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/EricsMedicalLectures/



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