Immediate Questions

A. Are parents able to quantify amount of bleeding? Would parents estimate blood loss as a spoonful, cupful, or more? Were there blood streaks or coffee-ground material in emesis? Was there frank bright red blood? Estimated volume of blood loss should be correlated with child's clinical condition. If required, initiate fluid resuscitation immediately.

B. Does patient appear to be in pain? Pain suggests an inflammatory or ischemic lesion. Causes needing urgent care include an obstructive lesion or abdominal trauma resulting in ischemia or massive hemorrhage. Bleeding into the biliary tract after abdominal trauma can also produce right upper quadrant pain and jaundice.

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