülikooli Kliinikum

When bleeding from the rectum, there is an admixture of blood in the feces
masses, the release of blood in the form of traces on toilet paper or in the form of drops on
feces

Rectal bleeding is a common problem in
any age.

Why does this happen?

There are many different reasons.The most common causes are fissure of the anus (anal fissure) and
hemorrhoids. Chronic constipation contributes to the development of these diseases;

• Anal fissure –
  this is
  a small tear (fissure) in the anus. The anus is a hole through
  which is the emptying of feces.
• Hemorrhoids – varicose veins in the lower rectum and anus. At the site of localization, hemorrhoids are divided into internal
  (in the lower part of the rectum, invisible without the use of special instruments) and external (visible
  around the anus).
• Diverticulosis (diverticulum) of the large intestine is
  a fairly common cause of rectal bleeding in people with middle and
  old age. A diverticulum is a saccular, small protrusion in the intestinal wall that forms in
  a consequence of a decrease in the elasticity of the wall. Feces can get into
  diverticula, resulting in inflammation and bleeding.

Other possible causes of bleeding from the anus are:

• intestinal infections.In these cases, it is characteristic
  violation of the stool. Bloody diarrhea lasts 1 to 3 days and then
  stops;
• inflammatory bowel disease (ulcerative colitis or
  Crohn’s disease). In these cases, the discharge of blood
  accompanied by abdominal pain, diarrhea, mucus is found in the stool;
• colon cancer;
• upper gastrointestinal bleeding
  path. In this case, the bleeding is profuse and needs urgent medical attention.
  help.

Symptoms

When bleeding from the rectum is observed
an admixture of scarlet blood in the feces, the release of blood in the form of traces on the toilet
paper or in the form of drops falling on the walls, toilet water.There may be pain
during bowel movements. With external hemorrhoids, pain in the sitting position is characteristic.

With diverticulosis, symptoms may be absent or
expressed in the form of paroxysmal pain in the abdomen. With the development of inflammation
the temperature rises.

In colon cancer, bleeding may be
the only symptom, but other symptoms such as alternation
constipation and diarrhea, abdominal pain, loss of
weight loss, decreased appetite, fatigue.

Colon cancer is not a common cause
severe bleeding from the anus.In most cases of cancer
blood is mixed with feces and is invisible to the naked eye. If cancer is suspected, special tests are done to confirm the diagnosis.

Research

Bleeding from the anus often
discovered by chance, during the analysis of feces for occult blood.

In the presence of bleeding from the anus, doctor
would like to know if you still have others
complaints. Your doctor will examine you for an anal fissure, hemorrhoids, or
malignant tumor.Will make a study of feces for occult blood.

If the examination does not find the cause of bleeding
and you are at risk for colon cancer, then you will have a sigmoidoscopy or colonoscopy. In
during this study, a thin, flexible tube is inserted through the anus and
part of the intestine is examined. This allows
identify diseases of the colon
including diverticulosis.

It is also possible to conduct an irrigoscopy – a contrast agent is injected through the anus into the colon and an x-ray is taken.A blood test is not excluded.

Treatment

Treatment depends on the cause of the bleeding. At
a crack in the anus and with hemorrhoids, you need to increase the amount of foods containing fiber in the daily diet and make other changes in your
lifestyle, to reduce constipation. For other causes of bleeding, your doctor will explain the treatment to you.

Recommendations for home care

• If there is bleeding from the anus, see your doctor for
  diseases.Bleeding from the anus may not be normal
  phenomenon. If bleeding is profuse and persistent, contact immediately
  hospital to the emergency room.
• Observe exactly
  your doctor’s prescription.
• If your condition does not improve, tell your doctor.

Preventive measures

Keep your digestive tract on
opportunities healthy.

Eat right. Eat fiber-rich foods (fruits, vegetables, grains).Drink plenty of fluids. Proper nutrition and an active lifestyle help the digestive tract work better and thus avoid the formation of constipation, hemorrhoids and diverticulosis.

