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Medical Author:

Dedra R Tolson, MD

Medical Editor:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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

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 three aspects:

1. Vital signs: Low blood pressure and elevated heart rate will indicate significant loss of blood. An elevated temperature will suggest infection.
2. 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.
3. 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 uncomfortable, 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 large 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.
• CT scan: May be used to diagnose diverticulitis or tumors in the bowel.
• Angiography: A contrast dye study is used to evaluate active areas of brisk bleeding.

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