Gastroenterology & Nutrition

Upper Gastrointestinal Bleeding

Bleeding above the ligament of Treitz, where the lesion (an acid-eroded artery or a ruptured portal-hypertensive varix) decides which of two entirely different drug pathways the patient needs.

Definition

Bleeding from a source proximal to the ligament of Treitz, presenting as haematemesis, coffee-ground vomiting, melaena or, when very brisk, fresh rectal bleeding.

First principles

The mechanism, not the site, chooses the drugs

Both branches look identical at the bedside, and their drugs do not overlap. A bleeding ulcer needs endoscopic haemostasis followed by high-dose acid suppression, and a proton pump inhibitor (PPI) given before endoscopy does not help. A bleeding varix needs a splanchnic vasoconstrictor and prophylactic antibiotics started at once, and a PPI is useless unless an ulcer coexists. So the first question is whether advanced chronic liver disease is present or plausible.

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This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.