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Morning Report- Monday, August 1 st 2011

Trivia of the day: Residents of which state got their nickname from the tar seeping out of the ground that became a major product of that state?. Morning Report- Monday, August 1 st 2011. North Carolina “ tarheels ”.

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Morning Report- Monday, August 1 st 2011

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  1. Trivia of the day: Residents of which state got their nickname from the tar seeping out of the ground that became a major product of that state? Morning Report- Monday, August 1st 2011

  2. North Carolina “tarheels” That was for Simone, who gave me the great idea for trivia at the beginning of AM report!!

  3. GI Bleeding in Infants and Children

  4. Initial Approach • Step 1: ABCs!! Assess hemodynamic status of the patient • Orthostatic changes- best indicator of significant blood loss • Step 2: Establish severity of bleeding • Coffee ground emesis, melena: lower rate of bleeding • Bright red blood: ?higher rate of bleeding

  5. UGI vs. LGI Bleeding • Step 3: Determine the location of the bleeding • UGI: bleeding above the ligament of Treitz • Hematemesis • LGI: bleeding distal to the ligament of Treitz • Bloody diarrhea • Bright red blood mixed with or coating stool • Hematochezia, melena, or occult blood loss can be due to both UGI or LGI bleeds • Passing NGT can determine if the blood is originating from the UGI tract ot LGI tract

  6. Is it Blood? Simulates Melena Simulates bright red blood Bismuth or iron preparations Spinach Blueberries Grapes Licorice • Food coloring • Colored gelatin or children’s drinks • Red candy • Beets • Tomato skins • Antibiotic syrups

  7. Group Assignment • Break into 3 groups: • Infant • 2-5 years old • Older child • Come up with a differential diagnosis for lower GI tract bleeding in your age group • The “Older child group” has an additional task…since our case is an older child, which diagnosis do you think is most likely and why?

  8. Infant

  9. LGI Bleeding in Infants • Necrotizing enterocolitis • Hirschprungenterocolitis • Volvulus/ Intussusception • Infectious colitis • Anal fissure • Eosinophilicproctocolitis • Nodular lymphoid hyperplasia • Swallowed maternal blood • Coagulopathy • Allergic colitis

  10. Child 2-5 years old

  11. LGI Bleeding in 2-5 year-olds • Intussusception • Volvulus • Henoch-Schonleinpurpura • Hemolytic-uremic syndrome • Meckeldiverticulum • Juvenile polyp • Ulcerative colitis/ Crohn’s disease • Infectious colitis • Nodular lymphoid hyperplasia • Perianal streptococcal cellulitis • Rectal prolapse/ rectal ulcer

  12. Older Child

  13. LGI Bleeding in the Older Child • Infectious colitis • Ulcerative colitis/ Crohn disease • HSP • Intestinal ischemia • Meckeldiverticulum • Juvenile polyp • Hemorrhoid

  14. Infectious Diarrhea

  15. Thanks for your attention! Noon Conference: Radiology

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