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.
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
Vital signs:Low blood pressure
and elevated heart rate will indicate significant loss of blood. An elevated
temperature will suggest infection.
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
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.
Anoscopy: A plastic or metal scope placed into the anus allows for quick examination of the rectal vault.
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.
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
contrast dye study is used to evaluate active areas of brisk bleeding.