GI Bleeding Causes, Symptoms and Diagnosis | Approach To Upper and Lower Pediatric GI Bleeding

Summary

This video provides an in-depth analysis of gastrointestinal bleeding in infants and children, covering both upper and lower GI bleeding causes across various age groups. It explains key diagnostic approaches, such as physical examinations and laboratory tests, and discusses common conditions like peptic ulcers, anal fissures, and inflammatory bowel disease. The video also highlights the importance of vital signs, stool examination, and imaging studies in identifying the location and severity of the bleeding. A comprehensive review of treatment options and diagnostic tools ensures a thorough understanding of pediatric GI bleeding management.

Takeaways

• 😀 Common causes of lower gastrointestinal bleeding in newborns and infants include peptic ulcer disease, necrotizing enterocolitis, and anal fissures.
• 😀 In older children, causes of lower gastrointestinal bleeding include juvenile polyps, inflammatory bowel disease, and lymphonodular hyperplasia.
• 😀 Upper gastrointestinal bleeding causes vary by age, with newborns commonly experiencing stress gastritis, vitamin K deficiency, or milk protein sensitivity.
• 😀 Key signs during physical examination include jaundice, skin tags, and signs of coagulopathy like petechiae or purpura.
• 😀 Vital signs such as tachycardia without orthostasis or hypotension can help assess the extent of blood loss during gastrointestinal bleeding.
• 😀 Bright red blood in stools typically indicates distal bleeding, while black, tarry stools suggest proximal bleeding.
• 😀 The most common causes of massive gastrointestinal bleeding in children include esophageal varices, Meckel’s diverticulum, and hemorrhagic gastritis.
• 😀 The easiest method to differentiate upper from lower gastrointestinal bleeding is via nasogastric lavage, which helps identify the bleeding location.
• 😀 False negatives in stool blood tests may occur due to large doses of ascorbic acid or bacterial overgrowth, while false positives can result from recent consumption of red meat or certain vegetables.
• 😀 Initial laboratory workups for GI bleeding in children include a complete blood count, liver profile, stool tests, and imaging to pinpoint the cause of bleeding.

Q & A

What are the common causes of lower gastrointestinal bleeding in newborns and infants?

Common mucosal causes include peptic ulcer disease, necrotizing enterocolitis, infectious colitis, allergic colitis, heat-stroke enterocolitis, or anal fissures. Structural causes may involve intestinal duplication, Meckel's diverticulum, or intussusception.

How do the causes of upper gastrointestinal bleeding differ by age group?

In newborns, common causes of upper GI bleeding include swallowed maternal blood, vitamin K deficiency, stress gastritis, coagulopathy, or milk protein sensitivity. In infants, causes include stress gastritis, acid peptic disease, esophageal viruses, and GI duplication. In children, common causes include Malory-Weiss tears, acid peptic disease, esophageal viruses, vasculitis, tumors, and hemophilia.

What are the signs on physical examination that can help identify an unknown cause of gastrointestinal bleeding?

Signs on physical examination include chronic liver disease (e.g., spider angiomas, jaundice), coagulopathy (e.g., petechiae, purpura), vascular dysplasia (e.g., telangiectasia), and inflammatory bowel disease (e.g., erythema nodosum). Palpable mass or tenderness in the abdomen may suggest inflammatory bowel disease.

What are the vital signs that indicate the extent of volume depletion in acute gastrointestinal bleeding in children?

In acute GI bleeding, tachycardia without orthostasis indicates 5-10% blood loss. Orthostatic changes (increased pulse, decreased blood pressure) suggest >10% blood loss. Hypotension with resting tachycardia indicates 30% blood loss, and non-palpable pulses suggest >40% blood loss.

How can the type of bloody stool help pinpoint the location of gastrointestinal bleeding?

Bright red blood in stool indicates distal bleeding (e.g., anal fissures or juvenile polyps). Melena (black, tarry stools) suggests upper GI bleeding, typically proximal to the ligament of Treitz. Currant jelly stools (dark maroon) usually indicate distal ileum or colon bleeding, often associated with ischemia or intussusception.

What are the seven most common causes of massive gastrointestinal bleeding in children?

The seven most common causes of massive GI bleeding in children are esophageal varices, Meckel's diverticulum, hemorrhagic gastritis, Crohn's disease, peptic ulcers, arteriovenous malformations, and button battery ingestion, particularly in toddlers.

What are the two most common causes of painless rectal bleeding in children?

The two most common causes of painless rectal bleeding in children are juvenile polyps and Meckel's diverticulum.

How can upper gastrointestinal bleeding be differentiated from lower gastrointestinal bleeding?

The simplest method is a nasogastric tube test. If 3-5 mL/kg of normal saline instilled into the stomach aspirates bright red blood or coffee ground material, the bleeding is proximal to the ligament of Treitz. If lavage is negative, it is likely lower GI bleeding.

What can cause false negative or false positive results when testing stool for blood?

False negatives can be caused by large doses of ascorbic acid, delayed transit time, or bacterial overgrowth. False positives may occur due to recent consumption of red meat, or peroxidase-containing vegetables like broccoli or radishes.

What is the initial laboratory workup for GI bleeding in children?

The initial laboratory workup includes a complete blood count, hemoglobin concentration, liver profile, coagulation studies (e.g., PT, PTT), ESR and CRP for inflammatory bowel disease, and stool examination for occult blood or infectious agents. Imaging like upper endoscopy and colonoscopy may be used to confirm sources of bleeding.