Transfer: Sister of the General Surgery Department Alla Actrakhantseva

90,000 Why does the cat have blood in the stool?

Why does the cat have blood in the feces?

Blood in the feces of a cat appears due to damage to one or another part of the gastrointestinal tract.

By the color of the blood in the stool of the cat, you can determine the source of the bleeding.

If the blood is scarlet, then these are problems of the lower intestine, if the blood is dark, then these are problems of the upper intestine, or stomach.

Reasons for the appearance of blood in the feces in a cat:

Constipation. Too hard or dry stool when passing, injures the intestinal mucosa, and this can cause bleeding.Remember that a cat, especially if it eats dry food, should always have clean, drinking water to soften the stool.

Intolerance to feed or any of its components. It can be ready-made feed, as well as natural

Diseases of the gastrointestinal tract: stomach ulcer, gastritis, colitis enteritis, pancreatitis. The use of poor-quality feed, violation of the rules for feeding and keeping a pet can lead to such diseases.

Foreign bodies. These can be bones, toys that have been swallowed or gnawed, etc.

Intestinal parasites (worms, protozoa)

Bacterial infection (salmonellosis)

Viral infections – plague, coronovirus, panleukopenia, calicevirosis.

· Intestinal neoplasms.

Pilobezoars (hairballs) in the intestine.These hairballs can cause intestinal inflammation and bleeding, especially in long-haired cats

· Blood clotting disorder. In case of violation of blood clotting in a cat, there may be not only intestinal bleeding, but also vomiting with blood, bleeding of the gums.

Abscess of the paraanal glands. In the paraanal glands there is a specific secret that is excreted along with the feces. This secret can be called the “calling card” of the animal.If the paraanal gland becomes inflamed, then the secret begins to accumulate in its cavity. An abscess occurs, which begins to bleed, and as a result, we see drops of scarlet blood in the stool.

What if your pet has blood in the stool and the animal is doing well?

1. Give a broad-spectrum anthelmintic.

2. Clean the cat’s intestines from pylobizars. Pet stores now sell a lot of drugs to make it easier to remove hair from the intestines.

3. Normalize power supply. Try changing feeds and make sure your cat has access to water at all times.

If the blood in the stool is due to the presence of helminths, hairballs in the intestines, or nutritional problems, then by applying these measures, you can do without visiting a veterinary clinic. In this case, it is necessary to observe the pet, its behavior, appetite, activity.

When shouldn’t veterinary treatment be delayed?

If the cat has blood in the stool and the following symptoms are present:

· Changes in stool consistency.

Vomiting.

· Lack or decreased appetite.

Dramatic weight loss

· Difficult painful bowel movements.

· Animal, apathetic, lethargic.

If your pet has at least one of these symptoms, you should immediately contact your veterinarian.

90,000 Vomiting blood after alcohol: why vomits blood

Excessive alcohol consumption disrupts the functioning of various organs and systems in the body.A severe hangover is accompanied by severe nausea and vomiting. If blood particles appear in the waste products, you should seriously think about it. This indicates severe liver damage , as well as problems with the stomach and esophagus.

If a person vomits blood after alcohol, it is necessary to cleanse the body and provide him with complete rest. When you feel better, you should definitely visit a doctor. A comprehensive examination will help identify the underlying causes of the ailment. The situation is too serious to be allowed to take its course.The appearance of blood in vomiting can be regarded as an SOS signal from the body. In order not to aggravate the problem, will have to completely abandon alcohol .

Causes of vomiting with blood

Nausea is a normal reaction to alcohol poisoning. The body tries to “throw away” toxic substances as quickly as possible. However, blood impurities usually appear at internal bleeding . In this situation, immediate hospitalization is required.

