Bleeding in Intestine

Gastrointestinal bleeding (GI bleed), is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. Bleeding is typically divided into two main types: upper gastrointestinal bleeding and lower gastrointestinal bleeding. Causes of upper GI bleeds include: peptic ulcer disease, esophageal varices (due to liver cirrhosis) and cancer. Causes of lower GI bleeds include: Diverticulosis, Angiodysplasia, inflammatory bowel disease (Ulcerative colitis & Crohn’s colitis), haemorrhoids & cancer. Obscure bleeding is defined as haemorrhage that persists or recurs after negative endoscopy. Occult bleeding is not apparent to the patient until presentation with symptoms related to the anaemia.

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Symptoms

Gastrointestinal bleeding can range from small non-visible amounts (that can be detected by laboratory testing), to massive bleeding where bright red blood is passed either in vomitus or in stool. When there is significant blood loss over a short time, symptoms may include vomiting red blood (hematochezia) , vomiting black blood, bloody stool, or black stool (melana). Small amounts of bleeding over a long time may cause iron-deficiency anaemia resulting in feeling tired or heart-related chest pain. Other symptoms may include abdominal pain, pale skin. Sometimes, there may not be any symptoms.

Diagnosis

Blood tests are done to check level Haemoglobin, associated liver/kidney disease.
Stool test: may detect the bleeding. Negative test does not rule out the ongoing bleeding. It may be false positive as some type of coloured food.
Endoscopy: Endoscopy of the lower and upper gastrointestinal track is main test to locate the area of bleeding. Endoscopy not only localises the site but also can stop the bleeding by banding/clipping/injection therapy.
CT angiography is useful for determining the exact location of the bleeding within the gastrointestinal tract. Nuclear scintigraphy is a sensitive test for detecting occult gastrointestinal bleeding when direct imaging with upper and lower endoscopies are negative. Direct angiography allows for control (embolization) of a bleeding source, but requires an ongoing bleeding rate faster than 1mL/minute.

Treatment

Initial treatment focuses on stabilisation (resuscitation) which may include intravenous fluids and blood transfusions. Often blood transfusions are recommended to maintain the haemoglobin at the level of 8g%. Endoscopy is the mainstay of treatment. It not only localises the site but also can stop the bleeding by various modalities (banding/clipping/injection therapy).

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