Vomiting blood, which may resemble coffee grounds Black stools with a foul odor Fresh blood passing through the anus, usually found with stool (this is more likely to indicate lower GI bleeding, but may still be present with upper GI bleeding) Feeling faint and lightheaded, weak Pain in the upper abdomen, just below the ribs Heartburn or indigestion
An abnormally rapid heart rate An abnormally low blood pressure An increased respiratory rate A decreased level of consciousness
The best way to assess the degree of blood loss, if it is uncertain (i. e. assuming you are not in shock or showing other clinical signs of blood loss), is through a blood test. The blood test will check your hemoglobin levels, which is the molecule in your blood that is responsible for carrying oxygen. Low hemoglobin is diagnostic of “anemia,” and the severity of the anemia correlates to the degree of blood lost from the GI bleed.
IV fluids are given in cases of less severe blood loss. They boost your blood volume (the amount of fluid traveling in your circulatory system), but do not directly increase the hemoglobin (or functional oxygen-carrying capacity) of your blood. If your hemoglobin is substantially decreased (i. e. if you have very severe anemia leading to functional compromise of your cardiorespiratory system), you may need a blood transfusion.
This allows for easier identification of the source of the upper GI bleed. It also allows for a clearer view to aid in treatment of the GI bleed (which depends upon having a view to identify the source of the bleed).
An upper GI endoscopy is usually recommended as a diagnostic evaluation within the first 24 hours of the bleed (if possible). An upper GI endoscopy is when a tube with a camera on the end is inserted down your throat, through your esophagus, and ultimately down to your stomach. The purpose is to visually assess (via the camera) for the source of the GI bleeding. Treatments may also be given endoscopically if and when the source of the bleeding is identified.
Mallory-Weiss tears — these are tears in your esophagus, often caused by extreme force such as forceful retching or vomiting leading to rupture of esophageal blood vessels. Esophageal varices — these are delicate blood vessels in the esophagus that may rupture and bleed. Arteriovenous malformations — these are genetic abnormalities of the blood vessels predisposing a person to bleeding in the area of the malformation. Cancer (such as stomach/esophageal/intestinal cancer) — the delicate blood vessels of cancerous growths are highly susceptible to bleeding. Gastritis — this is abnormal inflammation and irritation of the stomach lining, which may lead to blood loss. Duodenitis — this is abnormal inflammation and irritation of the duodenum in the small intestine, which may also lead to blood loss.
Injection of epinephrine Thermocoagulation Banding Application of clips Studies have shown that the combination of an epinephrine injection with another form of treatment for the bleed is the most successful at stopping the bleeding and preventing recurrences.
Blood thinning medications such as Warfarin (Coumadin) or others, which disrupt your natural clotting cascade and hence worsen any existing bleeds. Talk to your doctor about temporarily stopping these medications until your GI bleed is resolved or if you need to stop them permanently. NSAIDs such as Ibuprofen (Advil, Motrin), because in many cases these cause upper GI bleeds. Therefore, if you are taking one regularly, consider stopping it and/or replacing it with a different medication. Aspirin, which interrupts platelet aggregation and hence worsens any existing bleeds. Talk to your doctor about temporarily stopping this medication until your GI bleed is resolved.
