Bleeding originating proximal to the ligament of Treitz (suspensory muscle of duodenum, inserts into distal duodenum) in the GI tract.

Oesophagus: Ulceration (aspirin, NSAIDs), oesophageal varices, malignancy, 

Mallory-Weiss tear

Gastric: Ulceration, adenocarcinoma, varices, angiodysplasia

Duodenum: Ulceration, varices, malignancy, angiodysplasia

Haematemesis, malaena, shock

Stigmata of liver disease (Variceal bleeding): Jaundice, ascites, spider naevi, caput 

medusae, splenomegaly 

Oesophageal: dysphagia, odynophagia, dyspepsia. 

Gastric Ulcer: abdominal pain, worsens on eating 

Duodenal Ulcer:  abdominal pain, improves on eating 

Bloods: FBC - Anaemia, U&E showing increased urea (protein meal from blood), 

Clotting screen and Group and Save

OGD: Locate source of bleeding

CT Angiography: Locate source of bleeding

Medical: PPI, correct coagulopathy, blood transfusion

OGD: Treat ulcers to stop bleeding

CT Angiography: Embolisation of bleeding vessel

Surgery: If refractory bleeding 

The Rockall score is used to risk stratify mortality and rebleeding risk. The pre- endoscopy score is often used to calculate risks. Score > 3 is a high risk patient.