Which of the following is a recognized sign of a stress ulcer in a hospitalized patient?

• A. Unexplained shock
• B. Melena for several days
• C. A sudden massive hemorrhage
• D. A gradual drop in the hematocrit value

Answer: (D)

In stress-related mucosal disease, the protecting factors of the stomach lining are overwhelmed by severe physiologic stress, leading to shallow erosions and often occult bleeding. This means the patient may not have obvious signs of bleeding, but there can be a steady loss of blood over time. A gradual drop in hematocrit reflects this ongoing occult blood loss and is a common, recognized cue that a stress ulcer may be bleeding.

In contrast, a sudden massive hemorrhage would show up as an abrupt, dramatic blood loss event and is less characteristic of the typical presentation, while melena for several days could occur but isn’t as consistent a pattern as a gradual hematocrit decline. Unexplained shock is a late or severe consequence and not an early sign of a stress ulcer alone.