Gastrointestinal Bleeding

WHAT YOU SHOULD KNOW:

Gastrointestinal (gas-troh-in-TES-ti-nal) bleeding may happen when you have another disease or condition. Gastrointestinal (GI) bleeding can occur anywhere in your esophagus (e-SOF-ah-gus), stomach, and the large and small intestines (in-TES-tins). It is important to find and treat the cause of your bleeding, even if it stops on its own. The cause of your bleeding may be a minor problem. GI bleeding can also be a sign of a more serious condition.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

Blood loss from a GI bleed may make other health problems (such as heart or breathing problems) worse. Some diseases or conditions that cause GI bleeding may be life threatening. It is important to be checked by a caregiver, even if your bleeding stops on its own. You may die from a GI bleed if you lose too much blood.

WHILE YOU ARE HERE:

Activity:

You may need to rest in bed until your GI bleeding is controlled. Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you ever feel weak or dizzy, sit or lie down right away. Then call your caregiver.

Call button:

You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Tests:

You may need one or more of the following tests. The results of these tests help caregivers plan the best way to treat you.

• Abdominal x-rays: Abdominal x-rays are pictures of the organs inside your abdomen. Caregivers use these pictures to look for problems such as blocked or ruptured intestines, kidney stones, or solid masses (tumors) in your organs.
  
  
• Abdominal ultrasound: This test is done so caregivers can see the tissues and organs of your abdomen. Gel will be put on your abdomen and a small sensor will be moved across your abdomen. The sensor uses sound waves to send pictures of your abdomen to a TV-like screen.
  
  
• Angiography: Angiography (an-jee-OHG-rah-fee) is a test that uses dye in your blood vessels. This makes the blood vessels show up better in x-rays. An angiography may help your caregiver find where you are bleeding. During an angiography, medicine may be given at the site of your bleeding to help it stop.
  
  
• Anoscopy: Anoscopy (ay-NOS-koh-pee) lets caregivers look inside your anus (rear end) and rectum. The anus is the opening where BMs (bowel movements) are passed from your body. The rectum is the last part of the intestine (bowel). A plastic or metal tube is gently pushed into your anus and up into the rectum. Your caregiver can look through the anoscope for a cause of your bleeding. Samples of BM can also be taken and sent to the lab for tests.
  
  
• Barium enema: A barium enema is an x-ray of the colon. A tube is put into your anus, and a liquid called barium is put through the tube. Barium is used so that caregivers can see your colon better on the x-ray film.
  
  
• Blood tests: You may need blood taken for tests. Most blood can be taken from a vein in your hand, arm, or the bend in your elbow. Blood tests can give your caregivers important information about the cause of your condition, and how dangerous it is. You may need to have blood drawn often until your bleeding is under control.
  
  
• Endoscopy: Endoscopy (en-DOS-koh-pee) is a test that uses a scope to see the inside of your digestive tract. A scope is usually made of a long, bendable tube with a light on the end of it. A camera may be hooked to the scope to take pictures during an endoscopy. Samples may be taken from your digestive tract and sent to a lab for tests. During the endoscopy, small tumors may be removed. Bleeding may also be treated during an endoscopy. The type of endoscopy test you need depends on where you may be bleeding. Follow your caregiver's instructions for what to do before, during and after the test. Different types of endoscopy tests include:
  
  
  • Colonoscopy: A colonoscopy (koh-lon-OS-koh-pee) test looks at your large intestine (bowel), or colon. During a colonoscopy, a scope is put through your anus and into your colon.
    
    
  • EGD: This test looks at the lining of your esophagus (ee-SOF-ah-gus), stomach, and duodenum (du-oh-DEE-num). During an EGD, the scope is put in your mouth and into your stomach.
    
    
  • Sigmoidoscopy: A sigmoidoscopy (sig-moi-DOS-kah-pee) test looks at the part of your large intestine called the sigmoid (SIG-moid) colon. During a sigmoidoscopy, a scope is put through your anus into your sigmoid colon.
  
  
• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.
  
  
• Nuclear medicine scan: A special x-ray machine uses a computer to take pictures of the inside of your body. Before taking the pictures, you are given a safe amount of radioactive dye. The dye is given through an IV in your vein. The dye helps bleeding or other problems show up better in the pictures.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Stool sample: A sample of your stool (BM) is tested for bleeding or other problems. A quick test may be done at your bedside to check for blood in the stool. Then the stool sample may be sent to the lab for more tests.
  
  
• Upper GI x-rays: During an upper GI series, an x-ray machine is used to take pictures of your stomach and intestines (bowel). You may be given a chalky liquid to drink before the pictures are taken. This liquid helps your stomach and intestines show up better on the x-rays. An upper GI series can show if you have an ulcer, a blocked intestine, or other problems.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.

Medicines:

There are many medicines that may be given to treat your bleeding, its cause, or your symptoms. Ask your caregivers for more information about any medicines you are given. Some medicines you may receive include:

• Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  
  
• Antinausea medicine: This medicine may be given to calm your stomach and prevent vomiting.
  
  
• Antiulcer medicine: This medicine helps decrease the amount of acid that is normally made by the stomach.
  
  
• Blood pressure medicine: This medicine may be given in an IV to help improve your blood pressure.
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
  
  
  • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
    
    
  • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

Treatment Options:

Your treatment may change if your GI bleeding is not being controlled. This is often decided after you have tests. You may have some of the following treatments alone or together.

• Treatments during endoscopy testing: During an endoscopy, your caregiver may be able to stop certain kinds of bleeding. For example, a medicine may be given at the bleeding site. Heat or an electrical current may be applied to seal off a blood vessel. Other procedures, such as blood vessel banding, may also be used during an endoscopy. Banding uses a small metal or plastic band or clip to close off a bleeding vessel.
  
  
• CVP or central line: A CVP or central line is an IV catheter (KATH-e-ter) or tube. It is put into a large blood vessel near your collarbone, or in your neck or groin. The groin is the area where your abdomen (belly) meets your upper leg. The central line may be used to give medicines, blood, or IV fluids. It may also be hooked up to a monitor to take pressure readings from inside the body.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Blood transfusion: You will get whole or parts of blood through an IV during a transfusion. Blood is tested for diseases, such as hepatitis and HIV, to be sure it is safe.
  
  
• Foley catheter: This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.
  
  
• Nasogastric (NG) tube: A nasogastric (nay-zoh-GAS-trik) tube is a flexible, plastic tube. It is put into your nose and down into your stomach. If this tube is put into your mouth and into your stomach, it is called an OG tube. The tube may be attached to suction (vacuum) to keep your stomach empty. You may need a NG tube if your stomach gets too full. An NG tube can help decrease your nausea (feeling like throwing up) by emptying your stomach. Food or medicine may also be given through the NG tube. Stomach contents may be taken from the NG tube and tested for blood or other problems.
  
  
• Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
  
  
• Surgery: Surgery may be needed to stop your bleeding. The kind of surgery you may need depends on where your bleeding is. If your bleeding is serious, you may need emergency surgery.
  
  
• TIPS procedure: This procedure places a stent in a vein near the liver. A stent is a wire mesh tube that helps keep blood vessels open. A TIPS procedure may help decrease the chance of bleeding in the esophagus (food pipe).

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Gastrointestinal Bleeding (Inpatient Care)