We discussed a case of a man who presented with coffee-ground emesis and melena in the setting of anticoagulation. He was diagnosed with upper GI bleed due to gastric and duodenal ulcers.
We reviewed characteristics that favor UGIB vs LGIB, etiologies of UGIB and LGIB, worrisome features of GI bleeds, and practical skills when managing GI bleeds.
Characteristics that favor UGIB
- Melena (right-sided colonic bleed with slow transit can cause melena), Hematemesis, Coffee-ground emesis
- BUN/Cr > 30
- Hx UGIB
Characteristics that favor LGIB
- Clots per rectum
- Hematochezia (massive UGIB with rapid transit through the GI tract can cause hematochezia)
- Hx of LGIB
- Comorbidities that increase risk of bleed (cirrhosis, hx AAA repair)
- Symptoms: active bleeding, syncope / presyncope, tachycardia as an early sign of worsening bleed
- Normal Hgb with unstable vital signs (drop in Hgb can lag despite severity of bleed)
- Anemia that is unresponsive to transfusions