GASTROINTESTINAL-BLEEDING IN CHILDREN - IMPLICATIONS FOR NURSING

Gastrointestinal (GI) bleeding is a common reason for a pediatric surgical consult or referral. This bleeding may be evidenced by bright red or coffee-ground emesis (hematemesis), bright red or maroon blood per rectum (hematochezia), or dark, tarry stools (melena).(42) The causes of GI bleeding can be examined in relation to the anatomic source of the bleeding and the child's age. The presentation of the child with GI bleeding ranges from the rare child who presents in shock secondary to extensive hemorrhage to the stable patient who may be asymptomatic of minimal blood loss detected only in analysis of GI secretions or stool.(3) Nurses who care for children gather much important information in their assessments. Thus, an understanding of the cause, diagnosis, and treatment of select disease entities resulting in GI bleeding will aid the nurse in the assessment and care of these children. This article provides an overview of such conditions. There are five steps in the diagnosis and management of the child with GI bleeding: (1) resuscitation and stabilization (as necessary), (2) verification that the patient has actually bled, (3) differentiation between an upper or lower GI tract source of bleeding, (4) identification of the specific disorder causing the bleeding, and (5) treatment for the specific condition.(3, 25) The following section addresses management of the unstable patient. A brief discussion of the anatomy of the GI tract and the workup for GI bleeding follows. Finally, there is a review of the specific disorders resulting in GI bleeding.