PRESENTATION

  1. Hematemesis: Vomiting of blood or altered blood (“coffee grounds”) indicates bleeding proximal to ligament of Treitz.
  2. Melena: Altered (black) blood per rectum (>100-mL blood required for one melenic stool) usually indicates bleeding proximal to ligament of Treitz but may be as distal as ascending colon; pseudomelena may be caused by ingestion of iron, bismuth, licorice, beets, blueberries, and charcoal.
  3. Hematochezia: Bright red or maroon rectal bleeding usually implies bleeding beyond ligament of Treitz but may be due to rapid upper GI bleeding (>1000 mL).
  4. Positive fecal occult blood test with or without iron deficiency.
  5. Symptoms of blood loss: e.g., light-headedness or shortness of breath.

There's more to see -- the rest of this topic is available only to subscribers.