Imaging recommendation · Abdomen · Pelvis

Upper GI bleed

CT — CTA Abdomen → IR embolization (iv contrast).

NM — Tc-99m labeled RBC scan (iv contrast).

Recommended: EGD; CTA Abdomen if obscure or unstable is the preferred imaging study for upper gi bleed. Endoscopy is first-line.

Recommended study

EGD; CTA Abdomen if obscure or unstable

CT IV contrast Preferred Abdomen · Pelvis EmergencyAcute inpatient Reviewed 2026-05

Endoscopy is first-line. CTA detects active extravasation (> 0.3 mL/min). Nuclear bleeding scan if intermittent.

EGD non-diagnostic + ongoing bleed

CT CTA Abdomen → IR embolization IV contrast

Slow / intermittent bleeding

NM Tc-99m labeled RBC scan IV contrast

Massive hematemesis with airway compromise

Intubate for airway protection before EGD.

Aortoenteric fistula

Sentinel bleed in a patient with a prior aortic graft — CTA before EGD.

EGD within 24 hours for any significant UGIB; sooner for suspected variceal bleeding.
Forrest classification on EGD guides re-bleed risk and treatment intensity.
BUN:Cr ratio > 30 supports upper GI source over lower in unwitnessed bleeding.