Exams and Tests

A physical examination will be performed by the physician. If necessary, diagnostic tests may be ordered to assist with the diagnosis.

• Physical exam: The focus is on finding the source and extent of bleeding. Priority is to identify significant low blood volume and begin appropriate treatment. This is the most life-threatening situation. The physician will focus on 3 aspects:
  
  
  • Vital signs: Low blood pressure and elevated heart rate will indicate significant loss of blood. High temperature will suggest an infectious source.
    
    
  • Abdominal examination: The physician will search for abdominal distension, discomfort, or tenderness that may suggest a possible bleeding ulcer. A mass the doctor can feel is cause for concern about cancer.
    
    
  • Anal and digital rectal examination: The anus will be inspected for possible external sources of bleeding such as trauma, foreign body, or hemorrhoids. A finger examination is performed to assess tenderness, character of stool, and the presence of masses.

• Diagnostic tests: Depending on the type and severity of bleeding, special tests may be performed to aid in diagnosis.

• Blood tests: Blood samples are taken to assess the extent of blood loss, the clotting ability of blood, and the possibility of infection.

• Nasogastric tube: A flexible tube is passed through the nose into the stomach to check for the presence of active bleeding. This may be a little discomforting initially, but can be a vital diagnostic test.

• Scope examinations:
  
  
  • Anoscopy: A plastic or metal scope placed into the anus allows for quick examination of the rectal vault.
    
    
  • Flexible sigmoidoscopy: A flexible tube inserted into the rectum is used to evaluate the rectum and lower end of the colon.
    
    
  • Colonoscopy: A soft tube equipped with a light and camera is inserted into the rectum and pushed into the colon. The entire colon is visualized. It is used to locate areas of bleeding, masses, or irregularities.

• Barium enema x-ray: This study uses liquid barium inserted into the rectum. An x-ray is taken to highlight problem areas such as tumors or diverticula. However, sites of active bleeding cannot be distinguished.

• Nuclear medicine studies: A tagged red blood cell scan may be used to pinpoint areas of slow bleeding.

• Angiography: A contrast dye study is used to evaluate active areas of brisk bleeding.