Upper gastrointestinal bleeding

Global core

Vomiting blood, or black stool from digested blood, is gastrointestinal bleeding until another source is proved. Shock is treated with access, bloods including a sample for the laboratory, and resuscitation. Urgent endoscopy follows the unstable patient. A routine outpatient slot does not. The transfusion threshold and the acid-suppression protocol are local and are not given here as a single number.

What stays the same

• Hematemesis or melaena is bleeding until proven otherwise.
• Shock is treated now. A clinic endoscopy is not the first act.
• The transfusion threshold and the acid-suppression protocol are local.

1. Recognize. Hematemesis, coffee-ground vomit, or melaena, with or without a postural drop.
2. Reason. Pulse and blood pressure say whether he is compensating. Liver disease and anticoagulant use change the risk.
3. Prioritize. A falling pressure outranks a booking form.
4. Act safely. Two points of access if he is shocked, resuscitate, and arrange urgent endoscopy. Do not send him home because the vomiting has paused.

Local adaptation

No sourced local note is attached to this topic. That is not a statement that every country manages it the same way. The shared principle above is what this beta is willing to teach.

Exam lens

The next action in hematemesis: resuscitation and timing of endoscopy, not a clinic letter.