Gastrointestinal bleeding (peds)

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)

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

• 2mo–2yr
  • Gastroenteritis
  • Toxic ingestion
  • Mallory-Weiss tear
  • Vascular malformation
  • Esophagitis
  • Stress ulcer
  • Coagulopathy/bleeding diathesis
  • GI duplication
  • Ingested foreign body

• >2yr
  • Gastroenteritis
  • Mallory-Weiss tear
  • Peptic ulcer disease
  • Toxic ingestion
  • Vascular malformation
  • Gastritis
  • Varices
  • Hemobilia
  • Ingested foreign body

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

• 2mo–2yr
  • Anal fissure
  • 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
• 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

See Also

Gastrointestinal Bleeding Pages

• Adults
  • Upper GI bleeding
    • Balloon tamponade for massive GI bleeding
    • Upper GI bleeding guidelines
    • EBQ:Omeprazole in Bleeding Peptic Ulcers
  • Lower GI bleeding
• Pediatrics
  • Gastrointestinal bleeding (peds)

External Links

• Pediatric Emergency Playbook Podcast: GI Bleeding in Children

Video

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