The reasons why vomits blood after alcohol include:

1. Injury to the walls of the stomach .This condition is also called Malory-Weiss syndrome. The stomach is in a tense state. With emetic spasms, tears and cracks appear on the walls of the stomach. This is how the blood enters the esophagus and mouth. Another reason is a strong blow to the stomach. A drunken person may not even understand what is happening to him. This condition is treated with conservative methods, but in some cases, surgical intervention is required.
2. Varicose veins of internal organs . The symptom is scarlet blood clots in vomit.On the mucous membranes, the vessels are greatly dilated and torn. As a rule, bleeding is short-lived. If the clots are dark, you should immediately consult a doctor.
3. Acute gastritis . Observed with improper nutrition. In combination with alcohol, slight bleeding may occur. Not only addicts can face such a problem, but also people who decide to violate the recommendations of doctors and drank a little alcohol.
4. Peptic ulcer .Sometimes accompanied by gnawing pains. Minor bleeding is eliminated by therapeutic methods; in difficult cases, surgery is required.
5. Hepatitis . It is not always viral in nature. Systematic alcohol abuse provokes the development of the disease. If you do not monitor your health, the disease will quickly turn into cirrhosis. Women are at risk. In their body, much fewer enzymes are produced that can neutralize the breakdown products of alcohol.
6. Cirrhosis of the liver and stomach ulcer . With such diagnoses, alcohol is prohibited even in small doses. In people with cirrhosis, the vessels of the esophagus dilate strongly and rupture under strong stress. Bleeding often leads to the death of the patient.

Attention! Chocolate, as well as red-brown vegetables and fruits, color the contents of the stomach in a specific color, which is often confused with blood.

In addition to bloody vomiting, there are other symptoms .So, the skin becomes pale with a bluish tint, dizziness appears and darkens in the eyes. The person feels intense thirst and dry mouth, and loose stools become black. This lowers blood pressure. Visual impairment is also possible.

Emergency

Continuous nausea and vomiting with blood after alcohol exhaust and dehydrate the body. This condition is sometimes accompanied by painful sensations. If there is a dark shade of blood in the masses, doctors should be called immediately.It is not recommended to give medicines to the patient . Only a specialist can correctly establish the causes of bloody vomiting.

Before the ambulance arrives, you can take the following measures:

1. Put the patient on his side . Vomit will not accumulate in the airways and will not cause an attack of suffocation. On the back, a person can easily choke.
2. Above the patient should be covered with a rug or blanket. Constantly be near him, measure pulse and blood pressure.
3. If a person is thirsty, they give him clean water. No food or medicine.
4. It is permissible to give only activated carbon , according to the dosages in the instructions.
5. Doctors will flush, put on a dropper with glucose solution and give the necessary recommendations.

Vomiting with bloody matter is a dangerous condition. If you do not provide assistance on time, you can face various complications. Among them, one can especially single out general dehydration and weakening of the body, shock, anemia, convulsions and suffocation.By artificially inducing vomiting, can only exacerbate bleeding .

Professional help

If vomiting with blood after alcohol, the patient is carefully examined to determine the exact cause. In most cases, this is a stomach ulcer. Alcohol destroys the mucus barrier functions and blood vessels. Hydrochloric acid enters the stomach, corroding its walls. X-rays of the abdominal cavity , pH-metry, as well as analysis for the presence of Helicobacter pylori bacteria will help to establish the diagnosis.

Uncontrolled use of alcohol provokes the development of Malory-Weiss syndrome. For treatment, blood transfusions (crystalloid and colloidal) are used. Additionally, drugs are prescribed to stop vomiting. To cope with severe bleeding, resort to using the Blackmore probe . With its help, bleeding vessels are squeezed.

Also do local adrenaline blockade, which helps to constrict blood vessels. Bleeding caused by varicose veins of the stomach is fraught with cirrhosis.In such cases, the veins are checked regularly. At the slightest suspicion of bleeding, it is necessary to reduce the portal pressure .

