The diagnosis of upper gastrointestinal bleeding is assumed when hematemesis is documented.
In the absence of hematemesis, an upper source for gastrointestinal bleeding is likely in the presence of at least two factors among: black stool, age < 50 years, and blood urea nitrogen/creatinine ratio 30 or more.
 In the absence of these findings, consider a nasogastric aspirate to determine the source of bleeding.
If the aspirate is positive, an upper gastrointestinal bleed is greater than 50%, but not high enough to be certain.
If the aspirate is negative, the source of a gastrointestinal bleed is likely lower.
The accuracy of the aspirate is improved by using the Gastroccult test.
The diagnosis of upper gastrointestinal bleeding is assumed when hematemesis is documented. In the absence of hematemesis, an upper source for gastrointestinal bleeding is likely in the presence of at least two factors among: black stool, age < 50 years, and blood urea nitrogen/creatinine ratio 30 or more.  In the absence of these findings, consider a nasogastric aspirate to determine the source of bleeding. If the aspirate is positive, an upper gastrointestinal bleed is greater than 50%, but not high enough to be certain. If the aspirate is negative, the source of a gastrointestinal bleed is likely lower. The accuracy of the aspirate is improved by using the Gastroccult test.
Upper gastrointestinal bleeding