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?

Differential Diagnosis

Upper GI Bleeding

• <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

Upper GI Bleeding

<2 Mo	2 Mo–2 Y	>2 Y
*Swallowed maternal blood	*Gastroenteritis	*Gastroenteritis
*Stress ulcer	*Toxic ingestion	*Mallory-Weiss tear
*Vascular malformation	*Mallory-Weiss tear	*Peptic ulcer disease
*Hemorrhagic disease of newborn (vitamin K deficiency)	*Vascular malformation	*Toxic ingestion
*Coagulopathy/bleeding diathesis	*Esophagitis	*Vascular malformation
	*Stress ulcer	*Gastritis
	*Bleeding diathesis	*Varices
	*GI duplication	*Hematobilia
	*Foreign body	*Foreign body

Lower GI Bleeding

Upper GI Bleeding
<2 Mo	2 Mo–2 Y	>2 Y
Swallowed maternal blood Stress ulcer Vascular malformation Hemorrhagic disease of newborn (vitamin K deficiency) Coagulopathy/bleeding diathesis	Gastroenteritis Toxic ingestion Mallory-Weiss tear Vascular malformation Esophagitis Stress ulcer Bleeding diathesis GI duplication Foreign body	Gastroenteritis Mallory-Weiss tear Peptic ulcer disease Toxic ingestion Vascular malformation Gastritis Varices Hematobilia Foreign body
Lower GI Bleeding
<2 Mo	2 Mo–2 Y	>2 Y
Swallowed maternal blood Milk allergy Infectious colitis Intussusception Volvulus Meckel diverticulum Necrotizing enterocolitis Vascular malformation Hemorrhagic disease of newborn Hirschsprung disease Congenital duplications	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	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

Lower GI Bleeding (peds)

<2 Mo	2 Mo–2 Y	>2 Y
Swallowed maternal blood Milk allergy Infectious colitis Intussusception Volvulus Meckel diverticulum Necrotizing enterocolitis Vascular malformation Hemorrhagic disease of newborn Hirschsprung disease Congenital duplications	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	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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