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GI bleeding in children

GI bleeding in children. Clinical approach. Is the patient stable or unstable? Is this really blood, and is it coming from the GI tract? Is it a small amount of blood or a large volume? Has the child had prior episodes of bleeding . Is the patient stable. Tachycardia Pallor Tachypnea

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GI bleeding in children

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  1. GI bleeding in children

  2. Clinical approach • Is the patient stable or unstable? • Is this really blood, and is it coming from the GI tract? • Is it a small amount of blood or a large volume? • Has the child had prior episodes of bleeding

  3. Is the patient stable • Tachycardia • Pallor • Tachypnea • prolonged capillary refill time • altered mental status • metabolic acidosis indicate significant GI bleeding

  4. Is this really blood • Beets • food coloring • fruit juices • Iron • Pepto-Bismol • Spinach • Cranberries • Blueberries • licorice

  5. Is the blood coming from the gi tract • Epistaxis • recent dental work • gingival bleeding • GU bleeding • Neonatal girl with vaginal bleeding from hormone withdrawal

  6. diagnosis • If likely UGI bleeding and pale, low initial hemoglobin, significant tachycardia, or poor perfusion, insert NG tube • 12F on small children • 14-16F on older children • Rectal exam • CBC, type and cross, CMP, UA

  7. Treatment • resuscitation from hemorrhage shock and restoring the intravascular volume • restoring normal oxygen-carrying capacity by transfusion with packed red blood cells • identifying the source of bleeding • stopping ongoing blood loss.

  8. Variceal bleeding • Octreotide • 1 mcg/kg bolus and then 1 mcg/kg/hr infusion • Vasopressin • Consult pediatric gastroenterologist • 0.1 units per minute for children <5 years old • 0.3 units per minute in children ages 5 to 12 years old • 0.4 units per minute in those >12 years old.

  9. References • Tintinalli, Ch. 125

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