How does upper gastrointestinal bleeding present?

With haematemesis (fresh blood or 'coffee-grounds'), melaena (black, tarry stool) with or without fresh blood, and sometimes collapse from hypovolaemia. Upper GI bleeding is bleeding from a source proximal to the ligament of Treitz.

Clinical relevance. Recognising haematemesis and melaena identifies upper GI bleeding and prompts urgent assessment.

More Detail

Presentation of upper GI bleeding

Upper gastrointestinal (GI) bleeding arises from a source proximal to the duodenojejunal flexure (ligament of Treitz).

Modes of presentation

• Haematemesis: vomiting blood - fresh red blood (active brisk bleed) or 'coffee-grounds' (altered blood).
• Melaena: black, tarry, offensive stool from digested blood (with or without fresh blood if transit is rapid).
• Collapse: syncope or shock from significant blood loss.

Severity clues

• Fresh haematemesis and haemodynamic instability indicate major bleeding; melaena alone may be a smaller or slower bleed.