In a patient with suspected upper GI bleed who has been stabilized after resuscitation, what is the next step to evaluate the bleed?

In a patient with suspected upper GI bleed who has been stabilized after resuscitation, what is the next step to evaluate the bleed?

• A. Begin immediate exploratory laparotomy
• B. Perform nasogastric tube aspiration to test for upper GI bleed
• C. Obtain CT angiography of the abdomen
• D. Start broad-spectrum antibiotics

Answer: (B)

Placing an upper GI bleed is checked first by obtaining direct evidence from the stomach. After stabilization, the next step is to pass an nasogastric tube and aspirate gastric contents to look for blood or coffee-ground material. Seeing blood confirms an upper GI source and helps guide the plan—typically prompting urgent endoscopy for localization and possible therapeutic intervention. If the aspirate is clear, the bleeding source may be distal or intermittent, but this test still helps differentiate upper GI bleed from other sources and informs subsequent evaluation. Other options aren’t the next move in a stable patient with suspected upper GI bleed: exploratory surgery is overly invasive before confirming the source, CT angiography is reserved for specific scenarios such as ongoing or obscure bleeding when endoscopy isn’t definitive, and antibiotics don’t address the bleed itself.

Placing an upper GI bleed is checked first by obtaining direct evidence from the stomach. After stabilization, the next step is to pass an nasogastric tube and aspirate gastric contents to look for blood or coffee-ground material. Seeing blood confirms an upper GI source and helps guide the plan—typically prompting urgent endoscopy for localization and possible therapeutic intervention. If the aspirate is clear, the bleeding source may be distal or intermittent, but this test still helps differentiate upper GI bleed from other sources and informs subsequent evaluation.

Other options aren’t the next move in a stable patient with suspected upper GI bleed: exploratory surgery is overly invasive before confirming the source, CT angiography is reserved for specific scenarios such as ongoing or obscure bleeding when endoscopy isn’t definitive, and antibiotics don’t address the bleed itself.