Gastrointestinal Bleeding

Bleeding from the intestinal tract is a common encounter we see in practice at Liver Specialist of Texas.  The bleeding can originate from the upper part of the digestive tract or the lower part.
 
Generally speaking, upper gastrointestinal bleeding originates from either the esophagus, the stomach, or the duodenum, which is the first segment of the small intestine.  Any damage to the lining of the esophagus, stomach, or duodenum can lead to bleeding.  The bleeding may be obvious where the patient will notice the vomiting of bright red blood or old blood, that is somewhat coagulated, which will appear as old coffee grounds.  The cause of bleeding may be related to peptic ulcers due to an excess of production of acid in the stomach, gastritis, which is the irritation of the lining of the stomach due to medications, alcohol, or medicines such as aspirin or ibuprofen. Esophageal varicies, which are abnormal blood vessels that developed in chronic liver disease and cirrhosis, or esophagitis, which is related to gastroesophageal reflux and excessive acid exposure to the lower part of the esophagus can also lead to bleeding from the upper porting of the digestive tract.

Bleeding that originates from the lower portion of the gastrointestinal tract would predominantly involved the colon, and in some cases, the lower part of the small intestine.  Bleeding from the colon may present itself with bright red blood when someone passes their bowels or in some cases, the bowel movements may have a maroon appearance to them, which is also called hematochezia.  In some cases, bleeding from the lower intestinal tract is not noticed at all and this would be called occult gastrointestinal bleeding. In these cases, patients simply present with anemia.

Causes of bleeding from the lower intestinal tract include hemorrhoids, diverticulosis or diverticulitis, polyps of the colon, or anal fissures.  Additionally, other types of cancer of the colon or intestinal tract may present with bleeding as well as inflammatory bowel disease including Crohn disease and ulcerative colitis.  Infections of the lower intestine may lead to diarrhea and bleeding as well.

Symptoms of gastrointestinal bleeding depend on whether the bleeding is active or slow and chronic.  Due to the anemia and drop in hemoglobin, fatigue, weakness, and shortness of breath are common complaints.  Abdominal pain may also be present as well as a pale appearance to the skin.  The vomiting of blood usually indicates bleeding from the upper gastrointestinal system.  Bright red blood or maroon stool can be noted in lower sources such as the colon.

Whenever gastrointestinal bleeding is suspected, a thorough physical examination and history will be obtained as well as a blood work to determine the hemoglobin level.  Additionally, levels of iron in the blood are to be determined because with chronic bleeding over weeks to months, the iron level may be significantly reduced.

A sample of stool may be obtained to check for blood.  A detailed physical examination will be done to try and localize the source of bleeding.

In most cases, endoscopy will be required.  An upper endoscopy is a test that is performed where a flexible lighted instrument is passed through the mouth into the esophagus examining the esophagus, stomach, and the first portion of the small intestine looking to identify the source of bleeding.  At the time of this upper endoscopy, depending on the source of bleeding, various techniques can be used to control the bleeding.  If necessary, biopsies of the involved area can also be obtained at the time of the procedure.

To evaluate lower sources of bleeding, a colonoscopy will be performed.  This is a similar type of procedure as the upper endoscopy with a slightly longer instrument that will examine the entire length of the colon and the last part of the small intestine.  Similar to the upper endoscopy, there is the opportunity to control the source of bleeding if it is identified, as well as to take biopsies and remove polyps.

For both of these endoscopic procedures, the patient is sedated with what is called conscious sedation.  The patients are put into a relaxed state that allows the procedure to be performed. In most cases, a combination of Demerol and Versed are used.  Not only will the anesthesia relax the patient, but it will also produce a level of amnesia.

Dr. Galati performs the vast majority of his endoscopic procedures at the Texas International Endoscopy Center.