Case 2 – GI Bleeding

You are seeing Mr. Martin, a 58 year old male, in the ER for a one-week history of dark stools. Take a focused history of his complaint.


  • Onset of symptom
  • Change in bowel habit
  • Appearance of stool – distinguishes melena from bright red blood per rectum
  • Association with bowel movements
  • Tenesmus
  • Incomplete voiding
  • Pain on defecation
  • Abdominal pain
  • Dyspepsia
  • Symptoms of reflux
  • Nausea and vomiting
  • Systemic symptoms, especially weight loss
  • Personal history of constipation and/or hemorrhoids
  • Personal history of gastrointestinal ulcers
  • Country of origin (risk factor for H. Pylori infection)
  • NSAID use
  • Smoking history (quantity in pack-years)
  • Alcohol use
  • Hepatitis status
  • Past colonoscopy and upper endoscopy
  • Family history of gastrointestinal cancers
Case 2 – GI Bleeding