Gastroenterology -Therapeutics & Hepatology

Gastrointestinal Bleeding

Gastrointestinal (GI) bleeding is also referred to as upper, lower, obscure or occult. Upper GI bleeding commonly presents with hematemesis (vomiting of red blood), coffee-ground emesis and/or melena (black, tarry stools). The black colour of melena is the result of degradation of blood by intestinal bacteria. In comparison, the common sign of lower GI bleeding is hematochezia (bright red or maroon-coloured blood per rectum). Due to the overflow of blood through the gut, it can lead to hematochezia. Upper GI bleeding occurs proximal to the ligament of Treitz. Small bowel bleeding occurs from the ligament of Treitz to the distal ileum. Lower GI bleeding occurs from the terminal ileum and colon. Occult bleeding is bleeding that is not apparent to the patient. The quantity of bleeding is small so that the colour of stools is not altered. Patients may present with a positive faecal occult blood test (FOBT) result and/or iron-deficiency anaemia (IDA). Chronic loss of small amounts of blood can eventually lead to significant IDA.