Upper and lower gastrointestinal bleeding (hematemesis, hematochezia, melena) and their treatment

1. Big picture

Gastrointestinal bleeding is a surgical emergency until proven otherwise because the patient may die from hemorrhagic shock before the exact diagnosis is known. The first exam answer is never “endoscopy” or “CT”; the first answer is:

ABCDE → resuscitate → localize bleeding → control source

The examiner wants you to know:

• Is the patient stable or unstable?
• Is the bleeding likely upper GI, lower GI, or brisk upper bleeding presenting as hematochezia?
• What is the correct sequence: resuscitation → endoscopy/CT angiography → interventional radiology → surgery?
• When is surgery indicated?

NICE recommends formal risk scoring in acute upp