ISSN - 0973-0958
Menu
Disease
A-Z
Health Topics
Alternative Medicine
Developmental Pediatrics
General Pediatrics
Genetics
Immunodeficiencies
Infectious Diseases
Laboratory Medicine
Neonatology
Nutrition
Pediatric Cardiology
View all Topics
Featured Articles
Skin allergies
Diabetic ketoacidosis
Cushing's syndrome
Urticaria (hives) and angioedema
Anaphylaxis
Anal itching
Kids Corner
Health and Knowledge with fun.
Drugs &
Calculators
Medical Calculators
Drug Calculators
Growth Calculators
Renal Calculators
View all Calcualtors
Drug Index
ACE inhibitor
Alkylating agents
Allergies
View all Drugs
Poisoning Center
Aluminum phosphide
Anti-histaminics
Antidepressants
View all Drugs
Medical Eqipments
Monitors
Pumps
Incubators
View all Equipments
Diagnostic Aid
Get your diffrential
diagnosis.
Consult
& Posts
Ask a Doctor
Diagnostic Dilemma
Question of the Week
Pediatric Blogs
Spot Diagnosis
Grand Rounds
Pedi Poll
Pediatric
Journal
Current Issue
All Issues
Advance Access
About the Journal
Submit Article
Books
& Apps
Book Store
Pediatric Oncall
Medical Calculators
Vaccine Reminder
Pediatric Oncall Journal
Drug Center
Parenting
CME &
Videos
Upcoming Conferences
Conference Abstracts
MCQs
Videos
Vaccine
Reminder
Sign In
Home
Articles & Issues
Current Issue
All Issues
Advance Access
About
Pediatric Oncall Journal
Editorial Board
Peer Review Policy
Other Policies
Copyrights
Privacy Statement
Contribute
Open Access Statement
Authorship & Acknowledgment
Author Guidelines
Forms
Submit Manuscript
Dr Ira Shah
https://www.pediatriconcall.com/Journal/images/journal_cover.jpg
TEACHING FILES (GRAND ROUNDS)
Year :
July-September 2012
| Volume :
9
|
Issue :
3
DOI :
https://doi.org/10.7199/ped.oncall.2012.47
Hematemesis and malena
Hematemesis and malena
25/05/2012
25/05/2012
Ira Shah
https://www.pediatriconcall.com/Journal/images/journal_cover.jpg
Dr Ira Shah.
Medical Sciences Department, Pediatric Oncall, Mumbai, India.
Cite this article
Shah I. Hematemesis and malena. Pediatr Oncall J. 2012;9: 88. doi: 10.7199/ped.oncall.2012.47
Clinical Problem :
A 3 years old boy born of non consanguineous marriage presented with hematemesis and malena 1 year ago and again with malena 6 months ago for which child required blood transfusion. There is no jaundice or bleeding from any other site. On examination, he is pale. There is no jaundice and spleen is just palpable. Other systems are normal. Investigations are depicted in Table 1.
• Hemoglobin = 6.7 gm, dl, WBC = 6400, cumm, platelets = 1,27,000, cumm
• Bilirubin = 0.8 mg, dl, SGOT = 51 IU, L, SGPT = 67 IU, L, Total proteins = 6.9 gm, dl,
Albumin = 3.9 gm, dl.
• Prothrombin time, partial thromboplastin time = Normal
• Ultrasound abdomen = Normal.
Question :
What is the cause of hematemesis and malena in this child _?
Expert Opinion :
This child has hematemesis and malena with just palpable spleen, mildly elevated liver enzymes, thrombocytopenia, Thus one should consider differential diagnosis of extrahepatic portal hypertension, chronic liver disease, hemolytic anemia with hypersplenism and bleeding disorder. For chronic liver disease, the liver should be palpable. A non-palpable liver would suggest shrunken liver and cirrhosis. However, then patient should have hypoalbuminemia and coagulopathy which are all normal. Thus, in this child, chronic liver disease seems unlikely. Hemolytic anemia with hypersplenism would imply a large spleen and pancytopenia. In this child, spleen is just palpable and there is no pancytopenia so hypersplenism is also unlikely. In case of bleeding disorder, though this child has low platelet count, they are not that low to cause bleeding. Also, prothrombin time and partial thromboplastin time are normal. Thus, platelet function defects could be the cause of bleeding. However, bleeding disorders should cause bleeding in other areas as well and there should be petechiae or other signs of bleeding. Thus, bleeding disorder should not be considered as primary diagnosis. Extrahepatic portal hypertension can cause hematemesis and malena. Mildly elevated liver enzymes can occur due to portal biliopathy. In this child esophagcogastroscopy and colour doppler of abdomen should be done. Colour doppler showed portal cavernoma following portal vein thrombosis and multiple collaterals in periportal region suggestive of portal cavernoma. Thus, this child was diagnosed as extrahepatic portal hypertension.
