Bleeding

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Question Received:

A person is losing blood, it shows in urine and stool, a barium swallow X-ray is given, what will it show? Has had two blood transfusions, where could blood loss be coming from?

Answer

A person is losing blood, it shows in urine and stool, a barium swallow X-ray is given, what will it show? Has had two blood transfusions, where could blood loss be coming from?

4th July 2025

There are many conditions that may give rise to bleeding within either the gastrointestinal system or the urinary system, and some of these are listed below. However, it would be unusual for bleeding to occur simultaneously in both systems from a single cause as suggested by the question, unless there was an abnormal linking structure such as a fistula between them.

• Blood loss from the oesophagus

• Inflammation of the oesophagus (oesophagitis)

• Blood loss from leaking varicose veins within the oesophagus (oesophageal varices)

• Tearing within the wall of the oesophagus, usually as a result of ingesting food that contains sharp fragments such as pieces of bone from fish or poultry

• By vomiting

• Tumour formation – either benign or malignant.

Blood loss from the stomach and small intestine

• Peptic ulceration

• Gastritis (inflammation of the gastric mucosa)

• Tumour formation – either benign or malignant

• Drug induced – as a result of the ingestion of certain drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) which includes aspirin.

Blood loss from the large intestine, rectum and anus

• Inflammatory diseases such as diverticulitis and ulcerative colitis

• Polyps of the large intestine, benign or malignant

• Haemorrhoids

Investigations carried out to identify the source of bleeding from the gastrointestinal system include:

• Endoscopic examination, eg: oesophagoscopy, gastroscopy, and colonoscopy. These procedures enable biopsies to be taken whenever necessary and can also be used to control any bleeding

• Barium studies – barium swallow, to investigate oesophageal function; barium meal, for the upper part of the gastrointestinal tract; and barium enema for the large bowel and rectum.

The term used to describe the presence of blood in the stools is melaena.

Blood in the urine (haematuria) can be due to a wide range of conditions and, like bleeding from the gastrointestinal system or any other part of the body, warrants urgent investigation.

• Blood loss in the urine

• Urinary tract infection giving rise to urethritis, cystitis, and pyelonephritis

• Renal calculi (stone formation)

• Neoplastic disease, occurring either within the kidney or bladder

• Carcinoma of the prostate gland in the male

• Injury (trauma) to the thoraco lumbar region

• Severely elevated blood pressure (hypertension)

• Transient haematuria may also occur following a renal biopsy.

Investigations to determine the cause of haematuria:

• Examination of the urine

• Intravenous urography (also called pyelography). This involves the intravenous injection of a radio opaque dye that is excreted by the kidneys. X-ray pictures are taken

• Ultrasound scans

• Computerised axial tomography (CAT scan)

• Endoscopic examination such as cystoscopy, with, if necessary, biopsy.

If a person suffers chronic blood loss, a form of anaemia called iron deficiency anaemia will ensue. Individuals who experience anaemia often complain of fatigue and breathlessness (dyspnoea). In iron deficiency anaemia such people also look pale and may complain of a painful, sore and inflamed tongue (glossitis). Finding the underlying cause of the anaemia will be essential. Meanwhile treatment by increasing the iron intake either through the diet or by giving iron as a supplement is usually carried out. A transfusion of plasma-reduced blood may be necessary if the anaemia needs urgent correction.

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