Pediatric gastrointestinal bleeding can be divided into upper and lower GI bleeding.
Upper GI bleeding arises above the ligament of Treitz- also called the suspensory ligament of the duodenum- and it includes bleeding from the esophagus, stomach, or duodenum.
Common causes of pediatric upper GI bleeding include peptic ulcer disease, and esophageal bleeding.
Lower GI bleeding arises below the ligament of Treitz and includes bleeding from the small intestines past the ligament of Treitz, large intestines, rectum, and anus.
Common causes of lower GI bleeding include anal fissures, allergic, necrotizing or infectious enterocolitis, malrotation with volvulus, intussusception, Meckel’s diverticulum, juvenile polyps and inflammatory bowel disease.
Now, both upper and lower GI bleedings can be either visible or occult- meaning that there’s no visible evidence of bleeding. This is usually detected by a fecal occult blood test or if there are signs of iron deficiency anemia.
Okay, first things first. Visible upper GI bleeds may cause blood in the vomit, which might be fresh and bright red, known as hematemesis- and suggests moderate to severe ongoing bleeding, or it might look like coffee- grounds, which suggests that the blood has been oxidized by acid in the stomach so that the iron in the blood has turned black. This is a sign that bleeding was a small quantity or has stopped.
Blood in the stool or diaper may present as black and tarry stools, known as melena, which suggest small quantity bleeding, about 50 milliliters of blood, and that most often results from upper GI bleeding.