Upper GI Bleeding in Infants and

Children

Matthew Rubach, MD
Pediatrics Morning Report
February 2, 2011
 Etiology of Upper GI Bleed
Ill-appearing Well-high rate Well- low rate
Hemorrhagic gastritis Reflux esophagitis
Infants Stress ulcer Reactive gastritis
Vitamin K deficiency
Esophageal varices Esophageal varices Mallory-Weiss tear
2-5 yo Hemorrhagic gastritis PUD Gastritis
Stress ulcer Reflux esophagitis
Esophageal varices Esophageal varices Mallory-Weiss tear
Older Hemorrhagic gastritis PUD Reflux esophagitis
Child Dieulafoy, hemobilia Reactive gastritis

Pediatr Rev 2008;29:39-52

Management of Upper GI Bleed
 IV access
 Type & Cross (don’t forget crystalloid)
 Nasoenteric lavage (< 10 minutes)
 PPI IV: pantoprazole 0.5-1 mg/kg/day
(consider drip)
 Octreotide drip: 1 mcg/kg bolus, then 1
mcg/kg/hr
 Endoscopy
Infectious Esophagitides
 Candida: odynophagia as opposed to
dysphagia
 CMV vs. HSV:
 CMV: dysphagia
 Ulcers: linear, longitudinal, deeper
 HSV: odynophagia/dysphagia
 Ulcers: well-circumscribed, volcano-like
Sources

Nelson’s Pediatrics, 18th ed. Chapter 303

Pediatrics in Review 2008;29:39-52

Etiologies
Infant Child Adolesc.
Bacterial enteritis Bacterial enteritis Bacterial enteritis
Milk protein allergy Anal fissure IBD
Intussusception Colonic polyps PUD/gastritis
Maternal blood Intussusception Mallory-Weiss
Lymphonodular PUD/gastritis Colonic polyps
hyperplasia Mallory-Weiss
Volvulus Esophageal varices Hemorrhoids
NEC Esophagitis Esophageal varices
Meckel’s Meckel’s Esophagitis
Peptic ulcer Lymphonodular AVM
Coagulation hyperplasia
disorder HSP, IBD, AVM