What can help differentiate between an upper and a lower source of bleeding

What can help differentiate between an upper and a lower source of bleeding? 

Characteristics of a UGI source include the following:

  • History includes prior ulcer, chronic liver disease, or use of aspirin or NSAIDs.
  • Symptoms include nausea, vomiting, or hematemesis.
  • Nasogastric (NG) aspirate contains blood or “coffee grounds” material (NG aspirate positive for bile but negative for blood does NOT rule out a UGI source).
  • Serum blood urea nitrogen/creatinine ratio greater than 33 is highly suggestive.
  • Melena indicates a UGI source (can also be seen in LGIB, specifically with colon cancer).

Characteristics of an LGI source include the following:

  • Absence of UGI symptoms or risk factors indicates an LGI source (not always the case; one recent randomized controlled trial showed that the 15% of UGIB presenting as LGIB did not have UGI symptoms).
  • Bright red or maroon blood per rectum indicates an LGI source (although can be seen in brisk UGIB).
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