Special drugs (vasodilators and vasoconstrictors), balloon tamponade with two types of probes are used as therapy. Endoscopic and surgical methods are also used.

Folk remedies against vomiting

To eliminate vomiting, use the following means:

1. Potato starch (1 tsp.l. raw materials / 1 tbsp. l. warm water). This gruel will help to cope with unpleasant cramps.
2. Blackberry branches. A decoction is prepared from them. You will need 0.5 liters of water. The branches are boiled for 5 minutes, and after another 40 minutes they are insisted.
3. Dry chicory. The herb is ground into powder (1 tbsp. L / 300 ml boiling water). The resulting mixture is covered with a warm blanket and left overnight. Drink several times a day for 1 tbsp. l. 30 minutes before meals.
4. Egg whites. It will take only 3 eggs, and in an hour the nausea will bother you less.

In case of severe vomiting of blood, such remedies will not help. However, can quickly remove residual effects from .

Dieting

You will not only have to forget about alcohol, but also completely revise your diet. At first, the patient is better off not eating. The most important thing right now is to drink plenty of fluids to stay hydrated. It is useful to drink teas based on calendula, rose hips or chamomile. They have a calming effect, relieve inflammation and help to recover faster from illness.

Usually on days 2-3 there is a significant relief of the condition. This is only if the patient adhered to bed rest and followed all the prescriptions of doctors. Correctly selected food will help replenish the supply of nutrients, will not irritate the esophagus and stomach. During this period, it is important not to overload the liver and pancreas. All fried and fatty foods are completely excluded. Also, you can not eat marinades, canned food, raw vegetables and fruits, as well as red meat.Food should be soft, mashed, at a comfortable temperature.

It is best to start with weak tea and jelly, gradually moving on to liquid porridge, diluted chicken broth. Next, they move on to chopped chicken pulp and soft-boiled eggs. It is recommended to drink vitamin C to strengthen the body. After complete recovery, it will be necessary to strictly observe the dietary regimen and regularly visit a gastroenterologist. A specialist will help you choose the right diet for the future.

Preventive measures

It is always better to prevent a critical condition than to deal with it.

In this case, the following tips will help:

1. Try to get more rest and eat right.
2. Get rid of bad habits.
3. Avoid injury to the abdominal cavity.
4. Visit a gastroenterologist regularly and take all the necessary tests.

Vomiting blood cannot be ignored. Even if this condition has passed quickly, you need to visit a doctor. In the case when a person vomits blood after alcohol, only comprehensive examination of digestive organs can establish the reasons.With repeated use of alcohol, the situation can worsen even more and lead to tragic consequences.

A person who drinks will need help from those close to him. Getting rid of an addiction can be difficult. Therefore, you need to find a good narcologist who will help you solve your alcohol problem. The task of relatives is to convince a person of the need to give up alcohol. Only in this way will the treatment be effective. A healthy lifestyle, measured balanced nutrition , regular examinations will prevent the risk of recurrent bleeding.90,000 Vomiting with cancer of the brain, ovaries, lungs, pancreas, stomach, rectum, what to do

Vomiting for cancer: treatment, causes

Vomiting with cancer occurs quite often and not without reason. So, with a course of chemotherapy, vomiting is a frequent result of the use of drugs.

Vomiting is also observed with cancer of the liver.With brain cancer and gastrointestinal bleeding, vomiting also becomes one of the symptoms of the disease.

Causes of pathology

In the human brain there is a so-called vomiting center, which is responsible for the formation of an emetic reaction, like the chemoreceptor zone.

In a patient suffering from cancer, a central mechanism is triggered simultaneously (with it, impulses come from the cerebral cortex) and a peripheral mechanism (impulses come from the intestine, more precisely, its mucous membrane), or they appear separately from each other.

