GI Bleed

  • August 8, 2020

Vikas, a young man of 26, was doing well in his new job. But long office hours and work pressure which often saw him working till late nights even at home, resulted in him neglecting his health. Untimely meals, no exercise, little sleep and stress became his life. When he started suffering from chronic stomach pains with sudden bouts of fever, he did not give it much importance, and his friends at office said it was the canteen food that was causing him all the trouble. When his mother complained that he was losing weight, he brushed it off. But his condition deteriorated and things came to a head when one day Vikas vomited blood after his breakfast and fell unconscious. His terrified parents rushed him to the hospital.

Suspecting a GI bleed, the emergency doctors immediately transferred him to the ICU. Tests confirmed the diagnosis. His condition was critical and his pulse was rapid. The doctor told Vikas’ parents their son had bleeding ulcers in his stomach which had resulted in severe anaemia and fall in pressure.

What is a GI Bleed?

Gastrointestinal (GI) bleeding is a disorder of the digestive tract. During this blood appears in stool or vomit but is not always visible, although it may cause the stool to look tarry. The level of bleeding can be mild to severe and can at times be life-threatening.

Advanced imaging technology, can be used to locate the cause of the bleeding and treatment depends on the source of the bleeding.

Symptoms

Signs and symptoms of a GI bleed can be either obvious or hidden. Symptoms of such bleed depend on the location, which can be anywhere on the GI tract, from the mouth to the anus.

Obvious bleeding symptoms are:

  • Vomiting blood, red or dark brown in colour
  • Black, tarry stool
  • Rectal bleeding, with stool or in it

Hidden bleeding symptoms may be:

  • Light-headedness
  • Breathing Difficulty
  • Unconsciousness
  • Chest pain
  • Abdominal pain

Abnormal and sudden bleeding can sometimes make one go into shock whose symptoms may include:

  • Drop in blood pressure
  • Low urine output
  • Rapid pulse
  • Unconsciousness

Causes of Upper GI bleeding include:

  • Peptic ulcer – These are sores that develop on the lining of the stomach and upper portion of the small intestine. Stomach acid, from bacteria or use of anti-inflammatory drugs, damage this lining, leading to formation of sores.
  • Tears in the lining of the Oesophagus – Known as Mallory-Weiss tears, they cause a lot of bleeding and common in people who drink alcohol excessively.
  • Abnormal, enlarged veins in the Oesophagus (Oesophageal varices) – This condition occurs in people with serious liver disease.
  • Esophagitis – Here the inflammation of the Oesophagus is most commonly caused by gastroesophageal reflux disease (GERD).

Cause of Lower GI bleeding

  • Diverticular disease – When small, bulging pouches in the digestive tract get inflamed or infected, it’s called diverticulitis which may cause bleeding
  • Inflammatory bowel disease (IBD) – This condition includes Ulcerative colitis, which causes inflammation and sores in the colon and rectum, and Crohn’s disease, and inflammation of the lining of the digestive tract.
  • Tumours – Non-canerous (benign) or cancerous tumours of the oesophagus, stomach, colon or rectum can weaken the lining of the digestive tract and cause bleeding.
  • Colon polyps – Clump of cells on the lining of the colon can also cause bleeding. Most of them are harmless, but some might be cancerous or can become cancerous if not removed.
  • Haemorrhoids – These are swollen veins in your anus or lower rectum which can rupture and cause bleeding
  • Anal fissures – Small tears in the lining of the anus may cause bleeding
  • Proctitis – Inflammation of the lining of the rectum can lead to rectal bleeding.

Diagnosis

While diagnosing the cause for such bleeds the doctor will take a medical history, including a history of previous bleeding, conduct a physical exam and order tests. They include:

  • Blood tests – A complete blood count to see how fast your blood clots, a platelet count and liver function tests
  • Stool tests – Analyzing the stool can help determine the cause of hidden bleeding.
  • Nasogastric lavage – A tube is passed through your nose into your stomach to empty the stomach contents to determine the source of your bleed
  • Upper endoscopy – A tiny camera on the end of a long tube, is passed through the mouth to examine the upper gastrointestinal tract
  • Colonoscopy – Here again a tiny camera on the end of a long tube, is passed through the rectum to examine the large intestine and rectum.
  • Capsule endoscopy – Here one has to swallow a vitamin-size capsule with a tiny camera inside. As the capsule travels through the digestive tract it takes thousands of pictures that are sent to a recorder. This helps the doctor to see inside the small intestine.
  • Flexible sigmoidoscopy – In this a tube with a light and camera is placed in your rectum to look at your rectum and the last part of the large intestine that leads to your rectum (sigmoid colon).
  • Balloon-assisted enteroscopy – A specialized scope is used to check the small intestine that other tests using an endoscope can’t reach and sometimes the bleeding can be controlled or treated during this test.
  • Angiography – A contrast dye is injected into an artery, and a series of X-rays are taken to find bleeding vessels or other abnormalities.
  • Imaging tests – Other tests like abdominal CT scan, might be used to find the source of the bleed.

Complications

Complications caused by gastrointestinal bleed may be:

  • Shock
  • Anaemia
  • Death

Prevention

  • Limit use of nonsteroidal anti-inflammatory drugs
  • Limit alcohol use
  • Quit smoking
  • If you have GERD, treat it immediately

When to see a doctor

Thus, if you have acute abdominal pain, vomit blood, see blood in your stools or have black, tarry stools, seek immediate medical care for a quick diagnosis and fast treatment. For people who have lost a lot of blood, they may need blood transfusions also. So, it is best to get in touch with your doctor immediately.

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