Gastrointestinal Bleeding

Gastrointestinal (GI) bleeding may be 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 color of melena is the result of degradation of blood by intestinal bacteria. In comparison, hematochezia (bright red or maroon-colored blood per rectum) is usually a sign of lower GI bleeding. It is important to note that a very brisk upper GI bleed can lead to hematochezia as blood passes rapidly through the gut and is not degraded. 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 color of stools is not altered. Patients may present with a positive fecal occult blood test (FOBT) result and/or iron-deficiency anemia (IDA). Chronic loss of small amounts of blood can eventually lead to significant IDA. 

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