Approach to melena and hematemesis (pediatrics) Quiz: Ace Your Exams
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A 10-year-old boy presents to the primary care clinic with nausea and abdominal pain for one month. The pain localizes to the epigastrium and improves with eating and drinking milk. He has had two episodes of coffee ground emesis and one episode of black stool in the past 24 hours. The patient has not had diarrhea, mucous in stools, weight loss, or fever. Parents report he frequently takes ibuprofen for pain related to sports injuries. Family and surgical history are non-contributory. Temperature is 37° C (98.6°F), pulse is 85/min, respirations are 19/min, blood pressure is 110/61 mm Hg, and oxygen saturation is 96% on room air. Abdominal examination reveals mild epigastric tenderness, but no rigidity, rebound, or guarding. Cardiopulmonary exam is unremarkable. Labs are shown below. Endoscopy reveals atrophic gastritis with mucosal lesions and a punched-out, smooth ulcer base. Which of the following is the best next step in management?
| Laboratory value | Results |
| Hemoglobin | 10.5 gm/dL |
| Mean corpuscular volume (MCV) | 70 fL |
| Mean corpuscular hemoglobin (MCH) | 22 pg |
| Platelets | 230,000 /μL |
| Prothrombin time (PT) | 11 |
| Activated partial thromboplastin time (PTT) | 28 |
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