Hepatitis A with hematemesis

Author: Pediatric Oncall

Question
A 4½ years old girl born of non-consanguineous marriage presented with 2-3 episodes of vomiting containing food particles following by coffee-colored vomitus and fever. There was no jaundice, pain in the abdomen, drug ingestion, bleeding from other sites, or altered sensorium. Birth history and family history were non-contributory. She has never had any major illness in the past. Milestones were normal. On examination, vital parameters were normal. She had a just palpable liver and spleen. Other systems are normal. Investigations showed:
• Hemoglobin = 11.6 gm/dl
• WBC = 8,500/cumm [60% polymorphs, 40% lymphocytes]
• Platelets = 2,31,000/cumm
• Prothrombin Time (PT) = 12.6 sec (Normal)
• Partial thromboplastin Time (PTT) = 26.6 sec (Normal)
• Bilirubin = 3.0 mg% (Direct = 1.4 mg%)
• SGOT = 2220 IU/L, SGPT = 2550 IU/L
• Total proteins = 5.8 gm%, albumin = 3.8 gm%
• Serum electrolytes, creatinine, sugar = Normal
• Serum alkaline phosphatase = Normal
• Ultrasound abdomen and color doppler = Normal. Portal vein = 6.8 mm. No collaterals.
• Serum ammonia = 171 µg/dl (Normal = 30-90 µg/dl)
• Oesophageogastroscopy = Hiatus hernia with erosive gastritis
• HAV IgM = Positive
• HBsAg and HCV = Negative

Is hepatitis A the cause of the hematemesis?

Previous Discussions View All