Blood in Stool: Causes and Necessary Tests for Seniors

Hematemesis

Dear Dr.
Chen,
My grandfather is 90 years old.
Two months ago, he experienced gastrointestinal issues that led to vomiting and subsequently developed aspiration pneumonia, which put him in a critical condition.
He was hospitalized in the intensive care unit for a week and stayed in the hospital for a month before being discharged.
After discharge, he was fed via a nasogastric tube, but his appetite has been poor, and he has vomited once or twice, complaining of abdominal distension and inability to eat.
The presence of the nasogastric tube has also caused persistent sputum production, which recently led to esophageal bleeding, resulting in another emergency hospitalization.

Upon admission, aspiration pneumonia recurred.
The esophageal bleeding has been controlled, and an endoscopy confirmed that the esophageal ulcer has improved and there is no gastric bleeding.
However, he has had dark, tarry stools for nearly two weeks, which have also been sticky during the discharge period.
I am concerned that there may be issues with the intestines or other organs.
I believe the cause of the initial vomiting that led to aspiration pneumonia has not been identified.
I would like to ask what kind of examinations we should pursue.
Thank you.

Yang, 30~39 year old female. Ask Date: 2009/01/09

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, it is recommended to check for any obstructions and sources of bleeding in the colon and even the small intestine.
If none are found, factors such as advanced age, poor gastrointestinal function, being bedridden, and difficulty with bowel movements may contribute to gastrointestinal bloating and decreased motility.
This can lead to the regurgitation of gastric contents, which may result in aspiration pneumonia, and this condition can recur.
Wishing you good health.
Sincerely, Dr.
Chi-Feng Chen, Taoyuan Hospital, Department of Health.

Reply Date: 2009/01/09

More Info

Understanding blood in stool, especially in elderly patients, is crucial as it can indicate various underlying health issues. In your grandfather's case, given his complex medical history, it is essential to approach this situation with a thorough understanding of potential causes and necessary diagnostic tests.

Firstly, the presence of dark, tarry stools (melena) typically suggests that there is bleeding occurring from the upper gastrointestinal (GI) tract, such as the esophagus, stomach, or duodenum. This could be related to his previous esophageal ulcer, which, although it has reportedly improved, may still be a contributing factor. Additionally, the use of a nasogastric tube can sometimes lead to irritation or injury to the esophagus, potentially causing bleeding.

Given your grandfather's age and medical history, including aspiration pneumonia and the recent episodes of vomiting, it is also important to consider other potential causes of gastrointestinal bleeding. These may include:
1. Peptic Ulcer Disease: Even if the esophageal ulcer has healed, he could still have gastric or duodenal ulcers that may not have been detected yet.

2. Gastrointestinal Tumors: Malignancies in the GI tract can lead to bleeding, and given the age factor, this is a consideration that should not be overlooked.

3. Diverticular Disease: Diverticulosis can lead to diverticulitis, which may cause bleeding, particularly in older adults.

4. Hemorrhoids or Anal Fissures: While these typically cause bright red blood, they can also lead to darker stools if there is significant bleeding.

5. Medications: If your grandfather is on anticoagulants or non-steroidal anti-inflammatory drugs (NSAIDs), these could contribute to gastrointestinal bleeding.

To investigate the cause of the blood in the stool, the following diagnostic tests may be recommended:
1. Upper Endoscopy (EGD): This procedure allows direct visualization of the esophagus, stomach, and duodenum to identify any sources of bleeding, such as ulcers or tumors.

2. Colonoscopy: This test examines the lower GI tract and can help identify issues such as diverticulosis, polyps, or colorectal cancer.

3. CT Scan of the Abdomen: A CT scan can provide detailed images of the abdominal organs and help identify any masses, inflammation, or other abnormalities.

4. Stool Tests: Testing the stool for occult blood can help confirm the presence of bleeding. Additionally, checking for pathogens or signs of infection may be warranted.

5. Blood Tests: Complete blood count (CBC) can help assess for anemia due to blood loss, and liver function tests can evaluate for any liver-related issues that might contribute to bleeding.

Given your grandfather's recent health challenges, it is essential to work closely with his healthcare team to determine the most appropriate tests and interventions. Early identification and management of the underlying cause of gastrointestinal bleeding can significantly improve outcomes and quality of life.

In summary, the presence of blood in stool, especially in an elderly patient with a complex medical history, warrants a comprehensive evaluation. The combination of endoscopic procedures, imaging studies, and laboratory tests will provide a clearer picture of the underlying issues and guide appropriate treatment. It is crucial to remain vigilant and proactive in addressing these symptoms to ensure your grandfather receives the best possible care.

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