Gastrointestinal Bleeding in Children

What this deck covers

Gastrointestinal Bleeding in Children in twelve illustrated clinical cases with worked explanations – case presentations built around clinical images, radiology, teaching illustrations and real laboratory data, with the reference range beside every value a case quotes. This visual, data-interpretation style of practice suits candidates preparing for MRCPCH AKP in particular, alongside Saudi and Gulf licensing examinations such as the Arab Board, DHA and OMSB. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong.

The twelve cases, in order

1. Blood on day two, and a well baby
2. A large bleed with no pain at all
3. Haematemesis in a child with a big spleen
4. Streaks on the outside of a hard stool
5. Painless bleeding that keeps coming back
6. The stool that looks like redcurrant jelly
7. Red, but not blood
8. Blood after the fourth vomit
9. Streaks of blood in a thriving breastfed baby
10. Black stools and a low ferritin
11. A five-week-old who bruises
12. A rash on the legs and blood in the stool

What this deck teaches

• Age narrows the list faster than any test. Meckel and intussusception belong to the toddler, polyps to the preschool child, ulcers and Mallory-Weiss to the adolescent.
• Blood on the stool is distal, blood mixed through it is not. Surface streaks with painful defecation are a fissure; blood mixed through the stool comes from higher up.
• Painless and large in a toddler is a Meckel diverticulum. Technetium-99m pertechnetate is the test, because it finds the ectopic gastric mucosa that ulcerates the ileum.
• Do not wait for redcurrant jelly. Episodic colic with lethargy in an infant earns an ultrasound today, whatever the nappy shows.
• Resuscitate, vasoconstrict, then band. Variceal bleeding is transfused restrictively to about 70 to 80 g/L, because a high haemoglobin raises portal pressure.
• A child who has bled gets a scope. Test-and-treat for Helicobacter pylori is an adult strategy and is not enough once melaena has appeared.

Exam pearls from this deck

• A well newborn, a cracked nipple and a normal clotting screen – do the Apt test before anything invasive.
• Painless massive rectal bleeding in a toddler is a Meckel diverticulum until the scan says otherwise.

The twelve worked cases in this deck, with the images and the full explanation of every option, are part of Pediatric Case Review membership. See what is included, or start with the free Pediatric Exam Review Sets.

More from this system: all gastroenterology illustrated case decks · gastroenterology board questions for bank-style drilling · the free Pediatric Exam Review Sets · pediatric reference values.