The central mechanism is triggered when:

• A jump in intracranial pressure in the area of ​​brain damage;
• Elevated levels of calcium in the blood;
• Intoxication caused by products produced by the cancer focus or by its decay;
• As a result of an emetic reaction caused by psychogenic factors.

The peripheral mechanism is activated when:

• Complications caused by taking toxic medications;
• Occurrence of intestinal obstruction or stenosis;
• Liver tumor affection.

Constant nausea is removed by means of increased doses of analgesic drugs, however, the motility of the gastrointestinal tract slows down.

Vomiting and progression pathology

There is no single clear division into the types of vomiting, but, having considered the vomit, the following manifestations of pathology that occur after eating food can be distinguished:

1. Masses with altered blood – food has already been partially digested;
2. Vomiting during or immediately after eating.It is caused by an increase in pressure inside the skull, psychomotor, the development of a tumor in the esophagus.
3. In case of toxins: ingestion of atypical cells in the liver, side effects of chemotherapy and radiation therapy, vomiting may occur constantly.

The contents of the vomit itself, its appearance may indicate the cause of the complication:

• With practically unchanged food residues, oncology of the esophagus or the junction connecting the esophagus and stomach is observed;
• Sour smell, if the contents are partially digested, indicates oncology of the stomach, namely its lower third;
• The presence of bile indicates a disease of the small intestine;
• The color of “coffee grounds” – a signal of gastric bleeding;
• Bitter odor alongside and yellow contents are characteristic of liver dysfunction.

Vomiting as a result of therapy

The constant feeling of nausea and the presence of vomiting negatively affects the therapy of cancer. Their presence makes the chosen treatment method less effective, since it is important for the doctor to monitor the general condition of the patient and adjust the course of his treatment.

The injected cytostatic agent during a chemotherapy session causes the patient’s body to vomit. This happens over a number of days, even after using the drug.Sometimes it cannot be prevented with antiemetic medications.

All chemotherapy drugs have their own emetic period, their prevention and treatment begins on the first day of treatment and ends a few days after their end.

It is noteworthy that the organisms of men and women react differently to vomiting. So in some women, after the first chemotherapy treatment, reflex vomiting may begin as a reaction to it. For men, this is completely irrelevant.

During the application of radiation therapy, vomiting depends on two main factors – the area of ​​radiation, the preparedness and the internal readiness of the patient. Of course, age, gender and a number of other factors should be taken into account.

Treatment of vomiting in oncology

Our doctors have learned quite well how to treat vomiting caused by chemotherapy sessions. For its optimal treatment, a number of fundamental principles are currently applied:

• It is necessary to predict the intensity of pathology in advance and individually select combinations of medicinal drugs;
• Take medications in advance and strictly on time;
• The preference should be given to drugs administered intravenously or rectally;
• If the patient is nervous, give him the appropriate medication;
• Introduce drugs that protect the mucous membrane into the treatment regimen;
• Monitor the level of trace elements in the blood and the required volume of circulating plasma.

If vomiting occurs in a patient who is conscious, then the penetration of part of it into the respiratory tract is minimal. In cases of loss of consciousness, the head must be turned to one side and tilted lower.

When vomiting ends, rinse the mouth thoroughly. Compensation for lost fluid occurs through the consumption of water.

Vomiting and bleeding

A very alarming symptom of cancer is bleeding with vomiting.It can occur both with a large tumor, and insignificant, if it is localized in a large vessel. Vomiting with bleeding is typical for the final stages of oncology; almost 2/3 of patients suffer.

If you take a form of cancer such as carcinoma, then bleeding rarely manifests itself symptomatically at first. However, at the same time, its danger does not decrease, especially with tumor infiltration. It is noticed that serious bleeding develops in 7 out of 10 patients.Every 9th patient experiences shock due to the fact that blood loss develops rapidly. 2 out of 10 are faced with wall perforation or tumor invasion into neighboring organs.

