• As much diagnostic information as possible should be obtained before instituting treatment for massive upper gastrointestinal bleeding. A thorough • nesis may reveal previous hemorrhages, or operations, or treatment with a number of drugs that can provoke hemorrhage. Physical examination and laboratory studies are sometimes especially informative. X-ray examination can be done safely within 24 hours after the patient has entered the hospital; it is often decisive. If it is not, and if the bleeding continues, endoscopy is advised. Endoscopy has at times disclosed the source of bleeding when the x-ray findings had been normal.
Brick IB. EARLY DIAGNOSIS IN MASSIVE UPPER GASTROINTESTINAL BLEEDING. JAMA. 1957;163(14):1217–1219. doi:10.1001/jama.1957.02970490015004
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