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Bleeding per rectum lecture by Dr Rahul KMK
- 1. BLEEDING PER RECTUM IN CHILDREN RAHUL KHATRI MC/2025/074
- 3. COMMONCAUSES OF BPR NEWBORNS RED BLACK UPPER GIT (Esophagus, stomach, small bowel) .Volvulus of midgut .Bacterial enteritis .Drug induced .Congenital or acquired coagulopathies . Hemorrhagic disease of newborn .Intussusception .Erosions in stomach, esophagus , duodenu m .Peptic ulcer disease LOWER GIT ( Colon, rectum, anus) .Anal fissure .Arterio-venous malformations
- 4. INFANTS/TODDLERS RED BLACK UPPER GIT . Volvulus of midgut . Bacterial enteritis . Drug induced . Congenital/acquired coagulopathies . Gangrenous bowel-other causes . Band obstruction . Intussuception . Meckel’s diverticulum . Benign hamartomas . Tumors - Lymphoma/Carcinoid . GER . Gastritis/H.Pylori /Sress/Drugs/Syst emic illness/ . Peptic ulcer disease LOWER GIT . Rectal polyp . Anal fissure . Arterio-venous malformations . Colonic polyps
- 5. OLDER CHILDREN RED BLACK UPPER GIT . Esophageal varices – Portal HTN . Esophageal (Esophagus, . Gastric varices varices – Portal stomach, . Volvulus of midgut hypertension small bowel) . Bacterial enteritis . Peptic ulcer . Drug induced disease . Congenital/acquired coagulopathies . Hemorrhagic disease of newborn . Intussusception LOWER . Anal fissure GIT . Inflammatory bowel disease ( Colon, . Infectious diarrhoea rectum, .Arterio-venous malformations
- 6. Quantification MASSIVE – Evaluation & Rx of shock, control of bleed + evaluation of cause of bleed MODERATE – hospitalisation, rapid evaluation of source of bleed, control of bleed MILD – evaluation of cause on outpatient basis, Rx as per the source of bleed
- 7. Clinical scenarios Clinical picture Diagnosis Blood mixed with stools Infective – enteritis/colitis, Hemolytic Uremic syndrome, NEC, Eosinophilic enterocolitis, IBD Blood streaks on stool Anal fissure/rectal mucosal ulceration Constipation Rectal prolapse Blood after defecation in drops with normal stools Rectal polyp Vascular anomalies of lower GIT Blood with mucus in stools Infective Intussusception Frank blood Volvulus of midgut Arteriovenous malformations NEC Occult bleeding PR Worm infestation Acid peptic disease of upper GIT Celiac disease IBD
- 8. How could the clinician determine the severity of GI bleed? • Physical appearance • Pallor • Hemodynamic status • Estimated volume of blood lost • Color of lost blood Worrisome S/S Pallor Diaphoresis Restlessness Lethargy Abdominal pain DANGER SIGNALS Orthostatic changes in HR & BP
- 9. Clinical approach • Look at the child – well or ill • Look at vital parameters – hemodynamically stable or not • Look at the abdomen – distended or normal, lump palpable, tenderness anywhere, • Look at the rectum – do a per rectal examination – anal fissure, polyps • Look at the type of blood in the stools
- 10. Can the child suspected with bleeding P be normal? Substances that deceive • Red discoloration • candy, fruit punch, Jell-o, beets, watermelon, laxatives, pheny rifampin • Black discoloration • bismuth, activated charcoal, iron, spinach, blueberries, licorice
- 11. THANK YOU