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    UST Department of Pediatrics Pediatrics 2-Module 1 Gastroenterology-Hematology-Cardiology Module Student's Guide On Bleeding

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    Jolaine Vallo
    1) 11-year-old female presented with profuse nosebleed after picking her nose, which later resulted in vomiting blood. 2) On examination, she was anxious but conscious with stable vital signs. Physical exam found blood clot in right nostril and pale boggy turbinates. 3) Differential diagnosis includes conditions causing bleeding disorders like liver disease or vitamin K deficiency based on her bleeding history and physical exam findings. Laboratory tests will help evaluate for a potential primary bleeding disorder.

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    UST Department of Pediatrics Pediatrics 2-Module 1 Gastroenterology-Hematology-Cardiology Module Student's Guide On Bleeding

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    Jolaine Vallo
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    1) 11-year-old female presented with profuse nosebleed after picking her nose, which later resulted in vomiting blood. 2) On examination, she was anxious but conscious with stable vital signs. Physical exam found blood clot in right nostril and pale boggy turbinates. 3) Differential diagnosis includes conditions causing bleeding disorders like liver disease or vitamin K deficiency based on her bleeding history and physical exam findings. Laboratory tests will help evaluate for a potential primary bleeding disorder.

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    1) 11-year-old female presented with profuse nosebleed after picking her nose, which later resulted in vomiting blood. 2) On examination, she was anxious but conscious with stable vital signs. Physical exam found blood clot in right nostril and pale boggy turbinates. 3) Differential diagnosis includes conditions causing bleeding disorders like liver disease or vitamin K deficiency based on her bleeding history and physical exam findings. Laboratory tests will help evaluate for a potential primary bleeding disorder.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    42 views1 page

    UST Department of Pediatrics Pediatrics 2-Module 1 Gastroenterology-Hematology-Cardiology Module Student's Guide On Bleeding

    Uploaded by

    Jolaine Vallo
    1) 11-year-old female presented with profuse nosebleed after picking her nose, which later resulted in vomiting blood. 2) On examination, she was anxious but conscious with stable vital signs. Physical exam found blood clot in right nostril and pale boggy turbinates. 3) Differential diagnosis includes conditions causing bleeding disorders like liver disease or vitamin K deficiency based on her bleeding history and physical exam findings. Laboratory tests will help evaluate for a potential primary bleeding disorder.

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    © All Rights Reserved
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    UST Department of Pediatrics

    Pediatrics 2-Module 1
    Gastroenterology-Hematology-Cardiology module
    Student’s guide on bleeding

    #commonyetuncommon

    Anna, an 11-year old female, Filipino, Roman Catholic from Sampaloc Manila was brought to the
    Emergency Room due to profuse nosebleeding.

    History of the Present Illness:

    Two days prior to consult, Anna developed cough and colds. Few hours prior to consult, Anna
    picked her nose removing the nasal discharge that dried up (booger). She pinched her nose and
    put cold compress on her forehead. Bleeding was quite profuse. An hour later, she vomited
    previously ingested food admixed with blood. She panicked and turned pale. However, she
    remained conscious. She was immediately brought to UST Hospital Emergency Department for
    consult.

    PE: awake, anxious, ambulatory


    BP= 100/60, CR= 110/min, RR=24/min, T= 37.0oC, Wt= 33 kg. Lt = 135 cm
    Skin: with greenish discoloraYon on right thigh measuring 3 cm in widest diameter
    Pink palpebral conjuncYvae, anicteric sclerae, intact tympanic membrane, (+) blood clot in
    right nostril, with pale boggy turbinates in the right nostril, pinkish buccal mucosa, Grade
    1 slightly hyperemic tonsils without exudates,
    No enlarged cervical lymph nodes
    Symmetrical chest expansion, no retracYons, resonant, clear breath sounds
    Adynamic precordium, apex beat at 5th LICS MCL, normal heart sounds, no murmurs
    Abdomen flat, bowel sounds 12 click/minute, tympaniYc on all quadrants, liver span 6.5 cm,
    Traube’s space not obliterated, soa, non-tender
    ExtremiYes; no gross deformiYes, no edema, pulses full and equal, CRT < 2 seconds

    GUIDE QUESTIONS:

    1. What historical data will you gather from the informant?


    a. History of mucocutaneous bleeding or deep muscle and joint bleeding
    b. Underlying medical condiYons that can cause hemostaYc derangement like liver disease,
    malabsorpYon syndrome, Vitamin K deficiency, etc.
    c. Intake of drugs like aspirin, NSADS, anYbioYcs, anYconvulsants
    d. Family history of the same symptoms especially among the male relaYves
    2. What are the salient features of the case?
    3. Discuss the importance and clinical implicaYon of your physical examinaYon findings? How
    will you correlate these physical findings with the possible cause/s of bleeding in this paYent?
    4. What clinical condiYon/s would you consider given the above informaYon?
    5. What laboratory examinaYons will you request for? Give the principles of each. Correlate the
    expected results with the clinical condiYon of this paYent.
    6. Interpret the results
    7. What laboratory tests should be further requested if a primary bleeding disorder is highly
    suspected?
    9. How would you manage this paYent?

    Please refer to Nelson’s textbook of Pediatrics 21th ed. Chapter 504, pp2589-2618

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