Bleeding Per Rectum in Children | Examination | Causes | Management | Dr. Armaghan Ahmed скачать в хорошем качестве

Bleeding Per Rectum in Children | Examination | Causes | Management | Dr. Armaghan Ahmed

Bleeding Per Rectum in Children In this video we will discuss the following topics; What is rectal bleeding? Is rectal bleeding serious? How does rectal bleeding appear? What are the symptoms of rectal bleeding? What causes rectal bleeding? Are there any tests for rectal bleeding? How do I treat rectal bleeding? Will rectal bleeding go away on its own? When do I need to see a doctor about rectal bleeding? Bleeding Per Rectum in Children | Examination | Causes | Management | Dr. Armaghan Ahmed Rectal bleeding in children is less common than in adults. It can cause a great deal of anxiety amongst parents and thus requires appropriate assessment, explanation and reassurance. The vast majority of rectal bleeding in children is benign but it may indicate serious underlying pathology. Epidemiology The incidence and prevalence of rectal bleeding in children are poorly documented. Certain causes such as anal fissure are common in general practice. Overall it is not a common presentation in children attending hospital. History Questions to ask about the bleeding Is the bleeding acute or chronic? What is the colour of the blood? Is it bright or dark? Melaena rather than bright red blood indicates bleeding is higher in the bowel (usually duodenal or above). Anorectal disorders, anal fissures and distal polyps cause bright red bleeding. Dark blood or blood mixed with stool suggests more proximal source of bleeding. Be aware that massive upper gastrointestinal bleeding can cause bright red rectal bleeding in children when transit time is short. What is the quantity of bleeding? Questions to ask about other symptoms Either accompanying or antecedent to the bleeding: Is there any vomiting? An infectious cause is suggested by diarrhoea and vomiting, fever, illness in others, recent travel, etc. Has there been any straining? What is the character of stools passed? Constipation and large hard stools predispose to fissures. Accompanying diarrhoea and signs of obstruction suggest intussusception, volvulus and, in some groups, even necrotising enterocolitis. Acute bloody diarrhoea in children is a medical emergency. Has there been any abdominal pain? Has there been any trauma? Questions to ask about general health Is the child eating and thriving? Is there any past history of illness, including jaundice, blood disorders, or intrauterine or neonatal conditions? Questions to ask about family history Is there any history of gastrointestinal disease (acute or chronic)? Is there any history of haematological disease? Is there a family history of polyps[1]? Questions to ask about medication Particularly use of: Non-steroidal anti-inflammatory drugs. Steroids. Iron supplements. Any substances likely to colour the stool (liquorice, bismuth, etc). Examination Look for signs of shock. Look for signs of bleeding from other areas (oropharyngeal, nasal, etc). Examination of the skin may reveal evidence of systemic disorders (for example, Henoch-Schönlein purpura and Peutz-Jeghers syndrome). Examine the abdomen. Look for signs of constipation. Hyperactive bowel sounds may occur with upper gastrointestinal haemorrhage. Examine the perianal area. Look for evidence of fissures or fistulas and assess perianal skin. Consider rectal examination. This may reveal polyps, masses or occult blood. Differential diagnosis The likely causes of rectal bleeding in children vary with age. Swallowed maternal blood: Occurs in neonates. Also found in regurgitated milk of breast-fed infants. Maternal nipples may be cracked and sore. Anal fissure: Occurs in neonates and infants but also in older children. Bright red blood and pain are features of this condition. Fissure is visible on examination and no further investigation is required. Stool softeners may be needed if the child is constipated. Investigations Most cases of rectal bleeding in children are benign and self-limiting. The majority of cases will not require any investigation. When bleeding is substantial or recurrent consider: FBC - anaemia or thrombocytopenia. Clotting studies - clotting disorder is suspected. LFTs - liver disease. Imaging - this is not usually necessary or helpful but may be necessary where more unusual causes of bleeding need to be excluded (in ill children or children with substantial or recurrent bleeding). Endoscopic examination in children is usually done under general anaesthesia and by specialist paediatric gastroenterologists[12]. Management The management will depend on the cause and extent of bleeding. As most cases will be simple, self-limiting and benign, management will focus on explanation, reassurance and 'safety-netting'. When bleeding is profuse or recurrent then management will focus on resuscitation, investigation and then treatment of the cause. #BleedingPerRectum #DrArmaghanAhmed #pediatricsurgeon #childrenhospitallahore #doctor #healthcare