Gastrointestinal bleeding in patients at any age is frightening. The fear stems from the knowledge that bleeding, if severe enough and sustained for long intervals, may lead to shock and death. Fortunately, in both pediatric and adult patients, instances in which bleeding is so massive and uncontrollable that it leads to rapid demise are extremely rare. The approach to diagnosis and treatment of gastrointestinal hemorrhage by the physician should be calm, logical, and expeditious to help allay the fears of the patient and family, and to reduce the morbidity associated with the hemorrhage in the event its cause is found to be serious. Fortunately, the causes of gastrointestinal bleeding in the pediatric population are fewer than in adults; accordingly, the differential diagnosis is usually shorter, although not necessarily easier. In contrast to adults, the age of the pediatric patient may play a key role in determining the differential diagnosis.
MANIFESTATION OF BLEEDING (Table 1)
Before discussing the pathophysiology of bleeding, we will establish definitions of the words frequently associated with gastrointestinal bleeding.
Hematemesis is the vomiting of blood. The blood may be either bright red or "coffee ground" in appearance if it has been altered by gastric acid. Hematemesis implies that the site of bleeding is proximal to the ligament of Treitz.
