Gastro Intestinal Complications

If you or a loved one is recovering from complications of gastrointestinal (GI) bleeding, GI obstruction, or another GI disorder, it’s critical to have an experienced team of medical professionals to support what can sometimes be a difficult recovery process. At Kindred Hospitals, our goal is to treat GI complications as quickly and completely as possible, so you can transition easily from hospital to home. 

What Causes GI Complications?

The gastrointestinal tract is part of the digestive system, which extracts energy and nutrients from food and helps excrete waste from the body. It includes the esophagus, stomach, small and large intestines, rectum, and anus. GI complications are issues that occur within the GI tract, which can include bleeding, bloating, constipation, diarrhea, heartburn, incontinence, nausea, vomiting, and stomach pain.

When bleeding happens in any part of the GI tract, it is called gastrointestinal bleeding, or a gastrointestinal hemorrhage. A GI bleed can range from mild, with small, non-visible amounts of blood, to severe, with massive bleeding that can lead to shock. The GI bleed itself is not a disease, but it can be a result/sign of a number of different conditions.

Other gastrointestinal complications, including GI obstructions, fecal impactions, and radiation enteritis, are common in cancer patients. They may be caused by procedures, treatments like chemotherapy and radiation, or the disease itself. These complications can be life-threatening and require immediate medical attention. 

Causes and Symptoms of a GI Bleed

GI bleed causes depend on whether the bleed is located in the upper or lower gastrointestinal tract. Upper GI bleed causes include peptic ulcers, gastritis, cancer, esophageal varices (due to cancer or liver cirrhosis), and inflammation of the GI lining caused by ingested materials. An upper GI bleed is the more common scenario, accounting for about two thirds of all GI bleeds. The presence of an upper GI bleed is often indicated by the vomiting of blood, which can be bright red or take on the appearance of coffee grounds.

Lower GI bleeds typically occur in the colon, rectum, or anus and are caused by diverticular disease, gastrointestinal cancers, inflammatory bowel diseases (IBD, Crohn’s disease, ulcerative colitis), infectious diarrhea, angiodysplasia, polyps, hemorrhoids, and anal fissures. Patients with lower GI bleeds might notice blood in their stool, which can sometimes appear black and tar-like, as well as possible abdominal pain. When a person has lost a significant amount of blood from either an upper GI bleed or a lower GI bleed, they will experience fatigue, weakness, pale skin, and shortness of breath.

There are many risk factors associated with upper gastrointestinal hemorrhages. One of the first signs of esophageal or stomach cancer is blood in the vomit or stool, and patients with peptic ulcer disease, gastritis, or esophageal varices (a swelling of the veins in the lower esophagus) are also at risk of hemorrhages. Bleeding esophageal varices are generally a result of cirrhosis — severe scarring of the liver that often develops from excessive alcohol consumption or infections such as hepatitis. Esophageal varices treatments are mostly preventive, but there are some medications and procedures that can control esophageal varices symptoms.

Less serious risk factors for upper GI bleeds include forceful coughing, laughing, lifting, straining, or childbirth (which can result in a Mallory-Weiss tear — a tear in the esophageal or stomach lining). 

Blood in the stool can be an early sign of rectal or colon cancer, but there are many other possible causes of lower GI bleeds as well. People with diverticulitis are at high risk of a lower GI bleed, as are those with inflammatory bowel disease, which often causes the patient’s stool to contain mucous and blood. Infectious diarrhea, caused by viruses or bacteria, can be a risk factor in lower gastrointestinal hemorrhages, as it damages the inner lining of the intestines, which can cause bleeding. Some elderly people, and those with chronic kidney failure, may develop a malformation of the blood vessels in the GI tract. This condition, called angiodysplasia, can also cause a lower GI bleed. People over the age of 40 are at risk for intestinal polyps (non-cancerous tumors of the GI tract), which can result in bleeding that may be rapid or slow. Those who suffer from hemorrhoids (swollen veins in and around the anus) and anal fissures (tears in the anal wall) are also at risk for a lower GI bleed.

In addition, GI bleeds may be connected with increased intestinal permeability, a condition which allows partially digested food, toxins, and other matter to pass through small holes or cracks in the intestinal lining, causing inflammation and leading to problems in the digestive tract. This issue is associated with many gastrointestinal disorders, such as Crohn’s disease, inflammatory bowel disease, and diabetes. Although little research has yet been done into the causes and long-term effects of increased intestinal permeability, it is almost certainly another risk factor for GI dysfunction.

