Pediatric emergency medicine trisk 2050 2050
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FIGURE 91.1 Emergency management of severe UGI bleeding. The management involves
a multidisciplinary approach from resuscitation, to consultation, to medications, to
endoscopy if indicated.
Therapies for acute variceal hemorrhage include both pharmacologic and
endoscopic therapy. Multiple pharmacologic agents have been studied,
including vasopressin, somatostatin, and octreotide. While robust data is
lacking in children, octreotide is the preferred initial pharmacotherapy. It may
be given as an initial IV loading dose of 1 to 2 µg/kg, followed by a 1 to 2
µg/kg/hr continuous IV infusion.
Emergency flexible esophagogastroduodenoscopy should be arranged if the
patient remains hemodynamically unstable after initial pharmacologic
therapies. Endoscopic techniques used for acute management of variceal
bleeding include endoscopic variceal sclerotherapy and band ligation. Ideally,
endoscopy will be performed within 24 hours ( Fig. 91.1 ).
PEPTIC ULCER DISEASE
Goals of Treatment
Peptic ulcer disease (PUD) often presents with nonspecific symptoms of
abdominal pain, dyspepsia, and heartburn to varying degrees of severity. In
rare cases, children present with GI hemorrhage, GI perforation, or gastric
outlet obstruction. The primary goal of ED management is to identify the rare
child with a significant complication from PUD that requires further
stabilization and management (see Chapter 33 Gastrointestinal Bleeding ). In
the majority of cases, once PUD is identified as a potential cause of abdominal
pain, it is appropriate to initiate outpatient diagnostic testing, start a gastric
antisecretory regimen, and ensure close follow-up.
CLINICAL PEARLS AND PITFALLS