Manifestations of blood loss

Blood loss leads to a sharp decrease in pressure, a person, due to this, experiences weakness. On his face, one can observe a waxy pallor, his lips turn blue, his heartbeat increases. The person sweats significantly, the sweat is sticky and cold. In some cases, loss of consciousness is observed.

Vomiting with blood impurities is a very striking symptom of bleeding in the stomach.

Vomiting with an admixture of blood can be a signal of damage to blood vessels located in the respiratory tract, or an acute gastrointestinal disease.

These masses with food debris and an admixture of thickened blood have a disgusting odor.

The blood that enters the gastric lumen is fermented and turns dark brown.

When blood passes through the intestinal tube, the color of the stool changes to black due to the iron released from the dead red blood cells. Often in a patient with cancer, the masses become like a tarry gruel.

Thus, we can say that black feces and dark vomiting are characteristic signs of bleeding that occurs in the stomach.

Vomiting may also be typical of obstruction of the gastric outlet or intestines.

The stool is black, even with good health – this is a reason to see a doctor.

Treatment of vomiting with blood impurities

Vomiting with blood impurities is a signal for urgent gastroscopy. It is on the basis of it that the cause of bleeding can be found and measures taken to eliminate it.

Similar measures can be carried out during endoscopic intervention – hypothermia, hemostatic agents, vascular coagulation.

Unfortunately, the risk of recurrence after endoscopy is high enough that surgery is necessary in most cases.

To resort to a radical measure after endoscopy, i.e. removal of the stomach, it is not necessary immediately, but after the planned preparation of the patient for it, otherwise there is a significant danger of death.

The Onco.Rehab integrative oncology clinic is equipped with modern equipment and has highly qualified doctors to help you with your problems.

Preparation for diagnostic tests – TKB No. 3 named after Professor G.A. Zakharina

Preparation for diagnostic tests

Preparation for instrumental research methods (in detail)

Preparation for laboratory research methods (in detail)

Complete blood count – No special training required. It is recommended to take blood no earlier than 4 hours after the last meal. If possible, exclude high emotional and physical stress on the eve.General urine test – On the eve of the test, it is recommended not to eat vegetables and fruits that can change the color of urine (beets, carrots, etc.)

Before collecting urine, a thorough hygienic toilet of the genitals must be performed. Women are advised not to have a urine test during their period. Collect approximately 50 ml of morning urine in a container (with a blue lid). For a correct study, during the first morning urination, a small amount of urine (the first 1 – 2 sec.) to release into the toilet, and then, without interrupting urination, substitute a container for collecting urine, in which to collect approximately 50 ml of urine.

Urine test according to Nechiporenko

Rules for the collection of urine

Before collecting urine, hygienic procedures are mandatory so that bacteria of the sebaceous and sweat glands do not get into the urine. Collect strictly the morning portion of urine, allocated immediately after sleep, preferably the middle portion. A special set (sterile container)

is used to collect urine

Coagulogram

Blood sampling is recommended not earlier than 4 hours after a meal.

Preparation for the delivery of feces tests

3-4 days before the study of feces analyzes, stop taking laxatives, castor and petroleum jelly, activated carbon (sorbents) and stop the administration of rectal suppositories. Feces obtained after an enema, as well as after taking barium (with an X-ray examination), is unsuitable for research. Before collecting stool, first urinate in the toilet and flush it. Then, by natural defecation in a toilet bowl or bedpan, collect the stool.Then the middle portion of the stool is spooned into a clean, disposable container with a screw cap in an amount of no more than 1/3 of the container volume. If the feces are collected in the evening, storage in the refrigerator at T = 2-8 ° C during the night is allowed. In the morning, the feces must be delivered to the laboratory.

When taking a fecal occult blood test, special preparation is required in order to exclude a false-positive reaction: three days before this test, meat, liver, blood sausage and all foods containing iron (apples, bell peppers, spinach, white beans, etc.). The stool should be obtained without the use of enemas and laxatives. Feces are collected in a special container, which can be bought in pharmacies or obtained from us, with a volume of about 1 teaspoon. The material is delivered to the laboratory within 5 hours.

