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Bleeding from the intestinal tract is a common encounter we see in practice at Liver Specialist of Texas.  The bleeding can originate from the upper part of the digestive tract or the lower part.
Generally speaking, upper gastrointestinal bleeding originates from either the esophagus, the stomach, or the duodenum, which is the first segment of the small intestine.  Any damage to the lining of the esophagus, stomach, or duodenum can lead to bleeding.  The bleeding may be obvious where the patient will notice the vomiting of bright red blood or old blood, that is somewhat coagulated, which will appear as old coffee grounds.  The cause of bleeding may be related to peptic ulcers due to an excess of production of acid in the stomach, gastritis, which is the irritation of the lining of the stomach due to medications, alcohol, or medicines such as aspirin or ibuprofen. Esophageal varicies, which are abnormal blood vessels that developed in chronic liver disease and cirrhosis, or esophagitis, which is related to gastroesophageal reflux and excessive acid exposure to the lower part of the esophagus can also lead to bleeding from the upper porting of the digestive tract.

Bleeding that originates from the lower portion of the gastrointestinal tract would predominantly involved the colon, and in some cases, the lower part of the small intestine.  Bleeding from the colon may present itself with bright red blood when someone passes their bowels or in some cases, the bowel movements may have a maroon appearance to them, which is also called hematochezia.  In some cases, bleeding from the lower intestinal tract is not noticed at all and this would be called occult gastrointestinal bleeding. In these cases, patients simply present with anemia.

Causes of bleeding from the lower intestinal tract include hemorrhoids, diverticulosis or diverticulitis, polyps of the colon, or anal fissures.  Additionally, other types of cancer of the colon or intestinal tract may present with bleeding as well as inflammatory bowel disease including Crohn disease and ulcerative colitis.  Infections of the lower intestine may lead to diarrhea and bleeding as well.

Symptoms of gastrointestinal bleeding depend on whether the bleeding is active or slow and chronic.  Due to the anemia and drop in hemoglobin, fatigue, weakness, and shortness of breath are common complaints.  Abdominal pain may also be present as well as a pale appearance to the skin.  The vomiting of blood usually indicates bleeding from the upper gastrointestinal system.  Bright red blood or maroon stool can be noted in lower sources such as the colon.

Whenever gastrointestinal bleeding is suspected, a thorough physical examination and history will be obtained as well as a blood work to determine the hemoglobin level.  Additionally, levels of iron in the blood are to be determined because with chronic bleeding over weeks to months, the iron level may be significantly reduced.

A sample of stool may be obtained to check for blood.  A detailed physical examination will be done to try and localize the source of bleeding.

In most cases, endoscopy will be required.  An upper endoscopy is a test that is performed where a flexible lighted instrument is passed through the mouth into the esophagus examining the esophagus, stomach, and the first portion of the small intestine looking to identify the source of bleeding.  At the time of this upper endoscopy, depending on the source of bleeding, various techniques can be used to control the bleeding.  If necessary, biopsies of the involved area can also be obtained at the time of the procedure.

To evaluate lower sources of bleeding, a colonoscopy will be performed.  This is a similar type of procedure as the upper endoscopy with a slightly longer instrument that will examine the entire length of the colon and the last part of the small intestine.  Similar to the upper endoscopy, there is the opportunity to control the source of bleeding if it is identified, as well as to take biopsies and remove polyps.

For both of these endoscopic procedures, the patient is sedated with what is called conscious sedation.  The patients are put into a relaxed state that allows the procedure to be performed. In most cases, a combination of Demerol and Versed are used.  Not only will the anesthesia relax the patient, but it will also produce a level of amnesia.

Dr. Galati performs the vast majority of his endoscopic procedures at the Texas International Endoscopy Center.

Obesity and Fatty Liver Disease

Obesity, and all of its related complications, is more serious than most adults in America believe. More than one-third (34.9% or 78.6 million) of U.S. adults are obese. Obesity-related conditions include heart disease, stroke, type 2 diabetes, fatty liver disease, and certain types of cancer, are some of the leading causes of preventable death. We are seeing an increase in the number of young children and adolescents developing obesity, and all of the related complications.

The cost of obesity is staggering, with annual medical cost of obesity exceeding $147 billion in 2008 U.S. dollars. The medical costs for people who are obese were $1,429 higher than those of normal weight.

Dr. Galati and the Liver Specialists of Texas team are dedicated to evaluate, treat, and manage all aspects of obesity and non-alcoholic fatty liver disease (NAFLD and NASH), including the complication of cirrhosis and liver failure. Developing a customized plan of care for each patient they see is their objective.

Liver Transplant Resources

Dr. Galati has been involved in Liver Transplantation since 1989. As Medical Director for the Center for Liver Disease and Transplantation at Houston Methodist Hospital, Dr. Galati has cared for thousands of patients with advanced liver disease. In those with the most severe form of advanced liver disease and cirrhosis, liver transplantation is a life-saving surgery. For more information on liver transplantation, click here.

Indications for liver transplant include:

Online LIVER Second Opinion

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    From the comfort of your home, without the need to spend additional money on travel, lodging, and food, receive and expert second opinion from the expert physicians at Liver Specialists of Texas

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    There are five steps in the process of requesting a second opinion. We anticipate the steps will take you about 30-65 minutes to complete.

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    Have your medical records or those of your loved one on hand as you fill out the medical history questionnaire portion of the online process. The medical history questionnaire is detailed so having medical records to quickly reference will help make the process more efficient.

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    To start the process of an Online Liver Second Opinion, please fill out the initial contact form and fax back to our office. A representative from our office will call you for additional details.