Pediatric emergency medicine trisk 2064 2064
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considered for admission and more extensive evaluation.
ADDITIONAL CAUSES OF GASTROINTESTINAL
BLEEDING
Hemolytic Uremic Syndrome
HUS is a disorder characterized by the triad of acute microangiopathic
hemolytic anemia, thrombocytopenia, and acute kidney injury (see Chapter
100 Renal and Electrolyte Emergencies ). In children, the disease is most
commonly associated with infectious gastroenteritis and heralded by a
prodrome of intestinal symptoms, typically with abdominal cramps and
diarrhea. While initially nonbloody, a majority of patients experience
hemorrhagic colitis within 1 to 2 days. Fever and vomiting are also commonly
seen. Acute infectious gastroenteritis or colitis secondary to infection with
Escherichia coli O157:H7 is responsible for 70% of cases of HUS in North
America and Western Europe. Other causes of Atypical HUS include
complement dysregulation, cobalamin metabolism deficiency, autoimmune
disorders, HIV, influenza, and a multitude of drugs. Acute kidney injury is
common, with some progressing to renal failure and ultimately requiring
dialysis. Renal injury is usually seen 4 to 7 days after the onset of diarrhea.
All children with HUS require admission to the hospital. Laboratory studies
should be obtained, including a CBC count, platelet count, PT, PTT,
electrolytes, blood urea nitrogen (BUN), and creatinine. IV access needs to be
secured for the correction of dehydration and the potential administration of
blood products. The GI manifestations of HUS usually resolve without
sequelae or the need for antibiotic treatment of the initial intestinal infection.
Henoch–Schönlein Purpura
HSP is a systemic vasculitis that may cause edema and hemorrhage in the
intestinal wall. Peak age of onset is between 4 and 6 years of age. The
presentation consists of the onset of a purpuric rash, typically confined to the
buttocks and lower extremities, followed by arthralgias, angioedema, and
diffuse abdominal pain. While renal complications are typically the primary
concern with HSP, between half and two-thirds of children develop abdominal
pain. Intussusception is the most concerning GI complication of HSP and
affects approximately 3% to 4% of patients. A small minority of patients may
