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Important Considerations

History
  • Description of blood loss:
    • Upper vs. lower GI bleed
    • Time of onset
    • Quantity of blood loss
    • Hematochezia: Bright red blood vs melena; streaks vs. mixed with stool vs. clots
    • Hematemesis: Bright red blood vs. melena or “coffee ground” 
  • Related events:
    • Trauma
    • Foreign body or caustic Ingestion
    • Surgery
    • Diarrhea
    • Constipation
    • Recurrent vomiting
    • Epistaxis
    • Hemoptysis 
  • Significant underlying conditions: 
    • Hepatobiliary disease 
    • Peptic ulcer disease 
    • Coagulation disorders 
    • Vascular malformations 
    • Cystic fibrosis 
    • History of varices 
    • Prior history of intestinal surgery, especially bowel resection w/ anastomosis 
    • History of necrotizing enterocolitis
    • History of prematurity
  • Newborn Considerations: 
    • Vitamin K administration at birth 
    • Breastfeeding with maternal breast bleeding/infection 
    • History of prematurity
  • Medications: 
    • Increased bleeding risk
      • Aspirin
      • NSAIDs
      • Anticoagulants
      • Corticosteroids
      • Vascular Endothelial Growth Factor (VEGF) inhibitors
      • Selective Serotonin Reuptake Inhibitors (SSRIs) 
    • Pill esophagitis 
      • Acetaminophen 
      • Doxycycline 
      • Bisphosphonates 
      • Ascorbic acid 
      • Ferrous sulfate 
      • Potassium chloride

Physical Exam
  • Abdominal tenderness, evidence of peritoneal signs
  • Chest pain
  • Hepatomegaly or splenomegaly
  • Jaundice
  • Rectal exam
  • Signs of anemia (i.e., pallor, fatigue, dizziness, syncope, shortness of breath, palpitations) 

 

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  

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.

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