The first step in diagnosing bleeding in the digestive tract is locating the site of the bleeding. The doctor will take the patient’s complete medical history and perform a physical examination. Symptoms such as changes in bowel habits, black or red stools, and pain or tenderness in the abdomen may tell the doctor which area of the digestive tract is bleeding.
The doctor may need to test the stool for blood. Iron supplements, bismuth subsalicylate (Pepto-Bismol), or certain foods such as beets can give the stool the same appearance as bleeding from the digestive tract. Stool tests can also show bleeding that is not visible to the patient.
A blood test can help determine the extent of the bleeding and whether the patient is anemic.
Nasogastric lavage is a procedure that can be used to determine whether the bleeding is in the upper or lower digestive tract. With nasogastric lavage, a tube is inserted through the nose and into the stomach. The contents of the stomach are removed through the tube. If the stomach contains bile and does not contain blood, the bleeding either has stopped or is likely in the lower digestive tract.
Endoscopy is the most common method for finding the source of bleeding in the digestive tract. An endoscope is a flexible tube with a small camera on the end. The doctor inserts the endoscope through the patient’s mouth to view the esophagus, stomach, and duodenum. This examination is called esophagogastroduodenoscopy (EGD). An endoscope can also be inserted through the rectum to view the colon. This procedure is called colonoscopy. The doctor can use the endoscope to do a biopsy, which involves collecting small samples of tissue for examination with a microscope.
Bleeding that cannot be found with endoscopy is called obscure bleeding. The doctor may repeat the endoscopy or use other procedures to find the cause of obscure bleeding.
Enteroscopy is an examination of the small intestine. Because traditional endoscopes cannot reach the small intestine, special endoscopes are used for enteroscopy.
Enteroscopy procedures include
• Push enteroscopy
A long endoscope is used to examine the upper portion of the small intestine.
• Double-balloon enteroscopy
Balloons are mounted on the endoscope to help the endoscope move through the entire small intestine.
• Capsule endoscopy
The person swallows a capsule containing a tiny camera. The camera transmits images to a video monitor as the capsule passes through the digestive tract. This procedure is designed to examine the small intestine, but it also allows the doctor to examine the rest of the digestive tract.
Several other methods can help locate the source of bleeding:
Barium x rays
Barium is a contrast material that makes the digestive tract visible in an x ray. A liquid containing barium is either swallowed or inserted into the rectum. Barium x rays are less accurate than endoscopy and may interfere with other diagnostic techniques.
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