Biochemical blood test

It is recommended to donate blood in the morning (from 8 to 11 o’clock), on an empty stomach (at least 8 and no more than 14 hours of fasting, you can drink water). Avoid food overload the day before.

Gastroscopy

Do not eat, drink or smoke 6 hours before the test.If you are constantly taking medications, check with your doctor about the regimen and conditions for taking them. Be sure to inform your doctor about the presence of chronic diseases and previous operations, as well as about the presence of diseases of the gastrointestinal tract in your blood relatives. Upon completion of research:

• Do not eat or drink for 30 minutes.
• If biopsy was performed, consume chilled food and drinks throughout the day.
• It is not recommended to drive a car, operate any machinery or make important decisions within one hour, and if you are doing research in a dream, during a day.Important! Inform your doctor if you experience unusual symptoms or any circumstances that bother you in the first hours and days after the examination, especially about the appearance of pain, weakness, nausea, vomiting of blood, black tarry stools.

Colonoscopy

Diet three days prior to examination:

• Do not: brown bread, fresh vegetables and fruits, herbs, mushrooms, legumes, berries, cereals, seeds, nuts, jam with seeds, including small ones (currant, raspberry), grapes, kiwi.
• You can: broth, semolina, egg, boiled meat, chicken, boiled sausage, fish, cheese, butter, white bread, dairy products, except for cottage cheese.
• On the eve of the study, only liquid food was allowed (broths, jelly, juices without pulp). Preparation with Fortrans. Before use, be sure to read the instructions! One-stage preparation (if the study is carried out in the morning) On the eve of the study, the last meal should be no later than 15 hours.It is necessary to take Fortrans from 4 pm to 8 pm. Dissolve the contents of four packets of the drug in four liters of water at room temperature. Take one glass every 15 minutes.

Ultrasound of the abdominal organs

Diet:

For 2-3 days do not consume black bread, milk, carbonated water and drinks, vegetables, fruits, juices, confectionery, alcohol. In the absence of contraindications, you can also take any enterosorbent (polysorb, polyphepan, “white coal”, enterosgel) in a standard dosage, it is also desirable to make a cleansing enema 1.5-2 hours before the study.The study is carried out strictly on an empty stomach (at least 6, and better – 12 hours after eating).

Ultrasound of the pelvic organs

Diet:

For 2-3 days do not consume black bread, milk, carbonated water and drinks, vegetables, fruits, juices, confectionery, alcohol. In the absence of contraindications, you can also take any enterosorbent (polysorb, polyphepan, “white coal”, enterosgel) in a standard dosage. The study is carried out with a filled (!) Bladder, at least 6 hours after eating.To fill the bladder, you must drink at least 1 liter of plain water (in no case juice or carbonated water!) 2-3 hours before the examination. Do not empty the bladder before examination!

Preparation for the delivery of sputum tests

After a thorough toilet of the oral cavity (brushing the teeth and rinsing with boiled water), the morning sputum is collected in a sterile dish. A sufficient volume of sputum for research is 3-5 ml. To increase the information content, it is possible to re-examine the sputum, which makes it possible to increase the number of positive findings.

If sputum is secreted irregularly or in scanty amounts, expectorant drugs or irritating inhalation should be used the night before and early in the morning on the day of sputum collection. Preparation of smears from material obtained in this way should be done on the day of collection. In the absence of sputum, the impossibility of aerosol inhalation or its failure, the bronchial or gastric washings should be examined for testing for mycobacteria.

Throat swab and bacterial culture

It is very important to refrain from brushing your teeth and eating when preparing for bacterial culture and when preparing for a throat swab.You can drink. Food, toothpaste and even its remnants on the toothbrush can significantly change the bacterial environment and the culture result will turn out to be incorrect and will require repetition.