GI bleeding can be divided into upper GI hemorrhage (bleeding proximal to the ligament of Treitz) and lower GI hemorrhage (bleeding distal to that point). It is helpful to try and identify the site in the GI tract where the bleeding may originate from based on the color and nature of the bleeding, in context with the other presenting signs and symptoms.

The evaluation of a potential GI bleed should first establish the hemodynamic stability of the patient. Second, it is necessary to ensure that blood is present because many foods and drinks can discolor stool and vomit. The next step is to identify the bleeding source. A detailed history and physical examination with attention to the patient’s age can clarify the source.

Upper gastrointestinal bleeding (UGIB) is an uncommon but potentially serious problem in children. Acute UGIB can present with hematemesis, which is defined as the vomiting of gross blood or coffee ground material, or with the passage of melena, maroon colored stools, or tarry stools. Occasionally, UGIB may present with hematochezia, blood per rectum, because the bleeding is very rapid and, therefore, not altered by the transit time through the digestive system. A nasogastric tube lavage that yields blood or coffee ground material confirms the diagnosis of an UGIB.

An initial priority when evaluating a child with suspected GI bleed is to assess both the hemodynamic stability and the severity of the bleeding, followed by resuscitation if necessary. A nasogastric tube may be helpful to assess extent of bleeding. Significant losses may be caused by hemorrhagic gastritis, esophageal varices, peptic ulcers, and vascular malformations. Both a gastroenterologist and a surgeon should be notified early on if a patient is suspected to have severe acute bleeding.