Bleeding from the gastrointestinal tract is a fairly common occurrence and a frequent cause of emergency room visits, according to the textbook "Harrison's Principles of Internal Medicine." Hematemesis is the term used to describe vomiting blood, while hematochezia refers to bleeding from the rectum. The causes of hematemesis are usually distinct from that of hematochezia. When both symptoms occur simultaneously, the cause is most often bleeding from the upper gastrointestinal tract, which includes the esophagus, stomach and upper small intestines.
There are several esophageal conditions that can cause hematemesis, including esophageal varices, tumors, esophagitis and esophageal tears. The medical textbook "Robbin's Pathological Basis of DIsease" states that of these conditions, esophageal varices most likely causes both hematemesis and hematochezia.
Esophageal varices are abnormally enlarged blood vessels in the esophagus. This usually occurs where there is cirrhosis of the liver. These abnormal blood vessels are prone to bleeding and can bleed profusely, resulting in both vomiting blood and bright red blood from the rectum. Urgent medical care is often required to arrest the hemorrhage.
Ulcers, vascular malformations and tumors may all cause both hematemesis and hematochezia. Ulcers are mostly likely to cause massive gastrointestinal bleeding, according to "Sabiston Textbook of Surgery," accounting for up 50 percent of bleeds. This occurs as the ulcer erodes into a blood vessel, resulting in massive bleeding.
The blood from the rectum is usually altered and appears as very dark red or even black. Often this bleeding can be treated via endoscopy, but occasionally this method fails and major surgery is required to save the patient’s life.
Upper Small Intestines Causes
An ulcer in the duodenum, the first part of the small intestines, is usually the culprit behind a massive gastrointestinal bleed from the small intestines. Symptoms and treatment are the same as that of a bleeding ulcer from the stomach.
Vascular malformations may be found throughout the gastrointestinal tract. These malformations are congenital, poorly formed blood vessels with an increased propensity for hemorrhage. These are often difficult to locate endoscopically and usually require surgery to stop the bleeding.
- "Sabiston Textbook of Surgery"; Townsend, C.; et al; 2008
- "Bailey & Love Short Practice of Surgery"; Russel, R.C.G., Williams, N., Bulstrode, C.; 2009