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This ligament is an important anatomical landmark of

the duodenojejunal flexure, separating the upper and


lower gastrointestinal tracts. For example, bloody
vomit or melena, black tarry stools, usually indicate a
gastrointestinal bleed from a location in the upper
gastrointestinal tract. In contrast, hematochezia,
bright red blood or clots in the stool, usually indicates
gastrointestinal bleeding from the lower part of the
gastrointestinal tract.[6] It is an especially important
landmark to note when looking at the bowel for the presence of malrotation of the gut, a
syndrome often suspected in young children when they have episodes of recurrent vomiting.
Visualising a normal location of the ligament of Treitz in radiological images is critical in ruling
out malrotation of the gut in a child; it is abnormally located when malrotation is present.
Upper gastrointestinal bleeding (UGIB) is defined as bleeding derived from a source proximal to
the ligament of Treitz. [5]
Peptic ulcer disease (PUD) remains the most common cause of UGIB. In cases of ulcer-
associated UGIB, as the ulcer burrows deeper into the gastroduodenal mucosa, the process
causes weakening and necrosis of the arterial wall, leading to the development of a
pseudoaneurysm. The weakened wall ruptures, producing hemorrhage.

Vomiting-related UGIB
During vomiting, the lower esophagus and upper stomach are forcibly inverted. Vomiting
attributable to any cause can lead to a mucosal tear of the lower esophagus or upper stomach.
The depth of the tear determines the severity of the bleeding. Rarely, vomiting can result in
esophageal rupture (Boerhaave syndrome), leading to bleeding, mediastinal air entry, left
pleural effusion (salivary amylase can be present) or left pulmonary infiltrate, and subcutaneous
emphysema.

Hypovolemia is a decrease in the volume of blood in your body, which can be due to blood loss
or loss of body fluids. Blood loss can result from external injuries, internal bleeding, or certain
obstetric emergencies. Diarrhea and vomiting are common causes of body fluid loss. Fluid can
also be lost as a result of large burns, excessive perspiration, or diuretics. Inadequate fluid
intake can also cause hypovolemia.
At the onset of hypovolemia, the mouth, nose, and other mucous membranes dry out, the skin
loses its elasticity, and urine output decreases. Initially, the body compensates for the volume
loss by increasing the heart rate, increasing the strength of heart contractions, and constricting
blood vessels in the periphery while preserving blood flow to the brain, heart and kidneys. With
continuing volume loss, the body loses its ability to compensate and blood pressure drops. At
this point, the heart is unable to pump enough blood to vital organs to meet their needs and
tissue damage is likely to occur.
Hypovolemic shock occurs when a fifth of the blood volume is lost. Symptoms may include cold,
clammy skin, paleness, rapid breathing and heart rate, weakness, decreased or absent urine
output, sweating, anxiety, confusion, and unconsciousness. Hypovolemic shock is a medical
emergency requiring immediate intervention.
Common initial symptoms of hypovolemia include:
Decreased urine output
Dry mucous membranes, such as the mouth and nose
Loss of skin elasticity
Thirst

Causes of hypovolemia
A number of conditions may cause hypovolemia, many of which are serious conditions.
Examples include:
Decreased blood clotting ability
Diarrhea or vomiting
Excessive sweating (which can result from heat exposure)
Extremes of age (infants and the elderly may be unable to take fluids)
Kidney diseases resulting in increased urination
Placenta previa (placental tissue on top of the cervix) or abruption (early detachment of
the placenta)
Use of diuretics