Hematemesis
Coffee-ground emesis
Vomiting + retching followed by hematemesis is more likely Mallory-Weiss (esophageal)
Melena
Syncope or presyncope
Dyspepsia, epigastric pain or heartburn
Coffee-ground emesis
Tachycardia, hypotension
Normal vital signs do not preclude the possibility of a severe bleed
Altered mental status -> poor cerebral perfusion
Pallor
In the stable patient may indicate the anemia of a subacute/chronic bleed, in the unstable patient may indicate poor perfusion and massive blood loss
Liver disease
Spider angiomata, palmar erythema, jaundice, gynecomastia, hepatomegaly, ascites
Coagulopathy
Petechiae/purpura
ENT exam
Swallowed blood may result in coffee-ground emesis or melena
Rectal exam
Only 20% of patients with a positive fecal occult have an identified<unk>  GI bleed.
Normal vital signs do not preclude the possibility of a severe bleed
In the stable patient may indicate the anemia of a subacute/chronic bleed, in the unstable patient may indicate poor perfusion and massive blood loss
Spider angiomata, palmar erythema, jaundice, gynecomastia, hepatomegaly, ascites
Petechiae/purpura
Swallowed blood may result in coffee-ground emesis or melena
Only 20% of patients with a positive fecal occult have an identified<unk>  GI bleed.
Undifferentiated upper gastrointestinal bleeding
Peptic ulcer disease 
Lower gastrointestinal bleeding
Gastritis/esophagitis
Acute gastric dilatation
Gastric/esophageal varices
Splenic infarction
Mallory-Weiss tear