Some Causes and Features of Gastrointestinal Bleeding
Some Causes and Features of Gastrointestinal Bleeding
Cause* | Common Features† | Tests‡ |
|---|---|---|
Upper digestive tract (indicated by vomiting blood or dark brown material) | ||
Ulcers or erosions of the esophagus, stomach, or first part of the small intestine (duodenum) | Pain that
Painless ulcers can also cause bleeding | Upper GI endoscopy (examination of esophagus, stomach, and duodenum using a flexible viewing tube called an endoscope) |
Usually very heavy bleeding Often in people known to have chronic liver disease such as cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. The... read more Sometimes signs of chronic liver disease such as a swollen abdomen and yellowish discoloration of the skin and whites of the eyes (jaundice Jaundice in Adults In jaundice, the skin and whites of the eyes look yellow. Jaundice occurs when there is too much bilirubin (a yellow pigment) in the blood—a condition called hyperbilirubinemia. (See also Overview... read more | Upper GI endoscopy | |
Mallory-Weiss tear Esophageal Laceration (Mallory-Weiss Syndrome) An esophageal laceration (Mallory-Weiss syndrome) is a tear that does not penetrate the wall of the esophagus. The tear can be caused by forceful vomiting. Symptoms include blood in vomit. The... read more | In people who vomited one or more times before they started vomiting blood Sometimes pain in the lower chest during vomiting | Upper GI endoscopy |
Abnormal connections between the arteries and veins (arteriovenous malformations) in the intestine | Usually no other symptoms | Upper GI endoscopy |
Lower digestive tract (indicated by passing blood in the stool) | ||
Bright red blood only on toilet paper, dripping in the bowl, or on the surface of formed stools | Anoscopy (examination of the anus and rectum with a short, rigid tube) or sigmoidoscopy | |
Pain during bowel movements Bright red blood only on toilet paper or on the surface of formed stools Fissure seen during the doctor's examination | A doctor’s examination alone | |
Abnormal blood vessels (angiodysplasia) in the intestine | Painless, bright red blood from the rectum (hematochezia) Usually in people over age 60 (most common cause of large intestine bleeding in this age group) | Colonoscopy (examination of the entire large intestine, rectum, and anus using an endoscope) |
Inflammation of the large intestine due to radiation therapy, infection, or disruption of the blood supply (as occurs in ischemic colitis Ischemic Colitis Ischemic colitis is injury of the large intestine that results from an interruption of blood flow. Abdominal pain and bloody stools are common. Computed tomography is usually done, and colonoscopy... read more | Bloody diarrhea, fever, and abdominal pain | Colonoscopy Stool tests to look for infectious organisms Sometimes CT scan |
Sometimes fatigue, weakness, and/or a bloating sensation Usually in middle-aged or older people | Colonoscopy and biopsy (examination of tissue samples taken from the lining of the intestine) | |
Often no other symptoms | Colonoscopy | |
Painless hematochezia Sometimes in people already known to have diverticular disease | Colonoscopy Sometimes CT scan or CT angiography Rarely angiography (x-rays taken after injecting a dye into an artery using a catheter) | |
Inflammatory bowel disease Overview of Inflammatory Bowel Disease (IBD) In inflammatory bowel diseases, the intestine (bowel) becomes inflamed, often causing recurring abdominal pain and diarrhea. The two primary types of inflammatory bowel disease (IBD) are Crohn... read more (such as ulcerative proctitis, ulcerative colitis Ulcerative Colitis Ulcerative colitis is a chronic inflammatory bowel disease in which the large intestine (colon) becomes inflamed and ulcerated (pitted or eroded), leading to flare-ups (bouts or attacks) of... read more , or Crohn disease Crohn Disease Crohn disease is an inflammatory bowel disease where chronic inflammation typically involves the lower part of the small intestine, the large intestine, or both and may affect any part of the... read more | Bloody diarrhea, fever, and abdominal pain and cramps Sometimes in people who have had several episodes of bleeding from the rectum | Colonoscopy and biopsy |
* Causes are listed in order from the most common to the least. | ||
† Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. | ||
‡ Although a doctor's examination is always done, it is mentioned in this column only if the diagnosis can sometimes be made by the doctor's examination alone, without any testing. | ||
CT = computed tomography; GI = gastrointestinal. | ||
