19 GI Bleed

Necrotizing Enterocolitis

  • Pt: premature + GI bleed. In NICU

  • diagnosis: babygram, pneumatosis intestinalis

  • treatment: NPO, TPN, IVF, IV antibiotics

Anal Fissure

  • path

    • tear anal mucosa

    • iatrogenic: can be caused by anal exam

  • pt: tear in anal mucosa

  • diagnosis: clinical

  • treatment: reassurance (stool is soft. Heal by itsel)

Intussusception

  • path: tunneling of bowel into itself. Vascular compromise

  • pt: 3 mo to 3 yrs

  • symptoms

    • abrupt, sudden onset, colicky abd pain

    • knee-chest position relief

    • curant jelly diarrhea

    • PE: sausage shaped mass in RUQ

  • diagnosis

    • KUB: 1st film to ruleout perforation/obstruction

    • US: very sensitive, can track resolution. Target sign

    • air enema: propel air and push telescope section out

  • treatment

    • air enema

    • surgery if frank peritonitis, perforation, failure of air enema

  • vascular supply doesn't reach tunneled part of bowel

Meckel's

  • path: true diverticula, remnant of vitelline duct, consist of gastric content (secrete acid), can cause ulcers and bleed

  • pt:

    • toddler.

    • Rule of 2: < 2 yo, < 2% population, 2x likely in males, 2 ft from ileocecal, 2 inches long

    • "colon cancer": fetal occult blood test positive (FOBT), iron def anemia

  • symptoms: painless intermittent hematochezia (bright red blood)

  • diagnosis

    • Meckel's bleeding scan

    • Technicium 99 scan

    • CT scan for teenagers instead of bleeding scan

  • treatment: resection

Distractors

  • Reassure parents

  • During birth: babies swallow mom's blood. Symptoms of melena

    • Apt test test for baby vs mom blood

  • Swallow own blood with epistaxis (lean back)

  • Iron supplementation, beets (plant), medication

beets:

Others

  • IBD

    • Crohn's: watery diarrhea, weight loss. Endoscopy and colonoscopy, skip lesions. Anti-immune. Surgery reserved for fistula.

    • UC: bloody diarrhea. Colonoscopy, continuous lesions. Surgery curative. Q1y colonoscopy starting at 8 until resect

  • Infectious Colitis: fever and bloody bowel movement (invasive organisms)

    • don't treat unless suspect for shigella

    • stool cultures

  • Milk protein allergy

    • change to hydrolyzed formula

Previous18 SeizuresNext20 CT Surgery

Last updated