Gastrointestinal Bleeding: Causes, Symptoms, and Diagnosis

If you have bleeding in your gastrointestinal tract, you may experience blood in your stool or stool that is darker and sticky. It could indicate a severe health issue with your stomach, intestines, or other organs.

Gastrointestinal (GI) bleeding is a serious symptom that occurs within your digestive tract. Your digestive tract consists of the following organs:

• esophagus
• stomach
• small intestine, including the duodenum
• large intestine or colon
• rectum
• anus

GI bleeding can occur in any of these organs. If bleeding occurs in your esophagus, stomach, or initial part of the small intestine (duodenum), it’s considered upper GI bleeding. Bleeding in the lower small intestine, large intestine, rectum, or anus is called lower GI bleeding.

The amount of bleeding you experience can range from a very small amount of blood to a life threatening hemorrhage. In some cases, there may be so little bleeding, blood can only be discovered by testing the stool.

There are a few things that you can look for if you suspect that you might have GI or rectal bleeding. Your stool might become darker and sticky, like tar, if bleeding comes from the stomach or upper GI tract.

You may pass blood from your rectum during bowel movements, which could cause you to see some blood in your toilet or on your toilet tissue. This blood is usually bright red in color. Vomiting blood is another sign that there’s bleeding somewhere in your GI tract.

If you experience any of these symptoms, or if you have vomit that looks like coffee grounds, contact a doctor immediately.

When it’s an emergency: Symptoms of shock

GI bleeding could signal a life-threatening condition. Immediate medical treatment is essential. Also, seek treatment immediately if you experience any of the following symptoms:

• paleness
• weakness
• dizziness
• shortness of breath

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Different parts of the digestive tract are affected by specific conditions. Bleeding in the GI tract is usually divided into upper GI tract or lower GI tract bleeding. There are various causes of bleeding in different regions.

Causes of upper GI bleeding

Upper GI bleeding has several causes, including:

• Peptic ulcers. Peptic ulcers are a common cause of GI bleeding. These ulcers are open sores that develop in the lining of your stomach or duodenum. Taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), on a regular basis may increase your risk for peptic ulcers. You may also be at a higher risk if you take blood thinners. An infection from H. pylori bacteria can also cause peptic ulcers.
• Tears in the veins in your esophagus. Enlarged veins in your esophagus can tear and bleed as a result of a condition called esophageal varices. You may be at a higher risk for this condition if you have portal hypertension, which often results from cirrhosis, a severe scarring of the liver.
• Tears in the walls of your esophagus. This condition is known as Mallory-Weiss syndrome. This condition is often caused by severe or repeated vomiting.
• Gastritis and duodenitis. Gastritis is inflammation in your stomach, while duodenitis is inflammation in your small intestine. Both are commonly caused by an infection from H. pylori bacteria, but they can also be caused by other factors, including overuse of NSAIDs or alcohol.
• Foreign body ingestion. Swallowing something inedible can cause tears and bleeding in the upper GI tract.
• Upper GI tumors. Tumors, such as those caused by esophageal cancer, stomach cancer, and cancer of the small intestine, can cause bleeding. Sometimes pancreatic tumors can also cause bleeding in the GI tract, depending on their location.
• Angiodysplasia. Angiodysplasia causes enlarged blood vessels in the GI tract.

Causes of lower GI bleeding

Lower GI bleeding can be caused by:

• Hemorrhoids. Hemorrhoids are another common cause of GI or rectal bleeding. A hemorrhoid is an enlarged vein in your rectum or anus. These enlarged veins can rupture and bleed, causing rectal bleeding. This condition may resolve on its own or with minimal therapies. However, a doctor may decide to perform a colonoscopy if the bleeding seems suspicious for other more serious GI issues.
• Anal fissure. An anal fissure may also cause lower GI bleeding. This is a tear in the muscular ring that forms the anal sphincter. It’s usually caused by constipation or hard stools.
• Diverticulosis. This is a chronic condition where the wall of the colon protrudes at the location of vessels and over time can cause the vessels to rupture and bleed. Bleeding due to diverticulosis can often resolve on its own without invasive therapies. A doctor may perform a colonoscopy to rule out other, more serious causes of lower GI bleeding, such as cancer.
• Colon cancer. Colon cancer starts in your colon or rectum.
• Angiodysplasia. This condition causes enlarged blood vessels in the digestive tract.
• Colitis. One of the most common causes of lower GI bleeding is colitis, which occurs when your colon becomes inflamed.

