Gastrointestinal Bleeding Lower Tract

I. Problem. A 1-month-old infant is brought to the emergency department because his parents have noticed blood in the diaper.

II. Immediate Questions

A. What are the current vital signs and appearance of patient?

Vital signs and appearance provide an indication of patient's hemodynamic stability. Age-adjusted tachycardia is the most sensitive indicator of severe bleeding. Are parents able to quantify and describe the blood seen in the diaper? Has this been an acute or chronic process?

B. Are there symptoms of an acute abdominal process (eg, pain, distention, vomiting, lethargy)? Painful rectal bleeding is often seen in patients with infectious, inflammatory, or ischemic causes. Pain, vomiting, and small amounts of blood in stool should raise suspicion of bowel obstruction. Intussusception, intestinal volvulus and malrotation, and necrotizing enterocolitis are important diagnoses to consider early in evaluation.

C. Is there a history of recent diarrheal illness? What is patient's normal bowel pattern? Rectal fissures can be caused by either diarrhea or constipation.

D. What is patient's current dietary history? Brief dietary history should include information about weight loss, feeding intolerance, or multiple formula changes. All may be suggestive of allergic colitis.

E. If school-aged, has patient had any extraintestinal manifestations? Symptoms such as rash, arthralgias, anorexia, and weight loss are all indicative of inflammatory bowel disease, although this condition is rarely diagnosed before age 5 years.

F. Any recent medications or ingestions? Recent antibiotic exposure raises the possibility of Clostridium difficile-associated colitis.

G. Does patient have any underlying medical conditions? Brief past medical history should include information about previous bleeding, liver disease, or coagulation disorder. Also ask about family history of bleeding diathesis, familial polyposis, or inflammatory bowel disease.

Constipation Prescription

Constipation Prescription

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