Gastrointestinal bleeding (peds): Difference between revisions

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{{Peds top}} [[gastrointestinal bleeding]]
==Background==
==Background==
*4 Questions
*4 Questions
*#Is this really blood?
**Is this really blood?
*#Is blood really coming from the GI tract?
**Is blood really coming from the GI tract?
*#Is it a small or large amount
***Blood in diaper may also be vaginal or urinary source
*#Has this happened before?
**Is it a small or large amount
**Has this happened before?


==Clinical Features==
==Clinical Features==
*Blood in stool or vomit


==Differential Diagnosis==
==Differential Diagnosis==
===Upper GI Bleeding===
{{Upper GI bleeding peds DDX}}
'''<2 Mo '''
*Swallowed maternal blood
*Stress ulcer
*Vascular malformation
*Hemorrhagic disease of newborn (vitamin K deficiency)
*Coagulopathy/bleeding diathesis


'''2 Mo–2 Y'''
===Lower GI Bleeding (peds)===
*Gastroenteritis
*<2mo
*Toxic ingestion
**Swallowed maternal blood
*Mallory-Weiss tear
**Milk allergy
*Vascular malformation
**[[Infectious colitis]]
*Esophagitis
**[[Intussusception]]
*Stress ulcer
**[[Volvulus]]
*Bleeding diathesis
**[[Meckel diverticulum]]
*GI duplication
**[[Necrotizing enterocolitis]]
*Foreign body
**[[Vascular malformation]]
**[[Hemorrhagic disease of newborn]]
**[[Hirschsprung disease]]
**[[Congenital duplications]]


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


==Evaluation==
==Evaluation==
*CBC
*CBC
*NG Lavage
*[[NG tube|NG]] lavage
**Consider for ''suspected''sig. GI blood loss
**Consider for ''suspected''sig. GI blood loss
**Small child: 12F NG tube; instill 50cc saline
**Small child: 12F NG tube; instill 50cc saline
Line 142: Line 69:


==Management==
==Management==
*Contingent on underlying etiology


==Disposition==
==Disposition==


==See Also==
==See Also==
*[[Gastrointestinal bleeding]]
{{GI bleeding pages}}


==External Links==
==External Links==

Latest 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

References