Which statement about upper GI bleeding is true?

• A. It can present with tachycardia due to blood loss
• B. It never causes vomiting
• C. It always causes hypotension
• D. It is never associated with melena

Answer: (A)

Tachycardia is a common early response to upper GI bleeding because loss of circulating blood volume triggers the body’s sympathetic response to maintain perfusion. Even when blood pressure is still normal, the heart rate often rises as a compensatory mechanism, so tachycardia can be present with significant bleeding. Vomiting can occur with upper GI bleeding due to hematemesis, so it is not accurate to say vomiting never happens. Hypotension is not always present; once bleeding is rapid or large, hypotension may develop, but it can be absent in milder or slower bleeds. Melena can occur when swallowed blood is digested as it moves through the GI tract, producing dark stools; its absence does not rule out an upper GI source, but it can be seen, so saying it is never associated with melena is incorrect. The key idea is that signs depend on the bleed’s rate and location, with tachycardia often appearing early as perfusion is compromised.