Which clinical history findings are characteristic of pediatric gastrointestinal (GI) bleeding?

Updated: Dec 19, 2018
  • Author: Wayne Wolfram, MD, MPH; Chief Editor: Robert K Minkes, MD, PhD  more...
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Answer

A complete history can often identify a presumptive GI bleeding source and direct an efficient workup. For example, NEC in most neonates is diagnosed based on history and clinical presentation.

Ask age- and etiology-specific questions. Ask about acuteness or chronicity of bleeding, color and quantity of the blood in stools or emesis, antecedent symptoms, history of straining, abdominal pain, and trauma.

Melena, rather than bright red blood per rectum, is usually a sign of bleeding that comes from a source proximal to the ligament of Treitz. However, massive upper GI bleeding can produce bright red blood per rectum if GI transit time is rapid.

Blood mixed in stool or dark red blood implies a proximal source with some degree of digestion of the blood.

Intestinal malrotation is suspected with the sudden onset of melena in combination with bilious emesis in a previously healthy, nondistended baby.

For complaints of bloody stool, make sure to elicit a history of foods consumed or drugs used that may give a stool bloody appearance. This list includes certain antibiotics, iron supplements, red licorice, chocolate, Kool-Aid, flavored gelatin, or bismuth-containing products (eg, Pepto-Bismol).

A history of vomiting, diarrhea, fever, ill contacts, or travel suggests an infectious etiology.

Bloody diarrhea and signs of obstruction suggest volvulus, intussusception, or necrotizing enterocolitis, particularly in premature infants. Acute bloody diarrhea should be considered a medical emergency. [4]

Recurrent or forceful vomiting is associated with Mallory-Weiss tears.

Familial history or NSAID use may suggest ulcer disease.

Ingested substances, such as NSAIDs, tetracyclines, steroids, caustics, and foreign bodies, can irritate the gastric mucosa enough to cause blood to be mixed with the vomitus. [5]

Ask questions that may reveal underlying, but as yet undiagnosed, organ dysfunction.

Recent jaundice, easy bruising, and changes in stool color may signal liver disease.

Other evidence of coagulation abnormalities elicited from the history may also point to disorders of the kidney or reticuloendothelial system.

The rest of this section provides an age-specific discussion of patient history.


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