Gastrointestinal bleeding (peds): Difference between revisions
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==Clinical Features==
==Clinical Features==
*Blood in stool or vomit


==Differential Diagnosis==
==Differential Diagnosis==
===Upper GI Bleeding===
{{Upper GI bleeding peds DDX}}
 
===Lower GI Bleeding (peds)===
*<2mo
*<2mo
**Swallowed maternal blood (from chapped nipples)
**Swallowed maternal blood
**[[gastric ulcer disease|Stress ulcer]]
**Milk allergy
**Vascular malformation
**[[Infectious colitis]]
**Hemorrhagic disease of newborn ([[vitamin K deficiency]])
**[[Intussusception]]
**[[Coagulopathy]]/bleeding diathesis
**[[Volvulus]]
**[[Meckel diverticulum]]
**[[Necrotizing enterocolitis]]
**[[Vascular malformation]]
**[[Hemorrhagic disease of newborn]]
**[[Hirschsprung disease]]
**[[Congenital duplications]]


*2mo–2yr
*2mo–2yr
**[[Acute gastroenteritis (peds)|Gastroenteritis]]
**[[Anal fissure]]
**[[Toxic ingestion]]
**[[Anal fissure]]
**[[Mallory-Weiss tear]]
**[[Gastroenteritis]]
**Vascular malformation
**Milk allergy
**[[Esophagitis]]
**[[Intussusception]]
**[[gastric ulcer disease|Stress ulcer]]
**[[Volvulus]]
**[[Coagulopathy]]/bleeding diathesis
**[[Meckel diverticulum]]
**[[Hemolytic uremic syndrome]]
**[[Henoch-Schönlein purpura]]
**Polyps; benign, familial
**[[Inflammatory bowel disease]]
**GI duplication
**GI duplication
**[[Ingested foreign body]]
**Dieulafoy lesion
 
