Gastrointestinal Bleeding

Today started out as an ordinary day.  You’re going about your business as usual when you start to get a little crampy lower stomach pain.  You know that feeling, when you’ve got to find a bathroom?

No biggie, you head to the bathroom and have a seat.  After you’re done and tidied up, you stand up and get a big shock.  The toilet is full of blood!

Two patients this week have come in with similar stories so, in the interest of giving my readers an idea of what to do if something similar happens to them, I figured I’d better write about gastrointestinal bleeding.

Gastrointestinal bleeding is, as the name implies, bleeding that happens anywhere in the GI tract.  The most common places for bleeding to happen are in the stomach and first part of the small intestine (called upper GI bleeding) and the colon (called lower GI bleeding).

Let’s talk about upper GI bleeding first.  This is often caused by an ulcer in the stomach eroding into a blood vessel. There may be pain, but there may not.  The bleeding can be brisk, or it can be a slow seep that has no obvious symptoms but gradually results in iron-deficiency anemia.

Significant bleeding in the stomach can cause the stool to become very dark.  If the bleeding is very brisk the stool can become black and tarry and smell like blood or raw meat.  Generally upper GI bleeding will not cause red blood in the stool.

When fresh blood is digested by stomach acid it looks like coffee grounds.  Because blood is irritating to the inside of the GI tract, gastrointestinal bleeding often causes vomiting and diarrhea.  Another sign of an upper GI bleed is vomiting up a substance that looks like coffee grounds.

What about lower GI bleeding?  Usually that IS bright red.  Many things cause lower GI bleeding, from colon cancer to anal fissures to hemorrhoids to diverticulosis.  It may be just small amounts passed with formed stool, or it may be enough to completely fill the rectum and scare the pants off you when you look into the commode.  There may or may not be pain.

One word about bleeding from the small intestine – it usually does not cause obvious blood in the stool.  Generally small intestine bleeding is found because of iron deficiency and a positive test for blood in the stool.  This diagnosis is difficult to make and thankfully is not common at all.

So what do you do if you think you may be bleeding from your GI tract?  First of all, DON’T PANIC!  In nursing school, medical school and EMT training they teach you in an emergency, first take your own pulse.  It’s a little bit of a joke, but it’s a good time to mention that staying calm is the first order of business.

After you’ve taken your pulse (or a couple of good deep breaths) you should call your doctor.  He or she should be able to at least tell with a couple of questions whether you are safe to wait until you can be seen in the office, or whether you should get checked out right away at the urgent care or emergency room.

In general the evaluation for GI bleeding involves stopping the bleeding, finding and treating the source, and reducing the risk that it will happen again.

If you develop black, tarry stool, vomiting up something that looks like coffee grounds, or bright red blood in the stool (without a known history of something harmless like hemorrhoids) you should call your doctor right away and get it checked out.  The cause could be life-threatening.

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