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Gastrointestinal Bleeding
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Overview of Gastrointestinal Bleeding 
The digestive tract begins with the mouth and ends at the anus. Bleeding may occur anywhere along this pathway. Blood may be visible in vomit or in the stool.
Anemia can result as well as shock, due to massive blood loss.
Causes of Gastrointestinal Bleeding
Arteriovenous malformations represent a mass of abnormal connections between the arteries and veins. Sometimes they form in the stomach and in the small and large intestines. These abnormal blood vessels are fragile and are likely to rupture and bleed intermittently, sometimes heavily, especially in older people. Veins in the esophagus can become dilated and twisted, a condition called esophageal varices (varicose veins in the esophagus), making them fragile and prone to bleeding (see Clinical Manifestations of Liver Disease: Portal Hypertension).
Certain drugs, such as aspirin and many other nonsteroidal anti-inflammatory drugs (NSAIDs), can irritate the digestive tract and cause bleeding. Drugs that reduce the blood's tendency to clot (anticoagulants) or that dissolve clots once they have formed (thrombolytics such as streptokinase or tissue plasminogen activator) can cause gastrointestinal bleeding as well.
Injury to the esophagus by foreing bodies or repeated vomiting can lead to bleeding. Tumor the the stomach, esophagus and intestinal tract can lead to blood loss. This may occur with both benign and cancerous tumors.
Ischemic colitis, where these is impairment of blood flow to the large intestine, can lead to rectal bleeding. Inflammatory bowel disease, such as Crohns disease and ulcerative colitis, are both frequently associate with GI bleeding. Polyps of the colon can bleed.
Trauma to the rectum, hemorrhoids and anal fissures can produce blood loss.
Signs and Symptoms of Gastrointestinal Bleeding
Symptoms of gastrointestinal bleeding include vomiting blood, black tarry stools, and passing visible blood from the rectum.
Black tarry stools frequently result from bleeding that occurs high up in the digestive tract. Common areas for this type of bleeding include the stomach or first segment of the small intestine. Blood in the stomach turns black when exposed to stomach acid and enzymes. A single severe bleeding episode can produce tarry stools for as long as a week, so continuing tarry stools do not necessarily indicate persistent bleeding.
People with chronic bleeding that tends to occur in small amounts or intermittently may develop symptoms of anemia. Anemia is usually associated with tiring easily and looking unusually pale. In the absence of such symptoms, a doctor may be able to detect an abnormal drop in blood pressure when a person sits or stands up after lying down, orthostatic hypotension.
Symptoms indicating a serious and sudden blood loss include a rapid pulse rate, low blood pressure, and reduced urine flow. Shock occurs when there is insufficent blood or blood pressure to perfuse the entire body. Selective hormonal and neurological controls divert blood to essential organs. A person may also have cold, clammy hands and feet. The reduced supply of blood to the brain caused by the bleeding may lead to confusion, disorientation and sleeplessness.
Symptoms of serious blood loss may differ, depending on whether the person has other underlying diseases. For example, someone with coronary artery disease may suddenly develop chest pain, angina, or symptoms of a heart attack. Symptoms associated with diseases such as heart failure, lung disease, and kidney failure may worsen. In people with impairment of liver function, gastrointestinal bleeding can dlead to a buildup of toxins that, in turn, may cause a condition called liver encephalopathy. Hepatic encephalopathy is characterized by changes in personality, awareness, and mental ability. Late stages may be associated with coma.
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Medical Content Last Updated on 07/12/2008
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