*>2yr
*>2yr
**[[Acute gastroenteritis (peds)|Gastroenteritis]]
**[[Anal fissure]]
**[[Mallory-Weiss tear]]
**[[Anal fissure]]
**[[Gastroenteritis]]
**[[Hemorrhoids]]
**Polyps
**[[Colitis]] (infectious, ischemic)
**[[Meckel diverticulum]]
**[[Intussusception]]
**[[Hemolytic uremic syndrome]]
**[[Henoch-Schönlein purpura]]
**[[Inflammatory bowel disease]]
**Angiodysplasia
**[[Celiac disease]]
**Dieulafoy lesion
**Rectal ulcer syndrome
**[[Peptic ulcer disease]]
**[[Peptic ulcer disease]]
**[[Toxic ingestion]]
**Vascular malformation
**[[Gastritis]]
**[[Varices]]
**Hemobilia
**[[Ingested foreign body]]
===Upper GI Bleeding===
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''<2 Mo'''
| align="center" style="background:#f0f0f0;"|'''2 Mo–2 Y'''
| align="center" style="background:#f0f0f0;"|'''>2 Y'''
|-
| *Swallowed maternal blood||*[[Gastroenteritis]]||*[[Gastroenteritis]]
|-
| *Stress ulcer||*Toxic ingestion||*[[Mallory-Weiss tear]]
|-
| *Vascular malformation||*[[Mallory-Weiss tear]]||*[[Peptic ulcer disease]]
|-
| *Hemorrhagic disease of newborn (vitamin K deficiency)||*[[Vascular malformation]]||*[[Toxic ingestion]]
|-
| *[[Coagulopathy]]/bleeding diathesis||*[[Esophagitis]]||*[[Vascular malformation]]
|-
| ||*Stress ulcer||*[[Gastritis]]
|-
| ||*Bleeding diathesis||*[[Varices]]
|-
| ||*GI duplication||*Hematobilia
|-
| ||*[[Foreign body]]||*[[Foreign body]]
|}
===Lower GI Bleeding===
{| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" width="100%"
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
! valign="top" bgcolor="#ffffff" colspan="3" align="left" rowspan="0" | Upper GI Bleeding
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | <2 Mo
! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | 2 Mo–2 Y
! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | >2 Y
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" |
:Swallowed maternal blood
:Stress ulcer
:Vascular malformation
:Hemorrhagic disease of newborn (vitamin K deficiency)
:[[Coagulopathy]]/bleeding diathesis
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" |
:[[Gastroenteritis]]
:Toxic ingestion
:[[Mallory-Weiss tear]]
:[[Vascular malformation]]
:[[Esophagitis]]
:Stress ulcer
:Bleeding diathesis
:GI duplication
:[[Foreign body]]
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" |
:[[Gastroenteritis]]
:[[Mallory-Weiss tear]]
:[[Peptic ulcer disease]]
:[[Toxic ingestion]]
:[[Vascular malformation]]
:[[Gastritis]]
:[[Varices]]
:Hematobilia
:[[Foreign body]]
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
| valign="top" bgcolor="#ffffff" class="font12" colspan="3" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | '''Lower GI Bleeding'''&nbsp;
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | '''<2 Mo'''&nbsp;
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | '''2 Mo–2 Y'''&nbsp;
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | '''>2 Y'''&nbsp;
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" |
:Swallowed maternal blood
:Milk allergy
:[[Infectious colitis]]
:[[Intussusception]]
:[[Volvulus]]
:[[Meckel diverticulum]]
:[[Necrotizing enterocolitis]]
:[[Vascular malformation]]
:[[Hemorrhagic disease of newborn]]
:[[Hirschsprung disease]]
:[[Congenital duplications]]
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" |
:[[Anal fissure]]
:[[Gastroenteritis]]
:Milk allergy
:[[Intussusception]]
:[[Volvulus]]
:[[Meckel diverticulum]]
:[[Hemolytic uremic syndrome]]
:[[Henoch-Schönlein purpura]]
:Polyps; benign, familial
:[[Inflammatory bowel disease]]
:GI duplication
:Dieulafoy lesion
| valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" |
:[[Anal fissure]]
:[[Gastroenteritis]]
:[[Hemorrhoids]]
:Polyps
:[[Colitis]] (infectious, ischemic)
:[[Meckel diverticulum]]
:[[Intussusception]]
:[[Hemolytic uremic syndrome]]
:[[Henoch-Schönlein purpura]]
:[[Inflammatory bowel disease]]
:Angiodysplasia
:[[Celiac disease]]
:Dieulafoy lesion
:Rectal ulcer syndrome
:[[Peptic ulcer disease]]
|}
===Lower GI Bleeding (peds)===
{| {{table}}
| align="center" style="background:#f0f0f0;"|'''<2 Mo'''
| align="center" style="background:#f0f0f0;"|'''2 Mo–2 Y'''
| align="center" style="background:#f0f0f0;"|'''>2 Y'''
|-
|
*Swallowed maternal blood
*Milk allergy
*[[Infectious colitis]]
*[[Intussusception]]
*[[Volvulus]]
*[[Meckel diverticulum]]
*[[Necrotizing enterocolitis]]
*[[Vascular malformation]]
*[[Hemorrhagic disease of newborn]]
*[[Hirschsprung disease]]
*[[Congenital duplications]]
||
*[[Anal fissure]]
*[[Anal fissure]]
*[[Gastroenteritis]]
*Milk allergy
*[[Intussusception]]
*[[Volvulus]]
*[[Meckel diverticulum]]
*[[Hemolytic uremic syndrome]]
*[[Henoch-Schönlein purpura]]
*Polyps; benign, familial
*[[Inflammatory bowel disease]]
*GI duplication
*Dieulafoy lesion
||
*[[Anal fissure]]
*[[Anal fissure]]
*[[Gastroenteritis]]
*[[Hemorrhoids]]
*Polyps
*[[Colitis]] (infectious, ischemic)
*[[Meckel diverticulum]]
*[[Intussusception]]
*[[Hemolytic uremic syndrome]]
*[[Henoch-Schönlein purpura]]
*[[Inflammatory bowel disease]]
*Angiodysplasia
*[[Celiac disease]]
*Dieulafoy lesion
*Rectal ulcer syndrome
*[[Peptic ulcer disease]]
|}


==Evaluation==
==Evaluation==

Revision as of 23:48, 29 March 2022

This page is for pediatric patients. For adult patients, see: gastrointestinal bleeding

Background

  • 4 Questions
    • Is this really blood?
    • Is blood really coming from the GI tract?
      • Blood in diaper may also be vaginal or urinary source
    • Is it a small or large amount
    • Has this happened before?

Clinical Features

  • Blood in stool or vomit

Differential Diagnosis

Upper GI Bleeding (peds)

Lower GI Bleeding (peds)

Evaluation

  • CBC
  • NG lavage
    • Consider for suspectedsig. GI blood loss
    • Small child: 12F NG tube; instill 50cc saline
    • Older child: 14-16F NG tube; instill 100-200cc saline
    • Aspirate after 2-3min

Management

  • Contingent on underlying etiology

Disposition

See Also

Gastrointestinal Bleeding Pages

External Links

Video

{{#widget:YouTube|id=RW0qAo4mYks}}

References

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