Assessment assess hemodynamic stability NG tube to determine if upper or lower bleed history: acute or chronic, age of child ...
Assessment
- assess hemodynamic stability
- NG tube to determine if upper or lower bleed
- history: acute or chronic, age of child
- associated symptoms, etc...
- management
- volume resuscitation and stabilization
- treat underlying condition
mucosal lesions
- gastritis/gastroenteritis
- esophagitis
- duodenal/gastric ulcer
- Mallory-Weiss tear
- epistaxis, foreign body
vascular
- coagulopathy
- vitamin K deficiency (hemorrhagic disease of the newborn)
- esophageal varices
other : swallowed blood, food colouring
investigations
- CBC, stool OB, NG aspirate: blood, pH, Apt test in newborn
- endoscopy, colonscopy when stable
Treatment
-
underlying cause, may use H2 blockers
Lower GI Bleeding
1. Acute
- Infection
- bacterial, parasitic, antibiotic-induced (C. difficile)
- anatomic
- malrotation/volvulus
- intussusception “red currant jelly" stools
- Meckel's diverticulum
- anal fissures
- vascular/hematologic
- Henoch-Sch-nlein Purpura
- hemolytic-uremic syndrome (E. coli)
- coagulopathy
2. Chronic
- anal fissures most common
- colitis
- inflammatory: IBD
- allergic (milk protein)
- structural
- polyps: most are hamartomas
- neoplasms: rare
- coagulopathy
- 50% of abdominal masses in the newborn are renal in origin
