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After asking about bowel habits, ask, "Have you observed blood in or on your stools or on the toilet paper?" and then, "Do you sometimes bleed from the rectum without passing stool?" It is important to follow with the direct question, "Have you ever had a black or bloody stool?" A similar sequence to elicit hematemesis might be: "Have you vomited during the past year?" If the answer is yes, ask, "What did it look like?" "Was it bloody?" "Was it brown, or did it look like coffee grounds?"irect questions are the best approach to hematochezia