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.