![]() Chronic liver disease due to excessive use of alcohol can also cause bleeding. Several drugs increase the likelihood of bleeding, including nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, and heparin. Past medical history should also inquire about previously diagnosed or undiagnosed GI bleeding, inflammatory bowel disease (IBD), bleeding diatheses, and liver disease. These include presence of abdominal discomfort, weight loss, easy bleeding or bruising, previous colonoscopy results, and symptoms of anemia (weakness, fatigue, dizziness). To evaluate the patient, there are a number of symptoms that need to be reviewed after GI bleeding. Whether blood was passed with initial emesis or only after several nonbloody vomiting episodes could indicate different causes. However, quantity can be difficult to assess because even small amounts (5-10 mL) of rectal bleeding or modest amounts of vomited blood are alarming to a patient. History of present illness should be reviewed to ascertain quantity and frequency of blood passage. Upper endoscopy or colonoscopy are generally considered the best methods to identify the source of bleeding. ![]() The manifestations depend on the location and rate of bleeding, from nearly undetectable to acute and life-threatening. GI bleeding has a variety of causes, and a review of patient medical history and a physical examination can distinguish between the macroscopic and microscopic forms. It differs from internal bleeding, where blood leaks from the blood vessels in such a way that the bleeding cannot be seen outside of the body. Gastrointestinal (GI) bleeding can originate anywhere from the pharynx to the rectum and can be occult or overt.
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