Version June 2024
| History | Diagnostic considerations/implications |
| Characteristics of hematemesis | |
| Sudden onset, massive hematemesis | Vascular bleed (either from varices or arterial bleed). |
| Vomiting preceding hematemesis (usually with small blood) | Mallory-Weiss tear, esophagitis, or gastritis. |
| Characteristics of stool | |
| Melena (black or dark red stools) | Moderate or brisk UGI bleeding (versus lower GI bleed). |
| Hematochezia (bright red blood in stool) | LGI source, or very brisk UGI bleed. Hematochezia is common in infants with UGI bleeding, due to shorter transit time. |
| Accompanying symptoms | |
| Epigastric pain or heartburn | Gastritis, peptic ulcer, or esophagitis (peptic, eosinophilic, or pill esophagitis). |
| Vomiting and feeding intolerance | Many causes, including peptic disease in children and food protein intolerance ("allergy") in infants. |
| Odynophagia (pain with swallowing) | Pill esophagitis, foreign body, infectious esophagitis (eg, Candida, HSV, CMV). |
| Jaundice | Underlying liver disease. |
| Epistaxis (recent or recurrent) | Ingested blood from nasopharynx, or bleeding disorder. |
| Easy bruising or bleeding | Bleeding disorder (refer to below). |
| Underlying disease | |
| Chronic liver disease | Can cause either vascular bleeding (eg, varices, with brisk bleeding) or mucosal bleeding (eg, gastropathy, with slow bleeding or oozing of blood). |
| Bleeding disorder | Many causes; may be congenital (eg, Von Willebrand disease) or acquired (eg, ITP, liver disease, or vitamin K deficiency). |
| Critical illness | Risk factor for peptic gastritis, esophagitis, or ulcer disease. Also consider bleeding from a non-GI source (eg, traumatic NG or ET tube placement). |
| Medications | |
| Tetracyclines (eg, for acne) or NSAIDs, or bisphosphonates | Pill esophagitis, peptic disease (gastritis or ulcers). |
| Beta-adrenergic blockers | May impair hemodynamic response to hypovolemia. |
| Other history | |
| Breastfed infant | Swallowed maternal blood. |
| History of choking episode (including several days or weeks prior to hematemesis) | Esophageal or GI foreign body. |
| Alcohol ingestion (especially binge drinking) | Gastritis, esophagitis. |
| Severe cough, chronic lung disease, or congestive heart disease | Swallowed blood from lungs. |
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