Gastrointestinal Bleeding
Clinical Features
Gastrointestinal bleeding may present as blood in vomitus or in stool. In either case, there may be frank red blood or altered blood that would appear as coffee grounds or there may be black stool. Bleeding could occur from the upper or lower gastrointestinal tract. The amount of bleeding varies depending on the cause of bleeding. Massive bleeding can present with features of shock.
Among the common causes of features of upper gastrointestinal bleeding are:
For the newborn
Swallowed maternal blood: In this situation the baby looks very well.
Stress ulcers often following birth asphyxia.
Coagulopathy: DIC associates with asphyxia, sepsis, vitamin K deficiency.
Necrotizing enetrocolitis (NEC)-more common is sick preterm infants
Infants and children
Swallowed blood following epistaxis (history of epistaxis).
Gastritis.
Oesophageal varices.
Gastric/duodenal ulcers.
For all ages, the common causes of lower gastrointestinal bleeding include the following:
Anal fissure
Infectious diarrhoea (including NEC in neonates, shigella, campylobacter, salmonella, amoebiasis, and schistosomiasis)
Coagulopathy due to bleeding disorders that include liver disease and DIC.
Intussusception that is more common in infants and young children.
Investigations
Full blood count and blood film
Group and cross match if excessive bleeding
Stool for occult blood
Stool culture or microscopy as indicated
Specific tests according to suspected cause of bleeding:
Endoscopy
Barium swallow or meal or enema
Septic screen
Abdominal x-ray for neonate with suspected NEC
Coagulation screen
Liver function tests
Abdominal Ultrasound
Management
Initiate treatment for shock
Monitor vital signs half hourly until bleeding stops
Transfuse as soon as blood is available
Use nasogastric suction to assess blood loss and monitor continued bleeding
Be ready to give more blood when needed.
Investigate and treat the underlying condition