A 52-year-old woman presents with an episode of hematemesis 1 hour ago. Vital signs are within normal limits and she appears well. Which finding is most likely to indicate that this patient needs to be admitted to the hospital for observation?

• A. Self-reported history of melena
• B. Stable vitals
• C. Normal CBC
• D. History of liver disease

Answer: (A)

The main idea here is identifying red flags that push a patient with a suspected upper GI bleed toward hospital observation. A history of melena signals that blood has been entering the GI tract and that there may be an ongoing or recurrent source of bleeding. In a patient who has just had hematemesis, this prior evidence of GI blood loss raises the concern for a significant bleed that could worsen, so inpatient observation is warranted to monitor vitals, repeat labs, and arrange timely endoscopy if needed.

While stable vital signs and a normal CBC are reassuring and suggest lower immediate risk, they don’t override the warning sign that a prior episode of GI bleeding (melena) has occurred. A history of liver disease is also important because it raises risk, but the explicit history of melena more directly indicates a bleeding history that justifies admission for closer monitoring.