Pediatric emergency medicine trisk 0689 0689
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TABLE 33.2
COMMON CAUSES OF UPPER GASTROINTESTINAL BLEEDING BASED
ON AGE
Neonatal period
Swallowed maternal blood
Infancy
Gastritis
Esophagitis
Mallory–Weiss tear
Preschool age
Epistaxis
Gastritis
Esophagitis
Mallory–Weiss tear
School age and adolescents
Gastritis
Mallory–Weiss tear
Peptic ulcer
Although less common, gastritis (from stress, sepsis, cow’s milk intolerance, and
trauma from nasogastric tube insertion), necrotizing enterocolitis (NEC), and
coagulation disorders should be considered. If vitamin K was not administered in the
immediate postpartum period, vitamin K–deficient bleeding should be considered.
Maternal drugs that cross the placenta, including aspirin, phenytoin, and phenobarbital,
may also interfere with clotting factors and cause hemorrhage. Congenital intestinal
duplications or vascular malformations (hemangiomas and telangiectasias) can also
present as causes of upper GI bleeding.
Infancy (1 Month to 2 Years)
Common, and often less severe, causes of bleeding in this age group are gastritis and
reflux esophagitis. Significant and sometimes massive upper GI hemorrhage in a
newborn may occur with no demonstrative anatomic lesion or only “hemorrhagic
gastritis” at endoscopy. This is usually a single, self-limited event that is benign if
treated with appropriate blood replacement and supportive measures. Other causes of
significant hemorrhage may include pyloric stenosis (often at less than 2 months of age,
preceded by significant nonbloody emesis), peptic ulceration, a duplication cyst, foreign
body, or caustic ingestion.
Critically ill children of any age are at risk for developing stress-related peptic ulcer
disease. Such ulcers occur with life-threatening illnesses, including shock, respiratory
