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2463806621145Paediatrics00Paediatrics15208256620510<2/12: swallowed maternal blood, infectious colitis, intussusception, volvuls, AV malformation, haemorrhagic disease of newborn, Hirschsprung disease; milk allergy (onset 12-24 hours after introduction of new formula or chronic diarrhoea, poor weight gain and abdominal pain; IgE mediated); meckel diverticulum (remnant of omphalomesenteric duct in distal ileum, 2% incidence, lined with ectopic gastric mucosa, painless PR bleeding; may result in signficant bleeding)2/12 – 2yr: milk allergy, intussusception, volvulus, meckel diverticulum; anal fissure, gastro, HUS, HSP (may be severe), polyps, IBD>2yr: intussusception, volvulus, meckel diverticulum, anal fissure, gastro, HUS, HSP, polyps, IBD haemorrhoids, colitis, angiodysplasia, celiac disease, PUD00<2/12: swallowed maternal blood, infectious colitis, intussusception, volvuls, AV malformation, haemorrhagic disease of newborn, Hirschsprung disease; milk allergy (onset 12-24 hours after introduction of new formula or chronic diarrhoea, poor weight gain and abdominal pain; IgE mediated); meckel diverticulum (remnant of omphalomesenteric duct in distal ileum, 2% incidence, lined with ectopic gastric mucosa, painless PR bleeding; may result in signficant bleeding)2/12 – 2yr: milk allergy, intussusception, volvulus, meckel diverticulum; anal fissure, gastro, HUS, HSP (may be severe), polyps, IBD>2yr: intussusception, volvulus, meckel diverticulum, anal fissure, gastro, HUS, HSP, polyps, IBD haemorrhoids, colitis, angiodysplasia, celiac disease, PUD663638551536602463805153660Management00Management15208255153660IV fluidsAs outpatient if: bleeding not haemodynamically signficant and ceasedColonoscopy if: bleeding haemodynamically significant but ceasedAngiography if: bleeding haemodynamically signficiant and ongoing requires >0.5ml/min; 10% serious complication rateOT if: torrential bleeding or failed scope ?ischaemic colitis; laparotomy has increased mortality and morbidityTechnetium-labelled RBC: good at detecting intermittent bleeding; requires >0.1ml/min00IV fluidsAs outpatient if: bleeding not haemodynamically signficant and ceasedColonoscopy if: bleeding haemodynamically significant but ceasedAngiography if: bleeding haemodynamically signficiant and ongoing requires >0.5ml/min; 10% serious complication rateOT if: torrential bleeding or failed scope ?ischaemic colitis; laparotomy has increased mortality and morbidityTechnetium-labelled RBC: good at detecting intermittent bleeding; requires >0.1ml/min15201904330700Bloods: ? Ur:Cr and ? K suggests upper GI; ? Hb and normal MCV = acute; ? Hb and MCV = chronic; ? platelets = acute; macrocytosis = hepatic disease; group and save if moderate, XM if severeErect CXR: if abdominal pain or findings in chestCT: 79-100% sensitivity00Bloods: ? Ur:Cr and ? K suggests upper GI; ? Hb and normal MCV = acute; ? Hb and MCV = chronic; ? platelets = acute; macrocytosis = hepatic disease; group and save if moderate, XM if severeErect CXR: if abdominal pain or findings in chestCT: 79-100% sensitivity2463804330700Investigations00Investigations2463803489960Assessment00Assessment15201903489960Symptoms: blood mixed with stool = likely higher; pink frothy blood in pan or on paper = haemorrhoids; tarry black stool = upper GI; bright red and not severely shocked = lower GI; haematemesis = upper GI; bright red on surface of stool or toilet paper = fissureExamination: look for signs of chronic liver disease00Symptoms: blood mixed with stool = likely higher; pink frothy blood in pan or on paper = haemorrhoids; tarry black stool = upper GI; bright red and not severely shocked = lower GI; haematemesis = upper GI; bright red on surface of stool or toilet paper = fissureExamination: look for signs of chronic liver disease2463802366010Aetiology00Aetiology1520825236601060% diverticular disease (R=L; acute, painless; can be heavy; 90% resolve spontaneously)10-20% no cause found12% angiodysplasia (more in elderly; often recurrent; usually R; rarely severe; associated with AS)2% Cancer / polypOthers: ischaemic colitis, infection, IBD, aorto-enteric fistula If <20yrs: Peutz Jegher syndrome, HSP, Meckel’s diverticulus0060% diverticular disease (R=L; acute, painless; can be heavy; 90% resolve spontaneously)10-20% no cause found12% angiodysplasia (more in elderly; often recurrent; usually R; rarely severe; associated with AS)2% Cancer / polypOthers: ischaemic colitis, infection, IBD, aorto-enteric fistula If <20yrs: Peutz Jegher syndrome, HSP, Meckel’s diverticulus15208251782445Distal to ligament of Trietz00Distal to ligament of Trietz2463801782445Patho-physiology00Patho-physiology246380964565Epidemiology00Epidemiology1520190962025Mortality 5-10%; 20% of all GI bleeds; significant haemorrhage with haemodynamic compromise uncommon; stops spontaenously in 80%? morbidity rate if: haemodynamic instability, repeated haematochezia, gross blood on PR, initial Hct < <35%, syncope, non-tender abdominal, aspirin use, >2 co-morbid conditions00Mortality 5-10%; 20% of all GI bleeds; significant haemorrhage with haemodynamic compromise uncommon; stops spontaenously in 80%? morbidity rate if: haemodynamic instability, repeated haematochezia, gross blood on PR, initial Hct < <35%, syncope, non-tender abdominal, aspirin use, >2 co-morbid conditions246380330200Lower Gastrointestinal Bleeding00Lower Gastrointestinal Bleeding ................
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