Colitis has several causes, including:

• infection
• food poisoning
• parasites
• Crohn’s disease or ulcerative colitis
• reduced blood flow in the colon

Diagnosis of the underlying cause of your GI bleeding will usually start with a doctor asking about your symptoms and medical history. The doctor may also request a stool sample to check for the presence of blood along with other tests to check for signs of anemia.

Diagnosing upper GI bleeding

To diagnose upper GI bleeding and figure out what’s causing it, a doctor may perform the following tests:

• Endoscopy. Upper GI bleeding is most commonly diagnosed with an endoscopy. This procedure involves the use of a small camera located atop a long, flexible endoscopic tube the doctor places down your throat. The scope is then passed through your upper GI tract. The camera allows the doctor to see inside your GI tract and potentially locate the source of your bleeding.
• Enteroscopy. This procedure is performed if the cause of your bleeding isn’t found during an endoscopy. An enteroscopy is similar to an endoscopy, except there’s usually a balloon attached to the camera-tipped tube. When inflated, this balloon allows your doctor to open up the intestine and see inside.

Diagnosing lower GI bleeding

A doctor may perform the following tests to determine the cause of lower GI bleeding:

• Colonoscopy. During a colonoscopy, your doctor will insert a small, flexible tube into your rectum. A camera is attached to the tube so your doctor can view the entire length of your colon. Air moves through the tube to provide a better view.
• Biopsy. During the colonoscopy, the doctor may take a biopsy for additional testing.
• X-ray. You may also undergo a scan to locate your GI bleeding. A harmless radioactive tracer will be injected into your veins. The tracer will light up on an X-ray so your doctor can see where you’re bleeding.
• CT angiography. A CT scan is an imaging test that can help the doctor locate GI bleeding in the abdomen and pelvis. It often shows more detail than an X-ray.
• Capsule endoscopy. If your doctor can’t find the source of your bleeding with an endoscopy or a GI bleeding scan, they may perform a capsule endoscopy. Your doctor will have you swallow a pill that contains a small camera that will take pictures of your bowel to find the source of your bleeding.
• RBC nuclear scan. In this exam, a doctor injects a harmless radioactive tracer to track your red blood cells. This can show how the cells perform in your body.

Bleeding in the digestive tract may be a sign of a serious and life-threatening condition. It’s important to seek timely medical attention.

Untreated GI bleeding may result in serious complications, including:

• respiratory distress
• heart attack
• infection
• shock
• death

GI bleeding is a serious symptom that requires prompt medical treatment. From tears in the organs in the digestive tract to inflammatory conditions, these causes often require examination by a doctor to diagnose and treat.

Left untreated, they may result in serious complications, including heart attack and shock.

Some causes of bleeding, like hemorrhoids, may be treatable with OTC medications. It’s best to make an appointment with a doctor to determine the cause of your bleeding.

Internal Bleeding: Symptoms, Diagnosis, and Treatment

Internal bleeding occurs within your body, such as inside the stomach or the brain. Bleeding internally is often the result of trauma or an injury, but there are rarer causes.

An injury that damages the outside of your body is easy to see. A cut or tear in your skin usually bleeds. You can see what’s hurt, and it’s easy to pinpoint what caused it.

Internal bleeding isn’t as easy to see or diagnose. Less obvious causes can result in internal bleeding, too. These include gastritis, organ damage, or a bleeding disorder.

