Gastrointestinal bleeding — structured clinical encounter

Station 1 — recognition

The examiner asks what worries me about this child and how I frame the problem. I explain that bright red blood per rectum in a well toddler with no pain and a normal perianal exam points to a lower tract source, and that a Meckel diverticulum and a juvenile polyp head the differential. I confirm first that he is haemodynamically stable, because a painless bleed can still be large enough to cause shock, and I note that the colour and the age together set the direction before any test. ^{[1] [3]}