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Pediatrics > GI Bleeding > Flashcards

GI Bleeding Flashcards

1
Q

Type of bleeding

A
  • Upper: Hematemesis
  • Lower: Melena
  • Rectorrhagia = bright red rectal bleeding
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2
Q

Upper & Melena

A

1- Very little bleed
2- 1st & 2nd part of duodenum but pylor spasm

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3
Q

Infant (29d - 1yr)GI bleed reasons

A

1- Bacterial enteritis
2- Milk protein allergy
3- Intussusception
4- Maternal blood
5- Anal fissure
6- Lymphonodular hyperplasia

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4
Q

Bacterial enteritis

A
  • Bloody diarrhea
  • Shigella, Yersinia, Helicobacter, E. Coli, Salmonella, Amoeba
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5
Q

Milk protein allergy

A

Most common: Bloody stool w/o diarrhea
- Resolves til 1yr
- No complaints (kid) except bloody stool
- Diet milk (if baby formula)

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6
Q

Intussusception

A
  • Different places and names
  • No Peristalsis
  • 3m-3y Idiopathic
  • <3m or >3y needs lead point (polyp, submucosal bleed, intestinal lymphoma)
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7
Q

Intussusception causes _____

A
  • Hyperemia
  • Venous Return problem
  • Blood and fluid goes to intestine
  • Artery obstruction (Very Painful)
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8
Q

Intussusception clinical manifestations

A
  • Sudden crying then calming down then crying again after 1-2h
  • Increasing frequency
  • Telephone
  • Hard stomach
  • Can be touched in RUQ
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9
Q

Maternal Blood

A
  • 1-2h after birth
  • Nipple fissure
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10
Q

Lymphonodular hyperplasia

A

Allergy
- لبنیات، تخم مرغ، مغزیجات، ماهی و دریایی، سویا، کنجد
- In colonoscopy

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11
Q

Children GI bleed reasons

A

1- Bacterial enteritis
2- Anal fissure
3- Colonic polyps
4- Intussusception
5- Peptic disease
6- Swallowed epistaxis
7- Mallory-weiss syndrome

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12
Q

Colonic polyps

A
  • Bleeding & pain
  • Can cause obstruction & intussusception
  • Diagnosis & treatment = colonoscopy, polypectomy
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13
Q

Peptic disease

A

Stomach acid on stomach or duodenum mucous
- Gastric or duodenal + Inflammation, Erosion, Ulcers
- Food related (better or worse)
- Epigastric
Treatment = PPI (-prazole)

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14
Q

Mallory-Weiss syndrome

A
  • Esophagus tear
  • Forceful retching
  • Distal esophagus
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15
Q

Teen GI bleed reasons

A

1- Bacterial enteritis
2- IBD
3- Peptic disease
4- Mallory-weiss
5- Colonic polyps

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16
Q

IBD

A

Ulcerative colitis (1), Crohn’s (2)
Differences
- (1)just large intestine, (2) whole GI
- (1) single ulcer, (2) multiple
- (1) mucus and submucosal layer, (2) all layers so fistula
- (1) goes up from rectum

17
Q

Rare infancy GI bleed reasons

A

1- Volvulus
2- Meckel diverticulum
3- NEC (Necrotizing EnteroColitis)
4- Stress ulcer
5- Coagulation disorders

18
Q

Volvulus

A
  • Intestine twist around itself
  • Sigmoid
  • Bloody stool
19
Q

Meckel diverticulum

A
  • Most common congenital GI anomaly
    2 rule
  • 2% of people
  • 2 foot from ileocecal
  • 2 inch max
  • 2 out-of-place tissues (stomach, pancreas)
  • 2 problems (bleeding, perforation)
  • Onfalomesentrico (in open, out closed)
  • Can mimic appendicitis
  • Has stomach tissue so acid
20
Q

NEC

A
  • Premature, NICU, High calorie, Sepsis
  • Small bleeding ulcers
  • Typic = sepsis + blood from rectum
  • Treatment = Ab + Electrolytes
  • Can cause air in layers
  • Air in portal vein (tree)
21
Q

Stress ulcer

A

Stomach ulcer 0.5-1d after stress

22
Q

Coagulation disorder

A
  • Kids w/ melena & Hematemesis
  • Vit K inj immediately after birth
  • Can be congenital
23
Q

Rare children GI bleed reasons

A

1- Esophageal varices
2- Esophagitis
3- Meckel’s
4- Lymphonodular hyperplasia
5- Henoch-Schönlein purpura
6- Foreign body
7- AVM
8- HUS
9- IBD

24
Q

Henoch-Schönlein purpura

A
  • Vasculitis, Medium vessels
    Involved systems:
  • GI, Skin, Joints, Urinary
    If all 4 involved (Manifestations):
  • Hematemesis, Melena
  • Petechiae, Purpura (can be in GI)
  • Arthralgia, Arthritis
  • Hematuria
25
Q

AVM

A

Tangle of artery, arteriol, venule and vein

26
Q

HUS

A
  • Typically after E. Coli diarrhea
  • E. Coli toxin causes hemolysis then uremia
  • Hematemesis & Melena
27
Q

Esophageal varices

A
  • In end stage liver disease (chronic hep B, C, autoimmune hepatitis)
  • Portal vein hypertension
  • Splenomegaly
  • Retro-peritoneal Varices
  • Anal hemorrhoid
28
Q

Hematemesis approach

A
  • Emergency
  • If we’re sure it’s blood from GI then:
  • Diagnosis
  • Gastric lavage
  • IV & serum
  • Blood cross match
  • Pressure stabilization
  • Endoscopy
  • If nothing: epistaxis, maternal, allergy
29
Q

Melena approach

A

The upper the problem the blacker it gets
- If bloody diarrhea: Colitis
- Colitis: Bacterial, IBD, inflammation
- Colonoscopy
- Meckel’s diverticulum scan
- RBC scan (radioactive) then angiography

30
Q

GI blood supply

A
  • Celiac: Esophagus, stomach, beginning of small intestine
  • Superior mesenteric: Small intestine, beginning of large
  • Middle mesenteric: Transverse colon to end
31
Q

Hematemesis & Melena together approach

A
  • First endoscopy
  • If nothing, Colonoscopy
  • Bright red from beginning: Colonoscopy
  • If nothing, Meckel’s scan
  • If nothing, RBC scan, selective angiography, surgery

Pediatrics (12 decks)

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