In some cases, the bleeding may be a sign of a life threatening condition. If you or someone you know suddenly develops the following symptoms, seek immediate medical attention. These could be symptoms of internal bleeding:

• dizziness
• severe weakness
• passing out
• low blood pressure
• acute visual problems
• numbness
• weakness on one side of the body
• severe headache
• severe abdominal pain
• shortness of breath
• chest pain
• nausea
• vomiting
• diarrhea

You may notice bloody or dark vomit or stool. Occasionally, if the bleeding is behind the internal organs in the abdomen, you may have bruising around your navel or on the sides of your abdomen.

Other cases of internal bleeding can be less severe, but it’s still important you see your doctor as soon as you notice symptoms.

Internal bleeding is a symptom of an injury, condition, or disease. You won’t have internal bleeding without an underlying reason.

Recognizing the symptoms of internal bleeding can help you and your doctor understand what’s bleeding, why it’s bleeding, and what conditions could be contributing to the problem.

Internal bleeding in your head

This can cause:

• weakness, usually on one side of your body
• numbness, usually on one side of your body
• tingling, especially in hands and feet
• severe, sudden headache
• difficulty swallowing or chewing
• change in vision or hearing
• loss of balance, coordination, and eye focus
• difficulty speaking or understanding speech
• difficulty writing
• changes in overall alertness, including increases in sleepiness, lethargy, or stupor
• loss of consciousness

Internal bleeding in your chest or abdomen

This can cause:

• abdominal pain
• shortness of breath
• chest pain
• dizziness, especially when standing
• bruising around your navel or on the sides of your abdomen
• nausea
• vomiting
• blood in urine
• black, tarry stool
• bleeding from another area, including ears, nose, mouth, or anus

Internal bleeding into your muscles or joints

This can cause:

• pain in a joint
• swelling in a joint
• decreased range of motion

Other symptoms

It’s possible to experience shock in some cases of internal bleeding.

This is especially true if internal bleeding occurs in locations where a substantial amount of blood can be lost, such as your chest, abdomen, or thigh. Shock occurs when there’s not enough blood to supply your whole body.

Symptoms of shock include:

• rapid heart rate
• low blood pressure
• sweaty skin
• changes in overall alertness, including increases in sleepiness, lethargy, or stupor
• overall weakness

The presence of other underlying conditions may help doctors identify if you’re losing blood somewhere.

For example,anemia is commonly associated with a slow and chronic internal bleeding. It can cause fatigue, weakness, and shortness of breath.

Some people with internal bleeding will also have low blood pressure because of the constant blood loss. This is known as orthostatic hypotension. Common symptoms include feeling dizzy or light-headed when you stand.

Sometimes, identifying what’s causing internal bleeding can be simple. If you’ve been involved in an accident or had a recent injury, the bleeding is likely the result of that event.

Also, diagnosing the cause may be easier if you have a condition that can lead to internal bleeding, such as gastritis.

However, not every case of internal bleeding is so clear-cut. Finding the source of internal bleeding may take some time and require a thorough physical examination.

General causes

These can include:

• Damage to a blood vessel. Minor tears can occur with an injury.
• Clotting factors. Your body makes proteins to stop any bleeding if you’re cut or injured. If your body doesn’t make enough clotting factors, you may bleed freely.
• Certain medications. Certain medications, like blood thinners, can prevent clotting and lead to severe bleeding if you’re injured or have an accident. Some over-the-counter medications, including aspirin, can damage the lining of your stomach.
• Chronic high blood pressure. High blood pressure weakens blood vessel walls. Weak walls can form aneurysms that can rupture and bleed.
• Inherited bleeding disorders. Hemophilia is a genetic condition that prevents your blood from properly clotting. A minor injury may bleed heavily if it’s not properly treated.
• Gastrointestinal (GI) causes. Bleeding in your abdomen, or stomach, may be caused by one of several GI conditions. These include colon polyps, colitis, Crohn’s disease, gastritis, esophagitis, and peptic ulcers.
• Endometriosis. Endometriosis is a condition where endometrium-like tissue grows outside the uterus in areas like the ovaries, abdomen, and bowel. The uterus will shed its lining and cause bleeding in a separate place, such as the pelvis. Diagnosis is made with the help of biopsies, a CT scan, an MRI, and an ultrasound.
• Lifestyle factors. Alcohol, smoking, and illicit drugs can irritate the lining of your stomach.

