Blood and Bile-stained vomiting in pediatrics.pdf

This document briefly discusses about blood stained and bile stained vomiting in pediatric patients where both pediatric and neonatal emergencies. This contains causes for blood vomiting and bile vomiting, clinical features which may help you to exclude different differential diagnoses, relevant investigations and management. Hope you may improve your knowledge through this. Good Luck.!

1. BLOOD AND BILE-STAINED
VOMITING
Sankalpa Gunathilaka
MBBS(UG)
Dip.in Psychology and Counseling
In
Pediatrics

2. CONTENT
➢Vomiting introduction
➢Bile stained Vomiting – Causes, Clinical findings, Investigations, Management
➢Blood stained Vomiting – Causes, Clinical findings, Investigations, Management

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3. ▪Vomiting = forceful expulsion of gastric contents
▪Common symptom in infancy and childhood
▪Non specific symptom
▪May be due to medical, surgical or psychological causes
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Bile Stained (Bilious) Vomiting Blood Stained Vomiting
❑Intestinal Obstruction (Below the ampula) ❑GORD / Esophagitis
▪ Atresia and Stenosis of Jejunum and Ileum❑Gastric / Duodenal ulceration
▪ Meconium Ileus ❑Mallory Weiss syndrome
▪ Malrotation and midgut volvulus ❑Esophageal varices
❖Causes for blood and Bile stained vomiting :

4. BILE STAINED VOMITING
▪Bile stained vomiting in neonates/children always consider evaluation and investigation for
Intestinal Obstruction.
Bile stained vomiting is from Intestinal obstruction until proven otherwise.
▪Intestinal obstruction is a common surgical emergency in neonatal period.
▪Diagnosis is made on clinical features and abdominal X-ray showing intestinal obstruction.
▪Mostly present soon after birth but may takes some days to present.
▪Present with : Persistent vomiting
Bile stained vomiting
Abdominal distention
Delayed/failure to pass meconium
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5. Atresia and stenosis ❑Most astresias(including duodenal astresias) are postampulary.
▪Bilious vomiting (most common presentation)
▪Abdominal distention may occur in distal astresias where as no distention
in proximal astresias
Meconium Ileus ▪Bilious vomiting
▪Fail to pass meconium within 48 hours
▪Abdominal distention
Malrotation and
volvulus
▪Sudden onset of Bilious vomiting(Hallmark)
▪Prior feeding problems
▪Transient episodes of bilious vomiting
▪Failure to thrive
▪Colicky abdominal pain
▪Abdominal distention
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6. Examination : Growth parameters
Abdominal examination – Abdominal distention
Level of hydration
Signs of nutrition deficiency
Others systemic examinations - BP
Investigations : Supine abdominal X-ray is the investigation of choice in confirming the diagnosis
and identifying the level of obstruction.

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Abdominal X ray in duodenal atresia showing
“double bubble” appearance from distention
of stomach and duodenal cap.

7. Management :
▪ Keep the baby nil by mouth
▪ Nasogastric tube decompression
▪ IV fluid resuscitation
▪ Prevention of hypothermia
▪ Prophylactic IV antibiotics
▪ Plan for surgery
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8. BLOOD STAINED VOMITING
GORD / Esophagitis Hematemesis is a RED FLAG sign in GORD/ Esophagitis
▪Regurgitation
▪Symptoms precipitate with fatty meals and when lying down
▪Soreness of mouth
Gastric / Duodenal
Ulcer
▪Epigastric burning pain
▪Precipitate with foods -> Gastric Ulcer
▪Relieve with foods, Nocturnal pain awakening the child from sleep->
Duodenal Ulcer
Mallory Weiss
syndrome
▪History of repeated forceful vomiting (with initial vomitus without blood)
Esophageal varices ▪Bleeding tendency
▪History of blood transfusion/ needle prick injury/ maternal Hx of Hep.B
▪Yellowish discoloration of eyes and hypochondrial pain
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9. Investigation :
▪FBC – Hb
▪Blood grouping and cross matching
▪PT/INR
▪Upper GI Endoscopy
▪Liver function test (Esophageal varices is related with portal hypertension which can be
caused by an underlying liver pathology)
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10. Management of acute
upper GI bleeding
▪Correct hypovolemia
▪Correct anemia
▪Stop bleeding
▪Prevent recurrence

Management of
Esophageal varices
▪Stop bleeding
▪Endoscopic variceal ligation
▪Selective variceal ligation
Management of
GORD/Esophagitis
▪Omeprazole
▪Antacids
▪H2 blockers
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11. THANK YOU !
Sankalpa Gunathilaka
MBBS (UG), Dip.in Psychology and Counseling
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