Presentation

History should provide a fairly accurate estimation of the source of upper GI bleeding. Information pertaining to previous episodes of bleeding is of obvious importance. The presence of concurrent diseases such as hepatic disease, alcoholism, peptic ulcer disease, and hematological disorders may provide additional clues. For example, a patient who reports chronic upper abdominal pain and ingestion of large amounts of NSAIDS probably has a gastric ulcer or erosive gastritis.

The manner in which the bleeding presents can provide clues to its source. For example, hematemesis of either bright red blood or "coffee grounds" suggests a bleeding source proximal to the ligament of Treitz. The presence of "coffee grounds" indicates that the hemoglobin has been in contact with gastric acid long enough to be converted to methemoglobin. Hematochezia, the passage of bright red blood per rectum, suggests a distal lower gastrointestinal source of bleeding. Alternatively, massive upper GI hemorrhage can present as hematochezia. Otherwise, upper GI bleeding typically produces melena. This indicates that the blood has been in the GI tract for a longer period of time.

Physical exam may also provide information that can suggest the likely cause of bleeding. Stigmata of portal hypertension (e.g., ascites, jaundice, caput medusa, palmar erythema, etc.) may point to esophageal varices as a likely cause of bleeding. Cachexia, an abdominal mass, and an enlarged Virchow's node may suggest underlying malignancy.

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