More serious causes

These can include:

• Trauma. Experiences including car accidents, falls, and dropping a heavy object on yourself can damage your organs, blood vessels, and bones. You may experience internal bleeding without cutting your skin.
• Aneurysms. Weak blood vessel walls can bulge and form pockets of blood. Many aneurysms don’t cause any symptoms, but a burst aneurysm can be life-threatening.
• Broken bones. Most broken bones are nothing to be worried about, but breaking your body’s larger bones, such as the femur, can cause significant internal bleeding.
• Ectopic pregnancy. A pregnancy outside the uterus can cause internal bleeding as the fetus grows. The condition can be life-threatening.
• Surgery. Before a surgeon completes an operation, they make sure all the bleeding has stopped. If they miss something, bleeding may continue even after the incision is closed. In some cases, this bleeding can be severe.

No matter the cause, it’s important that you get medical attention. Minor internal bleeding can quickly become more serious if the cause isn’t identified and treated quickly.

Diagnosing an internal bleed usually requires medical tests, a physical exam, and a thorough review of your medical history. Your doctor may use lab tests and imaging tools to both identify the cause of your internal bleeding and measure the severity.

For injuries, an imaging test may be all that’s necessary. An X-ray shows an image of your bones. A CT scan is an advanced X-ray that can see bones, tissues, and blood vessels. Angiography is an imaging test that can carefully examine individual blood vessels.

If the cause of the bleeding isn’t easily determined, your doctor may order several medical tests to help identify what’s bleeding and why.

Depending on the severity, untreated internal bleeding can lead to organ failure, coma, and in some cases death. Even with treatment, severe internal bleeding can result in death.

It’s very important to identify and treat internal bleeding early in order to avoid any complications.

It’s important to find and treat the cause and risk factors that may lead to internal bleeding. Without quick treatment, you may experience lasting effects.

For example, bleeding in the brain may cause a stroke or long-term brain damage. You may need physical, occupational, and speech therapy to relearn certain behaviors and activities. These therapies may also help prevent future tears or blood vessel damage.

If internal bleeding is caught, diagnosed, and treated appropriately, the outlook is positive. Many people can make a full recovery. Additional treatments may be necessary to prevent a future bleed, but few lasting effects will remain.

Surgical treatment of gastrointestinal bleeding in Moscow. Prices for Surgical treatment of gastrointestinal bleeding in the Ilyinsky hospital

Pain in gastric bleeding almost never happens, this is an uncharacteristic symptom. Pain occurs when the esophagus ruptures, with peptic ulcer of the stomach or duodenum. Ilyinskaya Hospital
emergency care for patients with gastrointestinal bleeding. Patient
immediately placed in the intensive care unit, to prevent entry
blood into the respiratory tract, tracheal intubation is performed on him, the volume of
lost blood, endoscopic diagnostics and bleeding control are carried out.
To clarify the diagnosis and extent of surgical intervention promptly
computed tomography is performed. More about the emergency department of the Ilyinsky hospital can be found here.

• Esophageal rupture

operations on the esophagus, indomitable vomiting due to intoxication. At break
of the esophagus, surgeons at the Ilyinsky hospital perform a minimally invasive endoscopic
manipulation – installation of a vacuum-aspiration system. Learn more.

• Bleeding from varices
  dilated veins of the esophagus

The main cause of esophageal varicose veins is portal
hypertension and violation of the discharge of blood from the veins of the esophagus into the portal vein system,
arising from cirrhosis of the liver. Dilated veins bulge into the lumen of the esophagus
their wall is stretched and thinned. As a result of erosion or trauma to the wall
veins hard food bleeding occurs. Surgeons to stop bleeding
Ilyinsky hospital perform a modern minimally invasive operation –
endoscopic ligation of varicose veins of the esophagus. Learn more.

