Elderly Patients Upper Gastrointestinal Bleeding Symptoms

Upper gastrointestinal bleeding typically presents with hematemesis and melena. Due to advanced age, elderly individuals generally have a lower tolerance for blood loss compared to younger adults, making them more prone to symptoms such as fainting and shock. The following are the main clinical manifestations of upper gastrointestinal bleeding in the elderly:

Common Symptoms of Upper Gastrointestinal Bleeding

1. Hematemesis and Melena: When the bleeding site is located above the pylorus, patients often experience both vomiting of blood (hematemesis) and black, tarry stools (melena). In contrast, if the bleeding occurs below the pylorus, melena may be the only visible symptom.

Signs of Hypovolemic Shock

2. Circulatory Instability and Shock: If the blood loss is within 400 ml, symptoms may not appear immediately. However, when blood loss exceeds 400 ml, it can lead to anemia or progressive anemia, dizziness, weakness, fainting upon standing, thirst, cold extremities, and low blood pressure. In severe cases, where blood loss reaches 30%-50% of total blood volume, patients may develop hemorrhagic shock. Symptoms of shock include restlessness, altered consciousness, pale skin, cold and clammy limbs, cyanosis of the lips, difficulty breathing, undetectable blood pressure, reduced pulse pressure, and a weak, rapid pulse. Without timely intervention, this condition can be fatal.

Blood and Metabolic Changes

3. Hematologic and Metabolic Responses: Acute blood loss often results in anemia. During the early stages of bleeding, hemoglobin levels, red blood cell count, and hematocrit may remain normal, but signs of anemia typically become apparent after 3–4 hours. Additionally, elevated blood urea nitrogen (BUN) levels, known as azotemia, may occur due to blood absorption in the gastrointestinal tract.

Systemic Reactions

4. Fever: Moderate to severe bleeding often causes fever within 24 hours. The body temperature typically remains below 38.5°C and may persist for several days to a week. This is considered a systemic response to significant blood loss and does not usually require antibiotic treatment.