Consumer Information

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. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. 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: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

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: An abdominal ultrasound is a test that is done to see inside your abdomen. Sound waves are used to show pictures of your abdomen on 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, electrocardiogram, or telemetry. Sticky pads are placed on your chest or different parts of your body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. Do not remove any wires or sticky pads without asking your caregiver first.
Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.
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 machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
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: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
12-lead ECG: This test, also called an EKG, helps caregivers look for damage or problems in different areas of the heart. Caregivers may need to prepare your skin by shaving off some hair, or cleaning it with a gritty lotion. Sticky pads are placed on your chest, arms, and legs. Each sticky pad has a wire that is hooked to a machine or TV-type screen. A short period of electrical activity in your heart muscle is recorded. Caregivers will look closely for certain problems or changes in how your heart is working. This test takes about 5 to 10 minutes. It is important that you lie as still as possible during the test. You may need this test more than once.

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: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up).
Antiulcer medicine: This medicine helps decrease the amount of acid that the stomach makes. When taken by mouth, it should not be taken at the same time as antacids. This medicine may not work as well when taken at the same time as antacids.
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. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.

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 is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
Blood transfusion: During a blood transfusion, you will get whole blood, or parts of blood through an IV. Many people are worried about getting AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus. If you refuse a blood transfusion, your condition may get worse, and you may die.
Foley catheter: A Foley catheter is a tube that is put into your bladder to drain your urine into a bag. The bladder is an organ where urine is kept. Keep the bag of urine well below your waist. Lifting the urine bag higher will make the urine flow back into your bladder, which can cause an infection. Avoid pulling on the catheter because this may cause pain and bleeding, and the catheter may come out. Do not allow the catheter tubing to kink because this will block the flow of urine.
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 to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.
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).

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.

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