Gastrointestinal bleeding (peds): Difference between revisions

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{{PediatricPage|gastrointestinal bleeding}}
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==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==


{| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" width="100%"
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|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
{{Upper GI bleeding peds DDX}}
! valign="top" bgcolor="#ffffff" colspan="3" align="left" rowspan="0" | Upper GI Bleeding
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|- 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


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:[[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;" |
===Lower GI Bleeding (peds)===
:[[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;"
*<2mo
| 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;
**Swallowed maternal blood
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
**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'''&nbsp;
**[[Special:MyLanguage/Infectious colitis|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 Mo–2 Y'''&nbsp;
**[[Special:MyLanguage/Intussusception|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;" | '''>2 Y'''&nbsp;
**[[Special:MyLanguage/Volvulus|Volvulus]]
|- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
**[[Special:MyLanguage/Meckel diverticulum|Meckel diverticulum]]
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**[[Special:MyLanguage/Necrotizing enterocolitis|Necrotizing enterocolitis]]
:Swallowed maternal blood
**[[Special:MyLanguage/Vascular malformation|Vascular malformation]]
:Milk allergy
**[[Special:MyLanguage/Hemorrhagic disease of newborn|Hemorrhagic disease of newborn]]
:[[Infectious colitis]]
**[[Special:MyLanguage/Hirschsprung disease|Hirschsprung disease]]
:[[Intussusception]]
**[[Special:MyLanguage/Congenital duplications|Congenital duplications]]
:[[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;" |  
*2mo–2yr
:[[Anal fissure]]
**[[Special:MyLanguage/Anal fissure|Anal fissure]]
:[[Gastroenteritis]]
**[[Special:MyLanguage/Anal fissure|Anal fissure]]
:Milk allergy
**[[Special:MyLanguage/Gastroenteritis|Gastroenteritis]]
:[[Intussusception]]
**Milk allergy
:[[Volvulus]]
**[[Special:MyLanguage/Intussusception|Intussusception]]
:[[Meckel diverticulum]]
**[[Special:MyLanguage/Volvulus|Volvulus]]
:[[Hemolytic uremic syndrome]]
**[[Special:MyLanguage/Meckel diverticulum|Meckel diverticulum]]
:[[Henoch-Schönlein purpura]]
**[[Special:MyLanguage/Hemolytic uremic syndrome|Hemolytic uremic syndrome]]
:Polyps; benign, familial
**[[Special:MyLanguage/Henoch-Schönlein purpura|Henoch-Schönlein purpura]]
:[[Inflammatory bowel disease]]
**Polyps; benign, familial
:GI duplication
**[[Special:MyLanguage/Inflammatory bowel disease|Inflammatory bowel disease]]
:Dieulafoy lesion
**GI duplication
**Dieulafoy lesion
*>2yr
**[[Special:MyLanguage/Anal fissure|Anal fissure]]
**[[Special:MyLanguage/Anal fissure|Anal fissure]]
**[[Special:MyLanguage/Gastroenteritis|Gastroenteritis]]
**[[Special:MyLanguage/Hemorrhoids|Hemorrhoids]]
**Polyps
**[[Special:MyLanguage/Colitis|Colitis]] (infectious, ischemic)
**[[Special:MyLanguage/Meckel diverticulum|Meckel diverticulum]]
**[[Special:MyLanguage/Intussusception|Intussusception]]
**[[Special:MyLanguage/Hemolytic uremic syndrome|Hemolytic uremic syndrome]]
**[[Special:MyLanguage/Henoch-Schönlein purpura|Henoch-Schönlein purpura]]
**[[Special:MyLanguage/Inflammatory bowel disease|Inflammatory bowel disease]]
**Angiodysplasia
**[[Special:MyLanguage/Celiac disease|Celiac disease]]
**Dieulafoy lesion
**Rectal ulcer syndrome
**[[Special:MyLanguage/Peptic ulcer disease|Peptic ulcer disease]]


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:[[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
*[[Special:MyLanguage/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
**Older child: 14-16F NG tube; instill 100-200cc saline
**Older child: 14-16F NG tube; instill 100-200cc saline
**Aspirate after 2-3min
**Aspirate after 2-3min


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


==Disposition==
==Disposition==


==See Also==
==See Also==
*[[Gastrointestinal bleeding]]


==Video==
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{{#widget:YouTube|id=RW0qAo4mYks}}
{{GI bleeding pages}}
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==External Links==
 
*[http://pemplaybook.org/podcast/gi-bleeding-in-children/ Pediatric Emergency Playbook Podcast: GI Bleeding in Children]
 


==References==
==References==


<references/>
[[Category:GI]]
[[Category:GI]]
[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Symptoms]]
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Latest revision as of 17:16, 17 January 2026


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


References

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