Bleeding can vary from overt to occult and acute to chronic. In overt bleeding the blood is obvious to the patient in the form of bright red to maroon to digested black blood otherwise known as “melena”. Patients with overt acute bleeding can quickly become hemodynamically unstable presenting with shock including rapid pulse and drop in blood pressure. Such patients should seek immediate emergency care and call 911.
In some cases the bleeding is so small in volume that it is not apparent to the patient and is only suggested by unexplained anemia. Specific stool tests utilized by Dr. Mantas are able to detect these trace amounts of blood including Guaiac, Hemoccult-II, FIT and HemoQuant Tests. Patient with more occult chronic bleeding often experience chronic symptoms of anemia with fatigue, dizziness, shortness of breath, chest pain, paleness.
Locating the source of bleeding is imperative. A combination of history, physical examination, labs and imaging aid Dr. Mantas in determining the source of your bleed. Imaging techniques include not only CT scans and x-rays but also unique tests like Mesenteric Angiography and Radionucleotide Bleeding Scans.
Once a location is suggested Dr. Mantas will proceed endoscopy or colonoscopy to investigate the upper and lower third of the GI tract, respectively. Occasionally, if a source is not identified in these regions the middle third of the GI tact will need to be investigated with video capsule endoscopy or enteroscopy. In vary rare cases surgical exploratory laparoscopy is needed to identify the source.
Common causes of upper GI bleeds include, in order of decreasing incidence, gastritis and peptic ulcers, hemorrhagic inflammation, varices, Mallory Weiss tears, arteriovenous malformations, angioectasias/dysplasias, Cameron’s erosions, Dieulafoy lesions, Watermelon stomach and portal hypertensive gastropathy. A variety of other rare conditions exist.
Common causes of lower GI Bleeds include, in order of decreasing incidence, hemorrhoids, diverticular disease, angioectasia/dysplasia and hemorrhagic inflammation. A variety of other rare conditions exist.
Imperative in the management of acute bleeding is hemodynamic stabilization and risk stratification. In some instances patients will require iron supplementation and transfusions of blood products to correct impaired coagulation and increase blood counts. Depending on the underlying cause specific medications are also utilized by Dr. Mantas including proton pump inhibitors and hormones.
After localization bleeding is endoscopically managed using a variety of hemostatic techniques including medication injection, thermal therapy, clips and bands. Dr. Mantas is expertly trained in these techniques. In some cases surgical or interventional radiographic procedures are needed to provide hemostasis.
One of the most difficult aspects in GI bleeding is the management of anti-platelets and anti-coagulants used by patients for certain cardiovascular and neurologic conditions. Dr. Mantas will confer with your doctors in managing these medications.