Gastrointestinal bleeding

Abstract

The patient’s age and clinical presentation are the most useful pieces of information in determining the likely cause of bleeding and for directing the diagnostic and treatment algorithm. The approach to any patient with gastrointestinal bleeding should begin with an assessment of hemodynamic stability and overall clinical status followed by resuscitation, diagnosis, and therapy. After resuscitation, the level of bleeding must be established and a list of potential diagnoses generated based on the child’s age and clinical presentation. A nasogastric tube lavage helps to confirm or exclude an upper GI source of bleeding (proximal to the ligament of Treitz) and to remove particulate matter and clots from the stomach to facilitate endoscopy. For patients with a suspected upper GI bleed, EGD helps identify the bleeding source, permits treatment of the identified bleeding lesions, and allows for stratification of the risk for rebleeding. For patients with a suspected lower GI bleed, the diagnostic workup depends on the suspected diagnosis based on the patient’s age and presentation. Adjunct treatments for upper gastrointestinal bleeding may include intravenous proton pump inhibitors or octreotide.