Radiographic and Other Studies

1. Abdominal x-ray. Useful if foreign body, bowel perforation, or bowel obstruction is suspected.

2. Ultrasonography. Helpful when liver disease, portal hypertension, or vascular anomalies are strong possibilities in differential diagnosis.

3. Barium contrast. Too insensitive to detect superficial mucosal lesions; may delay diagnosis because presence of contrast material in stomach and duodenum at the time of endoscopy can obscure the bleeding source.

4. CT or MRI scan. Useful for evaluation of mass lesions and vascular malformations.

5. Upper GI endoscopy. Diagnostic test of choice for significant bleeding because it has a high degree of sensitivity and allows for therapeutic intervention. Patients who have had significant volume loss with vital sign changes should undergo endoscopy as soon as bleeding is controlled. If endoscopy is planned, avoid use of contrast radiology.

6. Angiography. Consider when bleeding is so massive that it obscures the view via endoscopy; can be both diagnostic and therapeutic.

7. Scintigraphy. Rarely indicated except in cases of suspected enteric duplications or obscure bleeding sites.

V. Plan. Upper GI tract bleeding is defined as bleeding above the ligament of Treitz. Approximately 20% of all GI tract bleeding in children arises from this area. Children typically present with hematemesis, melena, or both. Children can also present with hematochezia because of their accelerated intestinal transit times, and because blood acts as a cathartic.

A. Initial Management. The primary focus should be stabilization of patient. Always address resuscitative efforts first in a child who shows hemodynamic compromise.

1. First determine that vomited or excreted material actually contains blood. Many foods ingested by children may give the appearance of blood in stool or emesis, including many food colorings. This question can simply be answered with a fecal occult blood test. The Apt-Downey test can identify infants who may have swallowed maternal blood

2. Obtain vital signs, including orthostatics and clinical condition of patient. Tachycardia is indicative of acute blood loss. A child with hemodynamic instability requires placement of a large-bore IV line and administration of normal saline or lactated Ringer solution in boluses of 20 mL/kg until compatible blood products are available or patient is stable.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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