Upper Gastrointestinal Bleeding: How To Differentiate The Causes

When a patient presents with suspected upper gastrointestinal bleeding, the first step is to determine whether there is actual bleeding occurring. Certain foods and medications can mimic the signs of bleeding. For example, consuming animal blood or taking bismuth-containing medications can cause black, tarry stools. Similarly, eating dragon fruit may lead to the passage or vomiting of red-colored substances, which can be mistaken for blood but are not indicative of true hemorrhage.

Assessing The Presence Of Genuine Bleeding

If bleeding is confirmed, it is crucial to evaluate the patient's recent history, particularly whether they have experienced intense vomiting. Hematemesis following severe vomiting could suggest a Mallory-Weiss tear, which involves a laceration at the junction of the esophagus and stomach. In such cases, the vomit may contain streaks of blood. In more severe cases, significant bleeding may occur, especially in older patients who may have underlying conditions such as cirrhosis or chronic liver disease.

Considering Underlying Liver Conditions

In elderly patients presenting with massive upper gastrointestinal bleeding, it is important to assess for signs of liver disease. Physical indicators such as palmar erythema (liver palms), a dusky complexion, or a history of portal hypertension may point to esophageal varices as the source of bleeding. Ruptured esophageal varices are life-threatening and require prompt diagnosis and treatment.

Understanding The Patient's Medical History

Key Symptoms To Explore

Another important step is to review the patient's medical history for symptoms such as recurrent abdominal pain, frequent heartburn, or nocturnal pain. These symptoms are commonly associated with peptic ulcer disease, which is another frequent cause of upper GI bleeding. A detailed history can help guide the clinician toward the most likely diagnosis and inform the need for further diagnostic testing.

Diagnostic Confirmation Through Endoscopy

If the cause of bleeding remains unclear after initial assessment, emergency endoscopy is a valuable diagnostic tool. This procedure allows direct visualization of the upper gastrointestinal tract and can identify the exact source of bleeding. Whether the bleeding is due to peptic ulcer disease, ruptured esophageal varices, or a rare condition such as Dieulafoy's lesion, endoscopy provides critical insights for appropriate treatment planning.