| Etiology |
Dx |
Notes |
| Swallowed maternal blood |
Apt
Test (Hbg alkaline denaturation test) - detects Hgb F Hgb F >50% = fetal blood Hgb F <10% = maternal blood |
Leaving the stool sample
exposed to air for >30min will result in false positive |
| Anorectal Fissures |
Physical
exam |
More common in older children.
Consider Trauma, rectal therapy/meds, thermometer related injury. |
| NEC |
Septic Clinical picture, KUB showing dilated loops of bowel
consistent with Ileus and Pneumatosis
intestinalis (bubbles of gass in the bowel wall or in the portal
system) |
|
| Malro / Volvulus |
UGI
series with failure of the duodenum to cross the midline
confirms the diagnosis of malrotation. If UGI normal and clinical signs
consistent with LGI obstruction,
perform SBFT or barium contrast to look for colonic malrotation. Some
experienced centers can Dx malro with doppler US (normal US cannot
exclude malro) |
Life threatening emergency. |
| Hirschprung Disease |
Initial test: Contrast enema reveals marked
dilation of normal bowel segment proximal to small aganglionic
segment. Anorectal Manometry can
confirm diagnosis Gold standard = rectal biopsy demonstrating complete absence of ganglion cells in the meissner and auerbach plexus Squirt sign or blast sign (passage of large gas/stool with first digital rectal exam) suggest Dx |
usually with delayed passage of
meconium >48hrs after birth, signs of obstruction (25% with blood in
stool - emergency decompression with DRE or rectal tube and start Abx) |
| Coagulopathy |
look ofr other bleeding systems,
family h/o bleeding
|
| Etiology |
Diagnosis |
Notes |
| Anal Fissures |
Physical exam Rectal Exam |
most common cause of rectal
bleeding <1yo |
| Milk/Soy induced proctocolitis |
Trial of hydrolysed protein
formula or 2wk trial of maternal dairy and soy elimination diet |
occult or gross blood in stool
in otherwise healthy infant. 25% cross react with soy. resolves by
9-18mo with total elimination. Use alimentum or nutramigen FPIES (food protein induced enterocolitis) - usually presents with vomiting and ill appearance |
| Intussusception |
Abd US or Air contrast enema which can also be therapeutic |
current jelly stool ( blood
mucoid stools) may have palpable suasage mass in RUQ or near transverse
colon. may wake up in pain, vomit pass stool, symtpoms resolve and the
cycle repeats |
| Meckel's diverticulum |
Meckels scan (nuc med) |
Painless rectal bleeding
usually caused by mucosal ulceration secondary to acid produced by
ectopic gastric tissue in the diverticulum. can also have ulceration,
perforation, obstruction, diverticulitis, intussusception (lead point) |
| Lymphonodular hypoplasia |
may lead to mucosal thinning and
predispose to ulceration and hematochezia. Tx with stool softeners |
|
| GI Duplication Cyst |
Often do not communicate with
bowel lumen |
|
| Infantile or VEO-IBD |
Genetically different from IBD
which presents at an older age. |
| Etiology |
Diagnosis |
Notes |
| Infectious Colitis |
Cx Stool PCR |
|
| Hemolytic Uremic Syndrome |
Microangiopathic Hemolytic anemia Thrombocytopenia Acute renal injury |
usually due to prodromal
infection: shiga-like toxin, E Coli 0157:H7 (bloody diarrhea common) |
| IgA vasculitis |
Palpable purpura Abd pain (50% GI bleed) Arthralgias |
Ages 3-15yrs, systemic
vasculitis. Can be complicated by intussusception (purpuric lesions
within the GI tract serve as lead point) |
| Juvenile polyps |
Colonoscopy All polyps should be removed and sent for eval by pathology if 3-5 or more polyps are found patient should undergo neoplasia surveillance colonoscopy q2-3yrs |
Benign hamartomas Ages 2-10 Painless rectal bleeding -Up to 10% are adenomas (3% hyperplastic) |