Version July 2025
| Physical examination | Diagnostic considerations/implications |
| Rapid assessment | |
| Tachycardia, hypotension or orthostasis, poor capillary refill, cold extremities, altered sensorium | Shock (eg, due to massive gastrointestinal blood loss) |
| Skin and mucus membranes | |
| Pallor | Anemia (eg, due to substantial blood loss) |
| Bruising, petechiae | Bleeding disorder (eg, immune thrombocytopenia), physical abuse, trauma |
| Vascular malformations (eg, telangiectasias, hemangiomas) | Disorders with generalized vascular malformations (eg, hereditary hemorrhagic telangiectasia) |
| Mucocutaneous pigmentations* | Peutz-Jeghers syndrome (with intestinal polyposis) |
| Nasopharynx | |
| Blood or injury to the nares | Epistaxis with swallowed blood |
| Pharyngeal bleeding or injury | Posterior nasopharyngeal bleeding with swallowed blood |
| Abdomen | |
| Hepatomegaly, hard liver edge, and/or splenomegaly | Portal hypertension (eg, from cirrhosis, portal vein thrombosis, or Budd-Chiari syndrome) |
LGIB: lower gastrointestinal bleeding; PE: physical examination; UGIB: upper gastrointestinal bleeding.
* Mucocutaneous pigmentations (melanin spots) are present in more than 95% of people with Peutz-Jeghers syndrome. They occur most commonly on the lips and perioral region, palms of the hands, buccal mucosa, and soles of the feet. Peutz-Jeghers syndrome is associated with gastrointestinal polyps, which can cause LGIB (but probably not UGIB).
