Trivia of the day:

Residents of which state got their nickname from the tar seeping out of the ground that became a major product of that state?

Morning Report- Monday, August 1st 2011

North Carolina “tarheels”That was for Simone, who gave me the great idea for trivia at the beginning of AM report!!

GI Bleeding in Infants and Children

Initial Approach Step 1: ABCs!! Assess hemodynamic status of the

patient

Orthostatic changes- best indicator of significant blood loss

Step 2: Establish severity of bleeding

Coffee ground emesis, melena: lower rate of bleeding

Bright red blood: ?higher rate of bleeding

UGI vs. LGI Bleeding Step 3: Determine the location of the bleeding

UGI: bleeding above the ligament of Treitz

Hematemesis

LGI: bleeding distal to the ligament of Treitz

Bloody diarrhea

Bright red blood mixed with or coating stool

Hematochezia, melena, or occult blood loss can be due to both UGI or LGI bleeds

Passing NGT can determine if the blood is originating from the UGI tract ot LGI tract

Simulates Melena

Is it Blood?Simulates bright red blood

Food coloring

Colored gelatin or children’s drinks

Red candy

Beets

Tomato skins

Antibiotic syrups

Bismuth or iron preparations

Spinach

Blueberries

Grapes

Licorice

Group Assignment Break into 3 groups:

Infant

2-5 years old

Older child

Come up with a differential diagnosis for lower GI tract bleeding in your age group

The “Older child group” has an additional task…since our case is an older child, which diagnosis do you think is most likely and why?

Infant

LGI Bleeding in Infants Necrotizing enterocolitis

Hirschprung enterocolitis

Volvulus/ Intussusception

Infectious colitis

Anal fissure

Eosinophilic proctocolitis

Nodular lymphoid hyperplasia

Swallowed maternal blood

Coagulopathy

Allergic colitis

Child 2-5 years old

LGI Bleeding in 2-5 year-olds Intussusception

Volvulus

Henoch-Schonlein purpura

Hemolytic-uremic syndrome

Meckel diverticulum

Juvenile polyp

Ulcerative colitis/ Crohn’s disease

Infectious colitis

Nodular lymphoid hyperplasia

Perianal streptococcal cellulitis

Rectal prolapse/ rectal ulcer

Older Child

LGI Bleeding in the Older Child

Infectious colitis

Ulcerative colitis/ Crohn disease

HSP

Intestinal ischemia

Meckel diverticulum

Juvenile polyp

Hemorrhoid

Infectious DiarrheaTransmission

Symptoms Labs Treatment

Salmonella Chicken, milk, eggs; exotic pets (reptiles)

Fever, diarrhea with blood/ mucous

High WBC with left shift, +stool WBC, RBC (?+ BCx)

None with uncomplicated GE; at risk* Amoxil, Bactrim

Shigella Person-to person; daycare! Fresh fruits and veges

Fever, abd. pain, watery diarrhea that becomes bloody, szs

High WBC and band ct, +stool WBC, RBC

Azithromycin, 3rd gen. cephalosporins, quinolones

Campylobacterjejuni

Undercooked poultry or meat

Fever, abd pain, diarrhea with blood, vomiting

+stool WBC, RBC; Cx with chocolate agar

Erythromycin

E.Coli O157:H7

Undercooked beef, unpasturized milk

Fever, diarrhea with blood/ mucous

+stool WBC, RBC; look for signs of HUS

Abx not indicated! (increases risk for HUS)

Yersiniaenterocolitica

Pork (chitterlings)

Dysenteric syndrome, can mimic appy/ Crohns

+stool WBC, RBC

Bactrim, aminoglycosides, cephalosporins (3rd), quinolones

Clostridiumdifficile

ABx exposure Mild diarrhea dysentric syndrome

Dx with toxin assay

PO Flagyl (Vanc)

Thanks for your attention!Noon Conference: Radiology