Differential Diagnosis
Age |
Upper GI Bleed |
Lower GI Bleed |
|
All ages |
Gastric/duodenal ulcer Coagulopathy / bleeding disorder Disseminated intravascular coagulation (including in the setting of sepsis) Erosive esophagitis (including caustic injury induced) Toxic ingestion Esophagitis/gastritis/duodenitis Esophageal or ectopic varices Medication induced bleeding Trauma (including child physical abuse) Intestinal polyp Anastomotic ulcer Intestinal duplications Vascular malformation Hypothyroidism
|
Bleeding disorder Infective colitis Medication induced bleeding Variceal bleed Vascular malformation Volvulus Hypothyroidism |
|
< 2 years |
Neonates (< 1 month of age) Cow's milk protein allergy Swallowed maternal blood GI malformation Hemorrhagic disease of newborn Necrotizing enterocolitis
Cow's milk protein allergy Epistaxis Peptic ulcer disease GI malformation |
Allergic proctocolitis Anal fissure Hirschsprung enterocolitis Lymphoid hyperplasia Necrotizing enterocolitis
|
|
2 – 5 years |
Epistaxis Peptic ulcer disease Mallory-Weiss tear Esophageal varices Henoch Schonlein purpura Arteriovenous malformation Dieulafoy lesion Stromal tumors |
Anal fissure Inflammatory bowel disease Juvenile polyp Meckel diverticulum Rectal prolapse/ulcer Lymphoid hyperplasia Henoch-Schonlein purpura Hemolytic-uremic syndrome Perianal steptococcal cellulitis |
|
> 5 years |
Epistaxis Mallory-Weiss tear Peptic ulcer disease Inflammatory bowel disease Hemophilia Arteriovenous malformation Dieulafoy lesion Stromal tumors |
Anal fissure Hemorrhoids Inflammatory bowel disease Infective colitis Juvenile polyp Meckel diverticulum Rectal prolapse/ulcer Henoch-Schonlein purpura |
References
Novak, I., & Bass, L. M. (2023). Gastrointestinal bleeding in children: Current management, controversies, and advances. Gastrointest Endosc Clin N Am, 33(2), 401-421. https://doi.org/10.1016/j.giec.2022.11.003
Owensby, S., Taylor, K., & Wilkins, T. (2015). Diagnosis and management of upper gastrointestinal bleeding in children. J Am Board Fam Med, 28(1), 134-145. https://doi.org/10.3122/jabfm.2015.01.140153
Piccirillo, M., Pucinischi, V., Mennini, M., Strisciuglio, C., Iannicelli, E., Giallorenzi, M. A., Furio, S., Ferretti, A., Parisi, P., & Di Nardo, G. (2024). Gastrointestinal bleeding in children: Diagnostic approach. Ital J Pediatr, 50(1), 13. https://doi.org/10.1186/s13052-024-01592-2
These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.