Which physical 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

Look for signs of shock, and document findings such as heart rate, blood pressure, capillary refill, and orthostatic changes. [16]

During examination of the head, ears, eyes, nose, and throat, look for causes such as epistaxis, nasal polyps, and oropharyngeal erosions from caustics and other ingestions.

Examine abdominal surgical scars and elicit the reason for the surgery.

Specifically include bowel-sound frequency in the abdominal examination. Hyperactive bowel sounds are more common in upper GI bleeding.

Abdominal tenderness, with or without a mass, raises the suspicion of intussusception or ischemia.

Hepatomegaly, splenomegaly, jaundice, or caput medusa suggests liver disease and subsequent portal hypertension.

Inspection of the perianal area may reveal fissures, fistulas, skin breakdown, or evidence of trauma. Gentle digital rectal examination may reveal polyps, masses, or occult blood.

Looking for evidence of child abuse, such as perianal tearing, tags, or irregularities in anal tone and contour, is also important.

Examination of the skin may reveal evidence of systemic disorders, such as IBD, Henoch-Schönlein purpura, and Peutz-Jeghers polyposis.

Anoscopy can be performed (if required in an infant) by gently placing a lubricated red-top or purple-top test tube into the anus to enable visualization of the inner anal anatomy.


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