Complications of Gastrointestinal Bleeding

If the source of a GI bleed is not identified and treated, it can lead to serious complications, especially in patients with excessive or prolonged bleeding. Complications of gastrointestinal bleeding include:

• Anemia — Prolonged bleeding can lead to a lack of hemoglobin and red blood cells, causing anemia. Symptoms include chest pain, dizziness, fatigue, weakness, headaches, shortness of breath, and lack of mental clarity
• Hypovolemia — In cases of severe blood loss due to an acute GI bleed, a person’s heart may have difficulty pumping enough blood throughout the body. Signs of this life-threatening condition are cool, clammy skin, confusion, agitation, decreased urine output, weakness, pale skin, quick breathing, and loss of consciousness
• Shock — GI bleeds that come on quickly and progress rapidly can lead to a lack of blood flow to the rest of the body, damaging organs and causing organ failure. Without treatment, shock can worsen, causing irreversible damage or even death. Signs and symptoms of shock include extremely low blood pressure, bluish lips and fingernails, chest pain, confusion, dizziness, anxiety, pale skin, decreased or nonexistent urine output, racing but weak pulse, shallow breathing, and unconsciousness

What Is the Best Path to GI Complications Recovery?

“GI complications can be straightforward, or they can be incredibly complex – having serious and sometimes lasting effects on many different parts of the body,” said Dr. Dean French, Chief Medical Officer. “When a person suffers from serious GI complications, like an acute gastrointestinal hemorrhage that leads to hypovolemia or shock, it’s critical that they seek immediate medical care, and that they have an interdisciplinary care team that can take an integrated approach to treatment and recovery. At Kindred, our goal is always to treat every part of the condition and its symptoms so patients can return to the lifestyle they had before they got sick.”

Kindred Hospitals offer an interdisciplinary team approach to recovery, as well as a broad range of care services to treat GI complications and, in most cases, the underlying cause. Treatment might include medication, lifestyle changes, or procedures such as a blood transfusion, endoscopy, or surgery. Kindred’s team of doctors, nurses, therapists, nutritionists, and specialists are experts in designing individualized and holistic treatment plans that account for all of the ways your condition is affecting you.

Success Spotlight: Matthew’s Story

Matthew suffered from severe liver cirrhosis that led to pneumonia, an upper GI bleed, multiple strokes and kidney and respiratory failure. He was placed on a ventilator to support his lungs and given a feeding tube as he was unable to take anything by mouth. Unfortunately his prognosis was grim and his family was counseled to begin preparing for end-of-life arrangements.

At the hospital, Matthew remained in critical condition until he finally began to show signs of recovery. When he was stabilized, Matthew was transferred to Kindred Hospital and he immediately began to receive ongoing medical treatment for his multiple conditions, including respiratory therapy and rehabilitation. He also needed wound care for pressure ulcers from prolonged bedrest and dialysis due to kidney failure. Matthew’s recovery at Kindred was challenging as he still suffered from an altered mental status and, due to COVID-19 visitation restrictions, was unable to see any family members in person, although frequent contact through electronic media aided his recovery.

After over a month at Kindred, Matthew was finally able to be weaned off the ventilator and his mental faculties rapidly improved. He was then able to have the breathing tube removed and his speech pathologist assisted Matthew to recover his voice and the ability to swallow, enabling him to start to eat and drink a regular diet as his GI condition had also been brought under control. He also made significant progress prior to being discharged with his physical and occupational therapists who helped him get back up to his feet and walking with the aid of a walker as well as getting back the ability to take care of his daily needs.

“It was so nice to finally see Matthew up and awake,” members of his care team shared prior to his discharge. “As he is now able to talk and communicate we have come to discover he has a great sense of humor. It’s wonderful to be able to interact with him and we wish him all the best!”

References:

• “Digestive Disorder Center,” Emedicinehealth, https://www.emedicinehealth.com/gastrointestinal_bleeding/article_em.htm#facts_and_definition_of_gastrointestinal_gi_bleeding
• “Gastrointestinal Disorders,” Cleveland Clinic,
  https://my.clevelandclinic.org/health/articles/7040-gastrointestinal-disorders
• “Everything You Need to Know About Gastrointestinal Bleeding,” Healthline,
  https://www.healthline.com/health/gastrointestinal-bleeding#diagnosis
• “Complications of GI Bleeding,” Livestrong,
  https://www.livestrong.com/article/190741-complications-of-gi-bleeding/
• “Gastrointestinal Complications,” National Cancer Institute,
  https://www.cancer.gov/about-cancer/treatment/side-effects/constipation/gi-complications-pdq
• “Symptoms and Causes of GI Bleeds,” National Institute of Diabetes and Digestive and Kidney Diseases,
  https://www.niddk.nih.gov/health-information/digestive-diseases/gastrointestinal-bleeding/symptoms-causes