GI bleeding in Children Flashcards
Classification of GI bleeding
– –
Site/Location of bleeding
________ GI bleeding
________ GI bleeding
Type
________
________ /________
Symptoms/Presentation
________, ________, ________
Upper ; Lower
Overt
Covert /Occult
Haematemesis, Melena, Haematochezia
Aetiology(Upper GI bleeding)
Mucosal bleeds(Non variceal)
-__________ ,
- ___________
-___________
-___________ etc
Variceal
-___________ varices
Others
Vascular malformations
-___________ blood
-Foreign bodies etc
-Gastritis,
-Esophagitis
-PUD
-Mallory Weiss tear
-Esophageal varices
Swallowed blood
ETIOLOGY OF LOWER BLEED
Inflammatory Bowel disease: ____________ , ____________ disease.
Anal and rectal lesions: Juvenile polyps, ____________
Colonic lesions: __________________ , polyps, ____________ etc
____________
Ulcerative Colitis ; Chron’s disease.
Haemorroids
Meckel’s diverticulum ; Colitis
Diverticula
Management of GI bleeding
ABC of resuscitation
Set up _________ and take samples for Full blood count, grouping and crossmatching, E/U,Cr etc at the same time.
Expand intravascular space with parenteral fluid/ blood if there is already significant blood loss(PCV<_____%) or any evidence of haemodynamic instability.
Take quick history at the same time Do a quick physical examination Do a quick risk stratification
IV line
25%
Management of GI bleeding
oQuick _____________
oAggressive _________
oPrompt ____________
identification
resuscitation
consultation
Severe Anaemia is defined as Hb < ??
8g/dl
Variceal grading
Grade 1
Grade 2
Grade 3
Flattened
Not flattened but spaced out
Confluent and not flattened
Forrest classification(Upper GI)
_________ (__ parts)
_________ (__ parts)
_________ (__ parts)
Active bleeding; 2(plusatile, oozing)
Not active but recent;3
Not active, not recent 1(ulcer, no bleeding signs)
The “red wale sign” is an endoscopic finding, specifically a ____________________________ , seen on ____________________________. It’s a sign that the variceal wall is ________ and indicates an increased risk of _________
longitudinal red streak or stripe
esophageal varices.
weakened
bleeding
A ________ nasogastric aspirate may be helpful to predict high risk lesions
A _________ aspirate may predict a low risk lesion
bloody
clear
Summary of treatment
- Management of mucosal bleeds(Non variceal)
- Management of Variceal bleeds
- Use of primary prophylaxis
•- ________ in patients with PUD/esophagitis/Gastritis
• ________________________ , Use of _________ in patients with varices that have not bled before - Use of secondary prophylaxis
PPIs
Endoscopic variceal banding
propanolol
Endoscopic therapy for active bleeding
• _____________
• Heaterproble
• Local injection (polidocanol/glue/adrenalin)
•________
• ________
• Electrocoagulation
• Heaterproble
• Local injection (polidocanol/glue/adrenalin)
•Laser
• Clipping
Primary prophylaxis against Variceal Haemorrhage
Use of ___________ 1-2mg/kg twice a day
– Assess heart rate at every visit
Endoscopic ____________ every 2 -4 wks
– Surveillance EGD 1-3months after initial obliteration, then once every 6-12 months
Propanolol
variceal ligation
Secondary Prophylaxis
Risk of re-bleed in a child with varices is as high as ______% btw _____yrs of initial bleed.
Options:
– Non selective _____________+ isosorbide monohydrate(43% reduction)
–_______________ (32% reduction)
– Combination
– ____________
60; 1-2
beta blocker
Endoscopy Variceal ligation
Portosystemic shunt
Indications of surgery
Uncontrollable bleeding, requiring blood transfusions at the rate of more than _____ ml in ______ hours in order to maintain stable vital signs;
Marked ___________________ while the patient is under treatment in the hospital;
An _____________ gastric ulcer.
__________ of ulcer
500 ml ; six hours
recurrent bleeding
actively bleeding
Perforation
