🩸 Upper GI Bleeding · Hematemesis · Varices · Mallory-Weiss · Ulcer

Schwartz Clinical Handbook — Chapter 35 · Hematemesis · Coffee‑ground · Melena · Esophageal varices · Peptic ulcer · Gastritis · Esophagitis

Select emesis appearance (bright red, coffee‑ground), associated retching, epigastric pain, dysphagia, hepatic signs, and medications → differentiate Mallory‑Weiss tear, peptic ulcer/gastritis, esophagitis, esophageal varices, or vascular malformation.
⚠️ Red flags: massive hematemesis, hemodynamic instability, melena, known liver disease → urgent endoscopy, IV PPI, octreotide/vasopressin, blood transfusion.

📋 Step 1 — Bleeding nature & clinical clues
📌 Diagnostic impressions
📖 Schwartz Ch 35

Select emesis color (bright red vs coffee‑ground), forceful retching history, epigastric pain, dysphagia, splenomegaly, NSAID use, and endoscopic clues → differential includes Mallory‑Weiss tear, peptic ulcer disease, gastritis, esophagitis, esophageal varices, or Dieulafoy lesion.

✔️ Mallory‑Weiss: forceful vomiting → linear tear at GE junction.
✔️ Ulcer / gastritis: NSAIDs, H. pylori, epigastric pain.
✔️ Varices: known liver disease, splenomegaly, painless hematemesis.
✔️ Esophagitis: retrosternal burning, dysphagia.
📘 Schwartz pearls (Chapter 35)
• Nasogastric lavage: red blood suggests active bleeding; coffee‑ground suggests slower bleed.
• IV PPI (omeprazole 80mg bolus then 8mg/h) for ulcer bleeding.
• Variceal bleed: octreotide/vasopressin, sclerotherapy/band ligation, balloon tamponade if massive.
• Urgent endoscopy within 12‑24h for high‑risk lesions.