Clinical features

• any haematemesis or melaena before admission and its colour ^c and amount. ^d 
• other illnesses ^a  
  • previous peptic ulcers ^b and any previous peptic ulcer surgery ^b
  • H. pylori infection ^b  
  • alcohol-related disorders ^b  
  • liver cirrhosis, oesophageal varices or portal vein thrombosis ^{a b}
  • renal failure ^a  
  • disseminated malignancy ^a  
  • heart disease and heart failure ^a  
• how long a nasogastric tube has been in-situ ^b  
• current medication, particularly
  • anticoagulants ^a
  • non-steroidal anti-inflammatory drugs (NSAIDs) ^a  

• evidence of acute bleeding ^b
  • supine tachycardia (pulse > 100 beats/minute)
  • supine hypotension (systolic blood pressure < 95 mmHg)
  • postural pulse increase of > 30 beats/min or severe dizziness on sitting upright, then on standing

• evidence of anaemia 
  • conjunctival pallor ^a
  • facial pallor ^b  
  • palmar pallor ^b  
    The more that are present, the greater the chance of anaemia. ^b  
  • dyspnoea  ^c
  
  Do not bother looking for the following - they are little help at diagnosing or excluding anaemia
  • nail bed pallor  ^b  
  • palmar crease pallor  ^b  
  • koilonychia  ^c  

   

• evidence of cirrhosis, specifically ^a  

• facial telangiectasia
• vascular spiders
• abdominal wall veins
• white nails
• fatness
• peripheral oedema

• Perform a rectal examination ^d and a faecal occult blood test. ^a  
• Look at the appearance of any vomit or nasogastric aspirate, and test it using a gastrooccult dipstick ^c