🩸 Classifying Bleeding
• Hematemesis: UGI (bright red or coffee grounds)
• Melena: black tarry stool (upper or small bowel)
• Hematochezia: bright red/maroon per rectum (lower GI or massive upper GI)
• Occult blood: positive FOBT, no visible blood
⚠️ Red Flags (Emergent)
• Hemodynamic instability (tachycardia, hypotension)
• Massive bleeding with dropping Hgb
• Bilious vomiting + bloody stool (intussusception/volvulus)
• Suspected variceal bleeding (liver disease)
🩺 Common Lower GI Causes
• Anal fissure: bright red streaks on stool surface (most common cause of hematochezia in infants)
• Meckel diverticulum: painless, significant bleeding in toddler, Meckel scan
• Intussusception: currant jelly stool, colicky pain
• Juvenile polyps: painless bleeding, most common polyp in children
🩺 Common Upper GI Causes
• Mallory-Weiss tear: hematemesis after forceful vomiting
• Gastritis/peptic ulcer: NSAIDs, H. pylori, stress (NICU)
• Esophageal varices: portal hypertension (liver disease, portal vein thrombosis)
• Swallowed maternal blood (newborn, Apt-Downey test)
📌 Decision strategy: Hemodynamically unstable → resuscitate first. Swallowed blood (newborn) → Apt-Downey. Meckel: painless bleeding in toddler. Fissure: most common infant hematochezia.