• Gastric bleeding

The main causes of gastric bleeding are tumor decay and ulcer
disease. When bleeding from a decaying tumor, surgeons of the Ilyinsky hospital
perform endovascular surgery, the lumen of the damaged artery is blocked
artificial emboli. For ulcerative bleeding, endoscopic
vessel coagulation or clipping. Learn more.

• Bleeding from the colon

Bleeding from the colon can occur with complicated disease
Crohn’s (severe chronic inflammatory bowel disease),
nonspecific ulcerative colitis, disintegration and necrosis of colon tumors. At
bleeding caused by nonspecific ulcerative colitis, surgeons at the Ilyinsk
hospitals perform endoscopic application hemostasis – in the area
damage to the intestinal mucosa, a special hemostatic drug is sprayed. If
patient bleeding from the area of ​​tumor decay, then most often this
tumor and bleeding from it are associated with the presence of partial intestinal
obstruction of the colon. In this case, the patient is stented
– a special
stent. The stent compresses the tumor, the bleeding stops. Besides,
the stent prevents the development of obstruction of the colon. Clipping methods are also used
bleeding vessels and argon plasma coagulation.

• Bleeding from the small intestine (intestinal
  bleeding of unknown etiology)

Causes
bleeding from the small intestine are malformations of the blood vessels in
submucosal layer – angioectasia and angiodysplasia, as well as decaying
tumors. Patients have increasing symptoms of chronic blood loss –
anemia, weakness, decreased function of all organs. Diagnosis of bleeding from the small intestine
exceptional complexity, since their source can have very small
dimensions. Specialists of the Ilyinsky hospital use high-tech methods
diagnosis and surgical treatment of such conditions. Learn more.

• Accelerated rehabilitation

Ilyinskaya hospital has implemented the concept of accelerated rehabilitation surgery (fast track surgery). This ideology is based on the results of many years of international clinical research, recognized and implemented in all developed countries. It includes simplified preparation for surgery, performing surgery on the day of hospitalization, minimizing surgical access (laparoscopy and endoscopy), maximum efforts to preserve the affected organ (instead of removing the organ), early awakening of the patient after anesthesia, early mobilization of the patient (you can stand up shortly after surgery), early alimentation (you can start eating and drinking soon after surgery). This set of measures is aimed at the fastest possible rehabilitation of the patient after surgery and restoration of his quality of life.

Gastrointestinal bleeding: causes, symptoms and recommendations for the treatment of the disease.

Dr. Peter

• Directory of Diseases

August 23, 2022

Gastrointestinal bleeding is the loss of blood from the digestive tract (at the level of the stomach or intestines). It is also called gastrointestinal. Pathology refers to urgent conditions, requires close attention, since it can lead to severe blood loss, shock and death.

Source:

iStockphoto

If bleeding develops in the stomach or esophagus, the blood itself or its blood pigment (hemoglobin) is converted into hematin chloride by the action of stomach acid. As a result, the blood acquires a color from brown-dark to black. Therefore, with gastric bleeding, feces are called tarry because of the characteristic change in color and characteristic odor.

Severe bleeding from the intestines, causing the appearance of fresh (scarlet, cherry) or already coagulated blood in the stool, is called hematochezia.

Causes

Bleeding from the gastrointestinal tract can be caused by various causes, such as:

• Varicose veins in the esophagus (esophageal varices), which can result from cirrhosis of the liver.

• Tumor diseases in the esophagus.

• Mucosal rupture in the lower esophagus after repeated vomiting (Mallory-Weiss lesion).

• Severe reflux disease of the esophagus.

• Gastric ulcer (about half of all patients with gastric bleeding have a stomach ulcer).

• Inflammation of the gastric mucosa (gastritis). The cause of severe inflammation of the gastric mucosa is often chronic and heavy use of alcohol and nicotine.

• Tumor disease in the stomach area. Approximately 1-5% of all gastric bleeding is caused by a malignant, rarely also benign tumor.

• Varicose veins in the stomach, which may result from cirrhosis of the liver.

