Upper GI bleeding in children

Question 1

What is the approach to children who vomit blood or have rectal bleeding

Answer 1

Careful history and physical examination is important

Blood volume in children is small so begin resuscitation early

Urgent referral for therapeutic gastropscopy or colonoscopy

Patient should be stabilized for transport

Question 2

What is the definition of:
- Upper GIB
- Lower GIB

Answer 2

Upper GIB:
- Bleeding proximal to ligament of Treitz
- Source: Oesophagus, Stomach, Duodenum

Lower GIB:
- Bleeding distal to ligament of Treitz
- Source: Small bowel, colon, Rectum

Question 3

What is the definition of haematemesis and the different presentation

Answer 3

Vomiting up blood

Red blood + clots = ongoing bleeding
Dark coffee-ground vomitus: Slow bleeding or it stopped

Question 4

What are the common causes of UGIB in the following:
- Neonates
- Infants 1month to 1year
- Infants 1-2years
- Children older than 2 years

Answer 4

Neonates:
- Haemorrhagic disease of the newborn (vit K↓)
- Swallowed maternal blood
- Stress gastritis

Infants 1month to 1year
- Oesophagitis (reflux)
- Stress gastritis

Infants 1-2years
- Peptic ulcer disease
- Gastritis

Children older than 2years
- Oesophageal varices
- Peptic ulcer disease

Question 5

What are the relevant history for the following causes:
Infective cause
Drugs
Foreign bodies
Liver disease
Imitation of bloody stools

Answer 5

Infective cause:
- Vomiting, diarrhoea, fever

Drugs:
- NSAIDS, caustic substances

Foreign bodies:
- Damage to gastric mucosa

Liver disease:
- Jaundice, bruising, pale stools

Iimitation of bloody stools
- Certain antibiotics, iron supplements, bismuth, beetroot

Question 5

What are the indications of the following signs on physical examination
- Abdominal tenderness
- Hepato/spleonomegaly

Answer 5

Abdominal tenderness
- Gastro-oesophageal reflux
- Ulcer

Hepato/splenomegaly:
- Liver disease
- Portal hypertension

Question 6

What is the procedure for resuscitation in children

Answer 6

Place nasogastric tube
Intravenous fluid started:
- 20ml/kg Ringer’s lactate
- Blood products: No response to crystalloid, ongoing bleeding or pre-existing heart or lung condition

Question 7

How does heamorrhagic disease of newborn present

Answer 7

Coffee ground gastric aspirate or melena
Coagulation studies too confirm

Question 8

How does an infant that swallowed maternal blood confirmed

Answer 8

Cornfirm with Apt test:
- Blood on filter paper with 1% sodium hydroxide
- Maternal blood: Denatureated and appears rusty brown
- Foetal blood: No rection, remains pink

Question 9

How does a baby with stress gastritis present, caused by and how is it diagnosed and treated

Answer 9

Coffee ground
Stressful delivery, required resuscitation, premature mechanical ventilation

Negative Apt and normal coagulation

Nasogastric tube
Gastric irrigation
Intravenous H2 blockers/PPI