Funding:
None
Conflict of Interest:
None
DOI No. :
https://doi.org/10.7199/ped.oncall.2012.47
Cite this article as :
Shah I. Hematemesis and malena. Pediatr Oncall J. 2012;9: 88. doi: 10.7199/ped.oncall.2012.47
Journal Subscription
Pediatric Oncall Journal
Subscribe Now
This Article
Full Text
View Full Article (PDF)
Authors
Dr Ira Shah
[Google Scholar]
[Pubmed]
Other
Find Articles in same issue
Find Articles under same category
Cite this article as
Shah I. Hematemesis and malena. Pediatr Oncall J. 2012;9: 88. doi: 10.7199/ped.oncall.2012.47
Ask a Doctor
Recommended for you
Upper Gastrointestinal Bleed
Anesthesia and Associated Diseases
Eye Problems
Videos
Why are we failing in control of tuberculosis? - Lecture by Dr Ira Shah
Dr. Kheya Ghosh Uttam: About Newborn Screening Test | Pediatric oncall
Dr. Kumud Mehta: Nephrotic Syndrome
View All
Grand Round
Dilemma
A Queer Case of Thrombocytopenia in a Child
Answer
Acute liver failure due to acetaminophen toxicity - how to treat?
Paradoxical adenopathy in a child with tuberculosis
Arrhythmia
This girl presented with jaundice, skin lesions and anemia of 15 days duration. She was diagnosed to...
Answer
Congenital edema of feet
Hiv and tb
Kalaazar in child who has not visited endemic area
Pediatric Oncall Journal
Original Article
Health Conditions screened by the 4D`s Approach in a District Early Intervention Centre (DEIC) under Rashtriya Bal Swasthya Karyakram (RBSK) Program
Case Reports
Letter To Editor(Viewers Choice)
Multiple Bee Stings induced Multiorgan Dysfunction in a 4 Year Old Female
MCQ
MCQs Set 1
MCQs on Inborn Errors of Metabolism
MCQs on Respiratory System
MCQs in Neonatal Resuscitation
MCQs on Infectious Diseases - 2
This work is licensed under a
Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
X
Sign In
Disease A-Z
Health Topics
Alternative Medicine
Developmental Pediatrics
General Pediatrics
Genetics
Immunodeficiencies
Infectious Diseases
Laboratory Medicine
Neonatology
Nutrition
Pediatric Cardiology
View all topics
Featured Articles
Skin allergies
Diabetic ketoacidosis
Cushing's syndrome
Urticaria (hives) and angioedema
Anaphylaxis
Anal itching
Kids Corner
Drugs & Calculators
Medical Calculators
Drug Calculators
Growth Calculators
Renal Calculators
View all Calculators
Drug Index
ACE inhibitor
Alkylating agents
Allergies
View all Drugs
Poisoning Center
Aluminum phosphide
Anti-histaminics
Antidepressants
View all Drugs
Medical Eqipments
Monitors
Pumps
Incubators
View all Eqipments
Diagnostic Aid
Consult & Posts
Ask a Doctor
Diagnostic Dilemma
Question of the Week
Pediatric Blogs
Spot Diagnosis
Grand Rounds
Pedi Poll
Pediatric Oncall Journal
Current Issue
All Issues
Advance Access
About the Journal
Submit Article
Books & Apps
Book Store
Pediatric Oncall
Medical Calculators
Vaccine Reminder
Pediatric Oncall Journal
Drug Center
Parenting
CME & Videos
Upcoming Conferences
Conference Abstracts
MCQs
Videos
Vaccine Reminder
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0