May marschner, pa

Gastrointestinal (GI) bleeding is a common clinical problem frequently requiring hospitalization. It can vary in degrees, from massive life-threatening hemorrhage to lớn a slow, insidious chronic blood loss. The overall mortality for severe GI bleeding is approximately 8 percent, but this number is diminishing with the arrival of superior diagnostic techniques & newer medical treatments. Many bleeding episodes resolve sầu on their own, but it is still imperative sầu that the bleeding site be determined. An exact diagnosis may prsự kiện a recurrence of bleeding and may help us treat future episodes more effectively. Also, making an accurate diagnosis can allow a patient to lớn be treated appropriately for the underlying condition that caused the bleeding in the first place.

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What are the symptoms? 


The symptoms of GI bleeding depover on the acuteness and on the source of the blood loss.

Mild, chronic GI blood loss may not show any active bleeding, but can still result in an iron deficiency anemia. Many of these patients never notice any blood loss, but it occurs in small amounts with the bowel movement so that it is not noticeable. Blood in the stool often can be detected by hemoccult testing (testing for blood in your stool) during a routine office examination.

In more severe cases of chronic or adễ thương bleeding, symptoms may include signs of anemia, such as weakness, pallor, dizziness, shortness of breath or angina. More obvious bleeding may present with hematemesis (bloody vomit), which may either be red or dark và coffee-lượt thích in appearance.

Blood in the stool could either be bright red, burgundy và clotted, or blachồng và tarry in appearance, depending on the location of the bleeding source. A blachồng, tarry stool (melena) often indicates an upper GI source of bleeding although it could originate from the small intestine or right colon. Other causes of a blaông xã stool might include iron or ingestion of bismuth (Pepto-Bismol). Hematochezia, or bright red blood can be mixed in with the stool or after the bowel movement và usually signifies a bleeding source cthua thảm to lớn the rectal opening. This is frequently due to lớn hemorrhoids; however, you should never assume rectal bleeding is due khổng lồ hemorrhoids. Conditions lượt thích rectal cancer, polyps, ulcerations, proctitis or infections can also cause this type of bright red blood.

How is it diagnosed?

If it is suspected that the bleeding is in the upper gastrointestinal tract, then an upper GI endoscopy is usually the first step. This is a flexible Clip endoscope that is passed through the mouth & into lớn the stomach while the patient is sedated. It allows the doctor lớn examine the esophagus, stomach và duodenum for any potential bleeding sites. If a site is detected, therapeutic measures can be used lớn control the bleeding. For example, a bleeding ulcer may be controlled with use of cautery, laser photo therapy, injection therapy or tamponade.

If the bleeding is suspected khổng lồ be in the lower GI tract or colon, then a colonoscopy is usually performed. In a colonoscopy, a video colonoscope is passed through the rectum and across the entire colon, while the patient is sedated.

Other diagnostic methods for detecting a bleeding source might include a nuclear bleeding scan, angiography, or barium GI studies.

In the case of chronic low-grade or occult bleeding which may result in anemia, the work-up khổng lồ discover the source of the bleeding is usually done on an outpatient basis. Generally this consists of a colonoscopy and/or upper endoscopy to look for any potential sources of chronic blood loss.

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Once the cause for the blood loss is determined, appropriate treatment & management recommendations can be made.

How is GI bleeding treated?

If GI bleeding is very active or severe in nature, it may require hospitalization. Shochồng can occur when blood loss approaches approximately 40 percent of blood volume. If there is evidence of hypotension (low blood pressure) or a fast heart rate, dizziness, or light-headedness, then treatment would include IV fluids and monitoring of the blood count, with blood transfusions given, if necessary.

While in the hospital, the patient will continue lớn be monitored closely and certain medications will be employed in an attempt khổng lồ stop the bleeding. In addition, diagnostic tests are performed.

In some cases, GI bleeding will stop spontaneously.

If the bleeding persists, despite all of the above-mentioned therapeutic techniques, then surgery might be required as a last resort.

What causes GI bleeding?

The most common cause of an upper GI bleed is an ulceration, either in the duodenum (just beyond the stomach), in the stomach lining itself, or in the esophagus. Esophageal varices, or varicose veins, are usually the result of underlying chronic liver disease lượt thích cirrhosis & these can often bleed very briskly. A tear at the junction of the esophagus & stomach sometimes also occurs as a result of repeated vomiting or retching. In addition, tumors or cancers of the esophagus or stomach can also cause bleeding.

Factors that may aggravate upper GI bleeding include use of anti-inflammatory medications (in particular aspirin other arthritis drugs), underlying chronic liver disease, thinning of the blood from certain medications lượt thích Coumadin, or underlying medical problems lượt thích chronic renal disease, cardiac or pulmonary diseases.

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The most comtháng cause of bleeding from the lower GI tract or colon is diverticulosis. This accounts for over 40 percent of these cases. If diverticular disease is not found, then a patient could have sầu an angiodysplasia which is a tiny blood vessel lining the colon that sometimes can bleed briskly or ooze chronically. Colon cancers or colon polyps might also produce lower GI bleeding, as well as different causes for colitis. Colitis is an inflammation or ulceration of the lining of the colon that could be due to ulcerative sầu colitis, Crohn’s disease, radiation therapy, or poor circulation to lớn the colon itself.

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