Pediatric GI Bleeding

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Pediatric GI Bleeding Powered By Docstoc
					• Rare, not well documented
• Rectal bleeding 0,3%
• 6-20% from ICU population
• Acuteness or chronicity of bleeding, color and quantity of
  the blood in stool or emesis, antecedent
• Symptoms, history of straining, abdominal pain, or
• Anorectal disorders, fissures, and distal polyps (bright
  red blood)
• Melena (Proximal Treitz,but massive bleeding bright
• Blood mixed in stool or dark red blood (proximal source )
• A history of vomiting, diarrhea, fever, ill contacts, or
  travel (infectious etiology)
• Bloody diarrhea and signs of obstruction suggest
  volvulus, intussusception, or necrotizing enterocolitis,
• Recurrent or forceful vomiting (Mallory-Weiss tears).
• Familial history or NSAID (ulcer disease)
• Signs of shock
• Other hemorrhage
• Abdominal exam (increase bowel sound in
  the upper GI bleeding)
• Abdominal pain (intussuseption, volvulus)
• Signs of portal hypertension.
• Perianal area and DRE
• Child abuse
• Henoch-Schönlein purpura and Peutz-
  Jeghers polyposis.
• Neonates
  – Most common : bacterial enteritis, milk protein
    allergies, intussusception, swallowed maternal
    blood, anal fissures, and lymphonodular
• Infants
  – Most common : GI mucosal lesions and
    irritations, Intussusception Other causes include
    infectious diarrhea, midgut volvulus, Meckel
    diverticulum, arteriovenous malformation, and GI
  – Rare causes include foreign body ingestions,
    variceal disease, irritable bowel disease, and
    acquired thrombocytopenia.
• Children :
  – Duodenal ulcer, Mallory-Weiss tear, and
    nasopharyngeal bleeding, Juvenile polyps
  – Less common causes include gastritis or
    ulcers induced by salicylates or NSAIDs,
    Henoch-Schönlein purpura,caustic ingestions,
    hemolytic uremic syndrome, inflammatory
    bowel disease, and vasculitis.
• Apt-Downey test : differentiate fetal from
  maternal blood
• Plain abdominal X rays
• Contrast studies
• Endoscopy
• Scintigrafi (Tc 99m)
• Plain abdominal X rays
• Arteriography
• I - Active hemorrhage (Ia = bright red
  bleeding, Ib = slow bleeding)
• II - Recent hemorrhage (IIa, = nonbleeding
  visible vessel, IIb = adherent clot on base
  of lesion, IIc = flat
• pigmented spot)
• III - No evidence of bleeding.
• Medical intervention
• Endoscopic intervention
• Surgery :
  – Failure to resuscitate
  – Massive continuous bleeding

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