By Dr Saravana K.
Bleeding from the first part of the small intestine (duodenum)
Duodenal ulcer. An ulcer may bleed, sometimes heavily. Like stomach ulcers, a duodenal ulcer is usually caused by an infection with the bacteria called H. pylori. This can usually be treated quite easily. Anti-inflammatory medicines and aspirin, which are common causes of stomach ulcers, are uncommon causes of duodenal ulcers.
Inflammation of the duodenum lining (duodenitis) has similar causes to duodenal ulcers.
Rare causes from any part of the upper gut
Uncommon infections of the gut.
No cause identified. Even after tests, in some cases the cause cannot be found.
Bleeding which has not come from the gut
Sometimes when blood is vomited, it has not come from the gut. For example, if you have had a nosebleed and then swallowed the blood, you may vomit blood. Also sometimes it can be difficult to tell whether the blood has been vomited up from the gut, or coughed up.
What tests may be needed?
Your doctor is likely to ask various questions about the nature of the bleeding and ask if you have any other symptoms. He or she will also examine you.
The doctor will try to find out if this blood is truly coming from the upper gut. Sometimes it is difficult to be sure. Sometimes it can be difficult to say if the blood is:
Haemoptysis – that is, if the blood is coughed up, not vomited up.
Coming from somewhere in your mouth or nose that tracks to the back of your throat, which you then swallow and vomit back up. For example, from a nosebleed.
The doctor will also try to make a judgement about how much blood you have lost and how serious this is. They will be able to tell this from what you tell them and also by checking your pulse and blood pressure.
If it is clear that the blood is coming from the upper gut, tests are usually done to identify the cause.
Blood tests will usually be done to assess your general situation. For example, how much blood you have lost, and if you need intravenous fluid or a blood transfusion to counter any large amount of blood loss. Also, blood tests may help to assess your liver function if you have ‘scarring’ of the liver (cirrhosis), or to help diagnose or assess other causes of the bleeding.
A gastroscopy (endoscopy) is an internal examination. A thin, flexible telescope is passed down the gullet (oesophagus) into the stomach and to the upper duodenum. The cause of the bleeding can often be identified by endoscopy.