Gastrointestinal bleeding (peds): Difference between revisions

No edit summary
 
(32 intermediate revisions by 7 users not shown)
Line 1: Line 1:
== 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;" |
==Clinical Features==
:Gastroenteritis
*Blood in stool or vomit
: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;" |
==Differential Diagnosis==
:Gastroenteritis
{{Upper GI bleeding peds DDX}}
: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;"
===Lower GI Bleeding (peds)===
| 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;
*<2mo
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
**Swallowed maternal blood
| 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;
**Milk allergy
| 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;
**[[Infectious colitis]]
| 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;
**[[Intussusception]]
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
**[[Volvulus]]
| 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;" |
**[[Meckel diverticulum]]
:Swallowed maternal blood
**[[Necrotizing enterocolitis]]
:Milk allergy
**[[Vascular malformation]]
:Infectious colitis
**[[Hemorrhagic disease of newborn]]
:Intussusception
**[[Hirschsprung disease]]
:Volvulus
**[[Congenital duplications]]
: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;" |
*2mo–2yr
:Anal fissure
**[[Anal fissure]]
:Gastroenteritis
**[[Anal fissure]]
:Milk allergy
**[[Gastroenteritis]]
:Intussusception
**Milk allergy
:Volvulus
**[[Intussusception]]
:Meckel diverticulum
**[[Volvulus]]
:Hemolytic uremic syndrome
**[[Meckel diverticulum]]
:Henoch-Schönlein purpura
**[[Hemolytic uremic syndrome]]
:Polyps; benign, familial
**[[Henoch-Schönlein purpura]]
:Inflammatory bowel disease
**Polyps; benign, familial
:GI duplication
**[[Inflammatory bowel disease]]
:Dieulafoy lesion
**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]]


| 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;" |
==Evaluation==
: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
 
|}
 
== Diagnosis ==
 
== Work-Up ==
*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 109: Line 68:
**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