Intestinal bleeding in children

Question 1

Name the common causes of UGIB in neonates

Answer 1

Haemorrhagic disease of the newborn
Swallowed maternal blood
Stress gastritis

Question 2

Name the common causes of LGIB in neonates

Answer 2

Necrotizing enterocolitis
Anal fissure
Malrotation with volvulus

Question 3

Name the common causes of UGIB in infants <1y

Answer 3

Esophagitis

Stress gastritis

Question 4

Name the common causes of LGIB in infants <1y

Answer 4

Anal fissure
Intussusception
Milk protein allergy

Question 5

Name the common causes of UGIB in infants 1-2y

Answer 5

PUD

Gastritis

Question 6

Name the common causes of LGIB in infants 1-2y

Answer 6

Polyps

Meckel diverticulum

Question 7

Name the common causes of UGIB in children >2y

Answer 7

Oesophageal varices

PUD

Question 8

Name relevant history in intestinal bleeding in children

Answer 8

Vomiting, diarrhea, fever
NSAIDs, caustic substances
Pain
Jaundice, pale stools
Antibiotics
Iron
Beetroot

Question 9

What should you look for on physical examination?

Answer 9

Signs of shock
Other sources of bleeding
Abdominal scars
Bowel sounds
Abdominal tenderness
Liver pathology
Anal inspection
Rectal examination

Question 10

Discuss resus of children with intestinal bleeding

Answer 10

NGT on free drainage
IV RL 20ml/kg
Somatostatin analogue

Question 11

How do you test for swallowed maternal blood?

Answer 11

Alkali denaturation test (APT)

Question 12

Name causes of stress gastritis

Answer 12

Stressful delivery
Resus post-birth
Prematurity
Mechanical ventilation

Question 13

Name clinical features of necrotizing enterocolitis

Answer 13

Sudden feeding intolerance
Abdominal distension
Bilious vomiting
Abdominal wall erythema
Blood PR
Severe sepsis

Question 14

Discuss the management of necrotizing enterocolitis

Answer 14

NPO 
NGT
Antibiotics
TPN
Surgery

Question 15

Discuss the management of anal fissures

Answer 15

Local anesthetic cream
Stool softeners
Wait and see

Question 16

What sign is indicative of necrotic bowel?

Answer 16

Blood mucous from rectum

Question 17

Discuss the management of midgut volvulus

Answer 17

Emergency laparotomy
De-rotate bowel
Cut Ladd's bands
Broaden mesentery
Appendicectomy
Bowel in abdominal cavity (small on right, large on left)

Question 18

What is the most common kind of intussusception?

Answer 18

Ileo-colic

Question 19

Name clinical features of intussuception

Answer 19

Red currant jelly stools
Vomiting
Abdominal distension
History of recent viral infection

Question 20

How do you diagnose intussusception?

Answer 20

AXR - air fluid levels

U/S - target sign

Question 21

Discuss the management of intussusception

Answer 21

NGT
IV fluids

Pneumatic reduction
- child resuscitated
- no free air on AXR
- no peritonitis
Laparotomy 
- trial of manual reduction
- resection if fails

Question 22

What should you suspect if upper and lower endoscopy is normal in UGIB?

Answer 22

Meckel’s - do a Meckel’s scan

Question 23

Which area of the bowel does Meckel’s usually affect?

Answer 23

Ileum

Question 24

Discuss management of Meckel’s diverticulum

Answer 24

Surgical excision

Question 25

Name the common causes of LGIB in children >2y

Answer 25

Polyps
IBD
Infectious diarrhea