Gastrointestinal bleeding (peds)

Background

  • 4 Questions
    1. Is this really blood?
    2. Is blood really coming from the GI tract?
    3. Is it a small or large amount
    4. Has this happened before?

Clinical Features

Differential Diagnosis

Upper GI Bleeding

<2 Mo

  • Swallowed maternal blood
  • Stress ulcer
  • Vascular malformation
  • Hemorrhagic disease of newborn (vitamin K deficiency)
  • Coagulopathy/bleeding diathesis

2 Mo–2 Y

  • Gastroenteritis
  • Toxic ingestion
  • Mallory-Weiss tear
  • Vascular malformation
  • Esophagitis
  • Stress ulcer
  • Bleeding diathesis
  • GI duplication
  • Foreign body

>2 Y

  • Gastroenteritis
  • Mallory-Weiss tear
  • Peptic ulcer disease
  • Toxic ingestion
  • Vascular malformation
  • Gastritis
  • Varices
  • Hematobilia
  • Foreign body

Lower GI Bleeding

Upper GI Bleeding
<2 Mo 2 Mo–2 Y >2 Y
Swallowed maternal blood
Stress ulcer
Vascular malformation
Hemorrhagic disease of newborn (vitamin K deficiency)
Coagulopathy/bleeding diathesis
Gastroenteritis
Toxic ingestion
Mallory-Weiss tear
Vascular malformation
Esophagitis
Stress ulcer
Bleeding diathesis
GI duplication
Foreign body
Gastroenteritis
Mallory-Weiss tear
Peptic ulcer disease
Toxic ingestion
Vascular malformation
Gastritis
Varices
Hematobilia
Foreign body
Lower GI Bleeding 
<2 Mo  2 Mo–2 Y  >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
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
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

  • 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

Disposition

See Also

External Links

Video

[[Category:WikEM]]

References