Which of the following is a hallmark of upper GI bleeding?

• A. Jaundice
• B. Chest pain
• C. Melena
• D. Abdominal tenderness

Answer: (C)

The main idea is that melena signals an upper GI bleed. When blood comes from the esophagus, stomach, or the proximal small intestine, it travels through the GI tract and is altered by gastric acid and digestive enzymes. The iron in the blood is converted into sulfide compounds, turning the stool dark and tarry and giving it a distinctive odor. That black, tarry stool is a classic sign that the bleed is above the ileocecal valve. Other signs like jaundice, chest pain, or abdominal tenderness aren’t specific indicators of an upper GI bleed, so they don’t serve as the defining hallmark.