Gastrointestinal bleeding (peds): Difference between revisions

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'''This page is for pediatric patients. For adults, see [[gastrointestinal bleeding]]
==Background==
==Background==
*4 Questions
*4 Questions
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==Differential Diagnosis==
==Differential Diagnosis==
===Upper GI Bleeding===
===Upper GI Bleeding===
'''<2 Mo '''
*<2mo
*Swallowed maternal blood
**Swallowed maternal blood (from chapped nipples)
*Stress ulcer
**Stress ulcer
*Vascular malformation
**Vascular malformation
*Hemorrhagic disease of newborn (vitamin K deficiency)
**Hemorrhagic disease of newborn ([[vitamin K deficiency]])
*Coagulopathy/bleeding diathesis
**[[Coagulopathy]]/bleeding diathesis


'''2 Mo–2 Y'''
*2mo–2yr
*Gastroenteritis
**[[Acute gastroenteritis (peds)|Gastroenteritis]]
*Toxic ingestion
**[[Toxic ingestion]]
*Mallory-Weiss tear
**[[Mallory-Weiss tear]]
*Vascular malformation
**Vascular malformation
*Esophagitis
**[[Esophagitis]]
*Stress ulcer
**Stress ulcer
*Bleeding diathesis
**[[Coagulopathy]]/bleeding diathesis
*GI duplication
**GI duplication
*Foreign body
**[[Ingested foreign body]]


'''>2 Y'''
*>2yr
*Gastroenteritis
**[[Acute gastroenteritis (peds)|Gastroenteritis]]
*Mallory-Weiss tear
**[[Mallory-Weiss tear]]
*Peptic ulcer disease
**[[Peptic ulcer disease]]
*Toxic ingestion
**[[Toxic ingestion]]
*Vascular malformation
**Vascular malformation
*Gastritis
**[[Gastritis]]
*Varices
**[[Varices]]
*Hematobilia
**Hemobilia
*Foreign body
**[[Ingested foreign body]]


===Lower GI Bleeding===
===Lower GI Bleeding===


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Revision as of 00:26, 15 September 2019

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

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

  • <2mo
    • Swallowed maternal blood (from chapped nipples)
    • Stress ulcer
    • Vascular malformation
    • Hemorrhagic disease of newborn (vitamin K deficiency)
    • Coagulopathy/bleeding diathesis

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

References