Helpful Clues for Distinguishing Upper vs. Lower GI Bleeding
Upper GI Bleed (proximal to ligament of Treitz):
• Typically presents with hematemesis and/or melena.
• Can present with hematochezia if the bleeding is very brisk.
• Strong supporting features:
- A "positive" gastric lavage
- BUN/Cr ratio > 30 (using US units)
• Notable risk factors: cirrhosis, alcohol, NSAlDs, H.pylori, hiatal hernia.
Lower GI Bleed (distal to ligament of Treitz):
• Typically presents with hematochezia.
• Can present with melena if source is small intestines or ascending colon
• Strong supporting feature: Blood clots mixed with the stool
• Refuting feature: Hemodynamic instability
- Dr. Eric Strong @DrEricStrong - Strong Medicine https://www.youtube.com/c/EricsMedi
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