Pediatric emergency medicine trisk 0695 0695
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (130.16 KB, 1 trang )
In patients with persistent or recurrent hemorrhage, emergent endoscopy for diagnosis
(location of bleeding and biopsies as needed) and treatment may be necessary if the
bleeding is life-threatening (continued transfusion requirement, hemodynamic
instability). Endoscopy can now diagnose the cause of upper GI bleeding in more than
90% of patients. In the small percentage of patients in whom bleeding is massive,
making endoscopic visualization impossible, angiography or radionuclide studies
(Technetium-sulfur colloid/Tc-labeled red blood cells) may be indicated. In rare
emergencies, a surgeon may also be needed for diagnosis and treatment of severe
bleeding. Treatment of specific mucosal conditions and esophageal varices is discussed
in Chapter 91 Gastrointestinal Emergencies .
Eighty percent to 85% of upper GI bleeding stops spontaneously, regardless of the
source, before or early in the hospital course. In stable patients who have stopped
bleeding, an upper GI contrast study and endoscopy provide valuable and often
complementary information. In this group of patients, endoscopy need not be performed
on an emergent basis and may be done electively in the first 12 to 24 hours after
admission. Elective endoscopy should be performed in patients who stop bleeding
spontaneously but who have required transfusion and/or have a history of previously
unexplained upper GI bleeding episodes.
LOWER GASTROINTESTINAL BLEEDING
Differential Diagnosis
As previously mentioned, rectal bleeding is common in children. Similar to upper GI
bleeding, there is significant overlap among age groups in the etiology of lower GI
bleeding ( Table 33.4 ). The most common disorders by age group are listed in Table
33.5 , and the life-threatening causes are listed in Table 33.6 . Of note, many cases of
lower GI bleeding resolve spontaneously without a specific diagnosis being established.
Neonatal Period (0 to 1 Month)
As is true for upper GI bleeding, a common cause of blood in the stool in well-appearing
neonates is the passage of maternal blood swallowed either at delivery or during breastfeeding from a fissured maternal nipple. Infectious diarrhea can occur in very young
infants, and stools may contain blood or mucus. Common bacterial pathogens in this age
group include Campylobacter jejuni and Salmonella.