• Medicines. It is known that individual drugs, as well as a combination of different drugs, significantly increase the risk of gastric bleeding. Gastrointestinal complications, such as stomach bleeding, are not uncommon after long-term use of non-steroidal anti-inflammatory drugs, which are pain relievers with anti-inflammatory effects (eg, ibuprofen, diclofenac, naproxen, or acetylsalicylic acid).

• Diverticula (can occur anywhere in the digestive tract, but usually on the left side of the colon).

• Vascular malformations (angiodysplasia).

• Hemorrhoids are the most common cause of bright red bleeding from the anus.

• Tumor disease in the intestinal area.

• Polyps (adenomas) of the intestine, colon cancer.

• Chronic inflammatory bowel disease such as Crohn’s disease, ulcerative colitis.

Symptoms of gastrointestinal bleeding

Pathology can go unnoticed for a long time if it occurs in the form of latent erosive processes. With a massive loss of blood, it can manifest itself with the following symptoms:

• Abdominal pain.

• Nausea.

• Bloating.

• Vomiting of scarlet blood or mass that looks black and resembles coffee grounds.

• Black discolored chair (resinous chair).

• Bloody stools (hematochezia).

• Anemia.

• Decreased performance, shortness of breath during normal physical activity (climbing stairs).

• Dizziness, cold sweat.

Possible complications and risks

Acute gastrointestinal bleeding can also be life-threatening and lead to circulatory shock. Therefore, it is advisable in any case to go to the hospital or see a doctor as soon as possible. In addition, minor erosive bleeding occurring over a long period of time and subsequent anemia may also be an early symptom of malignant disease.

Diagnosis

Gastrointestinal bleeding is always taken very seriously. The following examinations may be carried out:

• General medical examinations to check for any circulation problems.

• Examination of stool for blood in occult bleeding.

• Gastroscopy (EFGDS).

• Colonoscopy (examination of the bowel through the rectum).

• Capsule endoscopy for examination of the small intestine.

• Ultrasound for examining the stomach and other organs.

• Monitoring of hemoglobin and blood clotting and iron metabolism, and, if necessary, vitamin B12 levels.

Depending on how severe the bleeding is and where the blood is coming from, your doctor will recommend appropriate diagnosis and treatment. In case of severe, acute blood loss, hospitalization is inevitable.

How to treat gastrointestinal bleeding

Gastrointestinal bleeding should always be treated and the volume of blood loss should be specified, as in extreme cases the pathology can lead to death. Depending on the severity of blood loss and the severity of the course, the following treatments may be considered:

• Endoscopic interventions to localize bleeding and, if necessary, stop it using various endoscopic techniques.

• If a blood vessel is damaged, in exceptional cases it may be necessary to close it surgically (cautery, ligation).

• If too much blood is lost, it is necessary to replenish the loss by transfusion of plasma, red blood cells. If necessary, replacement of lost clotting factors is also carried out.

• Reducing the production of gastric juice with the help of so-called proton pump inhibitors, if the source of bleeding is in the stomach.

In case of chronic erosive bleeding and slow development of anemia (anemia), capsule endoscopy may be required to further examine the small intestine.

The risk of death from acute gastrointestinal bleeding depends on the cause, severity and severity of bleeding, and how quickly medical attention is provided.

Prevention

The basis of prevention is the timely treatment of any gastroenterological diseases, regular examinations with the determination of occult blood in the stool and the level of hemoglobin in the blood.

Attention!

The information on this website is not a guide to self-medication. All materials are for reference only and do not replace a visit to the doctor. If any symptoms appear, you should contact a specialist.

Literature:

1. Zimmerman Ya. S. Peptic ulcer: a critical analysis of the current state of the problem // Experimental and Clinical Gastroenterology. – 2018. – No. 1. – S. 80-89.

2. Makarov IV, Dolgikh O. Yu. Private proctology. Hemorrhoids / Study Guide. — M.: Forum, 2015. — 96 p.

3. Vinokurov MM, Yakovleva ZA, Buldakova MV, Timofeeva MS Varicose veins of the esophagus and stomach in portal hypertension. Endoscopic methods for stopping and preventing bleeding of the esophagus // Fundamental research.