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GASTROINTESTINAL HEMORRHAGE

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Assessment

  1. assess hemodynamic stability
  2. NG tube to determine if upper or lower bleed
  3. history: acute or chronic, age of child
    • associated symptoms, etc...
  4. management
    • volume resuscitation and stabilization
    • treat underlying condition
Upper GI Bleeding

mucosal lesions
  1. gastritis/gastroenteritis
  2. esophagitis
  3. duodenal/gastric ulcer
  4. Mallory-Weiss tear
  5. epistaxis, foreign body 

vascular
  1. coagulopathy
  2. vitamin K deficiency (hemorrhagic disease of the newborn)
  3. esophageal varices 

other : swallowed blood, food colouring

investigations
  1. CBC, stool OB, NG aspirate: blood, pH, Apt test in newborn
  2. endoscopy, colonscopy when stable

Treatment


  • underlying cause, may use H2 blockers


Lower GI Bleeding


1. Acute
  1. Infection
    • bacterial, parasitic, antibiotic-induced (C. difficile) 
  2. anatomic
    • malrotation/volvulus
    • intussusception “red currant jelly" stools
    • Meckel's diverticulum
    • anal fissures
  3. vascular/hematologic
    • Henoch-Sch-nlein Purpura
    • hemolytic-uremic syndrome (E. coli)
    • coagulopathy

2. Chronic

  1. anal fissures most common
  2. colitis
    • inflammatory: IBD
    • allergic (milk protein) 
  3. structural
    • polyps: most are hamartomas
    • neoplasms: rare 
  4. coagulopathy
ABDOMINAL MASS




  • 50% of abdominal masses in the newborn are renal in origin
GASTROINTESTINAL HEMORRHAGE GASTROINTESTINAL HEMORRHAGE Reviewed by Radiology Madeeasy on August 27, 2010 Rating: 5
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