Intestinal bleeding in children Flashcards
Name the common causes of UGIB in neonates
Haemorrhagic disease of the newborn
Swallowed maternal blood
Stress gastritis
Name the common causes of LGIB in neonates
Necrotizing enterocolitis
Anal fissure
Malrotation with volvulus
Name the common causes of UGIB in infants <1y
Esophagitis
Stress gastritis
Name the common causes of LGIB in infants <1y
Anal fissure
Intussusception
Milk protein allergy
Name the common causes of UGIB in infants 1-2y
PUD
Gastritis
Name the common causes of LGIB in infants 1-2y
Polyps
Meckel diverticulum
Name the common causes of UGIB in children >2y
Oesophageal varices
PUD
Name relevant history in intestinal bleeding in children
Vomiting, diarrhea, fever NSAIDs, caustic substances Pain Jaundice, pale stools Antibiotics Iron Beetroot
What should you look for on physical examination?
Signs of shock Other sources of bleeding Abdominal scars Bowel sounds Abdominal tenderness Liver pathology Anal inspection Rectal examination
Discuss resus of children with intestinal bleeding
NGT on free drainage
IV RL 20ml/kg
Somatostatin analogue
How do you test for swallowed maternal blood?
Alkali denaturation test (APT)
Name causes of stress gastritis
Stressful delivery
Resus post-birth
Prematurity
Mechanical ventilation
Name clinical features of necrotizing enterocolitis
Sudden feeding intolerance Abdominal distension Bilious vomiting Abdominal wall erythema Blood PR Severe sepsis
Discuss the management of necrotizing enterocolitis
NPO NGT Antibiotics TPN Surgery
Discuss the management of anal fissures
Local anesthetic cream
Stool softeners
Wait and see
What sign is indicative of necrotic bowel?
Blood mucous from rectum
Discuss the management of midgut volvulus
Emergency laparotomy De-rotate bowel Cut Ladd's bands Broaden mesentery Appendicectomy Bowel in abdominal cavity (small on right, large on left)
What is the most common kind of intussusception?
Ileo-colic
Name clinical features of intussuception
Red currant jelly stools
Vomiting
Abdominal distension
History of recent viral infection
How do you diagnose intussusception?
AXR - air fluid levels
U/S - target sign
Discuss the management of intussusception
NGT
IV fluids
Pneumatic reduction - child resuscitated - no free air on AXR - no peritonitis Laparotomy - trial of manual reduction - resection if fails
What should you suspect if upper and lower endoscopy is normal in UGIB?
Meckel’s - do a Meckel’s scan
Which area of the bowel does Meckel’s usually affect?
Ileum
Discuss management of Meckel’s diverticulum
Surgical excision
Name the common causes of LGIB in children >2y
Polyps
IBD
Infectious diarrhea