Gastrointestinal Bleed (Part 1)

By Dr Saravana K.

Your gut is the tube that starts at your mouth, and ends at your bottom (anus).

The upper gut includes the gullet (oesophagus), stomach and first part of the small intestine (duodenum). Food passes down the oesophagus into the stomach. The stomach makes acid which is not essential but helps to digest food. After being mixed in the stomach, food passes into the duodenum, to be digested.

Some types of bleeding from the upper gut

The type of bleeding is sometimes described as follows:

Dark blood. This is often referred to as a ‘coffee ground’ colour. This suggests that the bleed has been relatively slow. The blood has been in contact with stomach acid long enough for the acid to turn the blood a dark brown/red colour. The bleeding in this situation may not yet have been heavy. However, it may become heavy at a later time.

A large amount of bright red blood suggests a rapid and large bleed.

Melaena is the medical word for old, dark blood in poo (stools/faeces). If you have melaena, your stools become very dark or black. There is often a tar-like consistency. Vomiting blood and having melaena are symptoms that often go together. Having both symptoms together means that you have had a lot of bleeding into the gut.

Other symptoms may occur at the same time as vomiting blood. For example, tummy pain, fever, or other gut symptoms. If you lose a lot of blood, it can make you feel dizzy or even pass out. The presence and type of other symptoms may help to point to a cause of the bleeding. Sometimes there are no other symptoms at first.

What are the causes of vomiting blood?

There are many possible causes. Below is a brief overview of the more common and important causes:

From the oesophagus

  • Oesophageal varices. Varices are enlarged, swollen blood vessels in the lining of the gullet or stomach. They are one of the possible complications of liver cirrhosis. In cirrhosis, scarred liver tissue blocks blood flow through the liver. This causes an increase in pressure in the vein that takes blood from the gut to the liver (the portal vein). The increased pressure pushes back into the gut and causes the veins to swell in the gullet. The swellings are quite fragile and may bleed heavily into the gullet.
  • Inflammation of the oesophagus (oesophagitis) is often due to acid reflux from the stomach. The inflamed oesophagus sometimes bleeds.
  • Oesophageal cancer sometimes causes bleeding into the oesophagus.
  • Mallory-Weiss syndrome is bleeding caused by a tear in the lining of the oesophagus or stomach. The tear can be caused by anything that leads to a sudden rise in pressure in the stomach or the oesophagus. For example, repeated retching or vomiting, excessive straining, violent coughing or hiccupping.

From the stomach

  • Stomach ulcer. An ulcer is a small hole in the lining of the stomach. An ulcer may bleed, sometimes heavily. There are several causes of stomach ulcers, including:
  • Infection with Helicobacter Pylori
  • Anti-inflammatory medicines, Aspirin
  • Stress.
  • Stomach cancer
  • Inflammation of the stomach lining (gastritis) has similar causes to stomach ulcers.
  • Varices in the lining of the stomach may occur similar to oesophageal varices described above.

Mallory-Weiss syndrome may affect the lining of the stomach.

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