Clinical assessment

There are a number of signs and symptoms which may identify a patient having a GI bleed. Identifying the presence of upper GI bleed can range from relatively easy to more challenging. In some instances where haematemesis (present in 50%) or melaena (present in 70%) exists – the diagnosis is easier. It can be more difficult to identify in those patients which present with syncope (or parasyncope), dizziness, haematochezia, hypotension or tachycardia. A high index of suspicion is required for these symptoms. Hypotension (Systolic BP < 90mmHg)– is associated with a increased risk of mortality (odds ratio 9.8).[19]

Patients with haematemesis tend to have more severe bleeds than those with only melaena. [5]

Points to look for in the history

  • Known or suspected liver disease
  • Profuse recent vomiting (suggests Mallory-Weiss tear)
  • Previous peptic ulcer disease or gastritis
  • Known or previous Helicobacter pylori infection
  • Alcohol (not a direct pointer to variceal bleeding – peptic ulcer disease bleeding is still more common within this cohort)

Medication, particularly NSAIDs which increase the risk of UGIB four-fold

Learning Bite

Do a PR early as it may confirm fresh melaena.

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