Gastrointestinal bleeding (peds): Difference between revisions

(Created page with "== 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? == DDX...")
 
 
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== Background ==
{{Peds top}} [[gastrointestinal bleeding]]
 
==Background==
*4 Questions
*4 Questions
**1. Is this really blood?
**Is this really blood?
**2. Is blood really coming from the GI tract?
**Is blood really coming from the GI tract?
**3. Is it a small or large amount
***Blood in diaper may also be vaginal or urinary source
**4. Has this happened before?
**Is it a small or large amount
 
**Has this happened before?
== DDX ==
 
{| 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
 
|}
 


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


==Differential Diagnosis==
{{Upper GI bleeding peds DDX}}


===Lower GI Bleeding (peds)===
*<2mo
**Swallowed maternal blood
**Milk allergy
**[[Infectious colitis]]
**[[Intussusception]]
**[[Volvulus]]
**[[Meckel diverticulum]]
**[[Necrotizing enterocolitis]]
**[[Vascular malformation]]
**[[Hemorrhagic disease of newborn]]
**[[Hirschsprung disease]]
**[[Congenital duplications]]


== Diagnosis ==
*2mo–2yr
 
**[[Anal fissure]]
== Work-Up ==
**[[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
*>2yr
**[[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==
*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
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**Aspirate after 2-3min
**Aspirate after 2-3min


== Treatment ==
==Management==
*Contingent on underlying etiology
 
==Disposition==


== Disposition ==
==See Also==
{{GI bleeding pages}}


== See Also ==
==External Links==
*[http://pemplaybook.org/podcast/gi-bleeding-in-children/ Pediatric Emergency Playbook Podcast: GI Bleeding in Children]


== Source ==
==Video==
Tintinalli
{{#widget:YouTube|id=RW0qAo4mYks}}


[[Category:WikEM]]
==References==
<references/>
[[Category:GI]]
[[Category:Pediatrics]]
[[Category:Symptoms]]

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