Doctors usually ask questions that sometimes seem a little strange to patients, and it is normal, because each question has a background that is intended to search for a possible reason for the person's ailment.
In this order of ideas, specific questions can help to make a diagnosis, and to be able to act quickly to avoid complications in the patient. There is a particular disease that with a special question can achieve a good diagnostic impression, and this is the digestive hemorrhage.
It is obvious, of course, that when we see bleeding from the anus or in the form of vomit we are in the presence of bleeding, it is logical, but there is another important detail to consider when this situation arises that can be really emergency, then I will explain it, as usual, in an easy and simple to understand.
I have to say that gastrointestinal bleeding is not in itself a disease, but rather the expression of a disease, i.e. a sign. Because it is usually the result of a lesion in one or more blood vessels (arteries or veins, or both), which is caused by a specific pathology. Having this clear, let's continue.
For the diagnosis of this medical situation a question is usually asked when the relatives take the patient to the emergency room, and express that he/she has been evacuating with blood, the question is: what color is the blood? black, bright reddish?, depending on the answer given one will already have a diagnostic impression regarding the origin of the blood. The reasons for this I will explain below.
Digestive hemorrhages are usually divided into two types:
Upper Digestive Hemorrhage are those that originate in the Stomach, esophagus or duodenum.
Lower Digestive Hemorrhage are those that originate in the large intestine, small intestine, rectum or anus.
Depending on the magnitude of the hemorrhage, it is logical that there will be different symptoms. If the blood loss is great, it could even produce a great hypotension, sweating, loss of consciousness, and even death if not attended in time, but it is not precisely this distinction in the symptomatology that I want to mention or explain, but rather the issue related to the "questions we ask".
As I said above, the color of the stool or the blood that is expelled is definitive in determining the type of hemorrhage that the patient is presenting (high or low). If it is bright red, we are in the presence of a lower gastrointestinal bleeding, and if it is dark it will be an upper gastrointestinal bleeding.
And the reason for this is simple and interesting, and has to do with the fact that depending on the site where the hemorrhage occurs, it will be digested to a greater or lesser extent by its passage through the digestive tract.
As I have mentioned in previous publications, the process of digestion consists of degrading what is in the digestive tract to the point that it can be absorbed, for this the food is mixed first with the enzymes of the saliva, then it passes to the stomach where it comes into contact with stomach acid, then passing to the duodenum, where it comes into contact with pancreatic enzymes and bile.
Once they pass from the duodenum to the small intestine and then to the colon what follows is a process of absorption basically.
This alone explains the reason for the change in stool color and blood in a GI bleed. When it is high, the blood goes through that whole process of digestion and binding with the various enzymes, which will cause it to radically change color, and become very dark, that when it is evacuated the color is almost black and the smell is foul, really the smell is very unpleasant. it is called melena.
But this does not occur when the hemorrhage is low, since it does not go through all that digestion process, therefore, when the person evacuates the feces are mixed with a blood that is bright red, intense, and the odor is not so foul.
In this way, with a simple question we can already have a good notion of the area where the bleeding is being generated.
Evidently, this would only be the beginning of the diagnosis, because later on a series of tests would be performed, not only laboratory tests but also invasive ones, such as a gastroscopy or colonoscopy, which are tests that will be used to absolutely define the origin of the bleeding, and they can also be used for treatment, since certain procedures can be performed through these instruments.
Imaging studies such as CT scans are also used, but the reality is that the best for their accuracy are the invasive ones mentioned above.
As you can see, precise questions are important in order to get a good impression of the cause and to know what is probably happening to the patient. The intention is always to determine the cause to help people as soon as possible, it is the raison d'être of all medical activity, having that in mind we must act under a scientific thinking.
Conclusion
This is just one case, but most patient consultations should be very well guided by structured questions that allow us to obtain the necessary information from patients to finally be able to help, which is the reason why they come or are brought to a hospital center.
