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Child has chronic constipation, increase in epistaxis. Vomiting, emesis with blood clots. How worried should I be?

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My 9 yr old son, otherwise healthy (chronic constipation, successfully treated with lactulose daily) has had recent increase in epistaxis (both frequency and volume). Last episode was about 3-4 days ago. Last night had some fatty foods and garlic. Vomited after 5-6 hours, felt better. Since then had a couple more episodes of emesis (small volume), this time with blood clots, very few in the first one, about 20 ml in the second. The latter was bilious in colour. No abdo pain, feels "yucky", looks a bit pale, but not weak. How worried should I be? Should I go to ER?
Posted Thu, 12 Apr 2012 in Digestion and Bowels
Answered by Dr. Poorna Chandra K.S 3 hours later
Hi and thanks for the query
The two symptoms of epistaxisis and blood in vomitus can be either due to a single disease or a mere co-incidence.
Epistaxsis is a common disorder and retching involved in vomiting itself causes erosions at the Gastroesophageal junction (Mallory Weis tear) and subsequent blood in vomitus. The classical history is that of vigorous vomiting initially followed by blood in the vomitus. The bleeding is often self limited and healing is accelerated with the use of acid suppresants.
The clinic history suggests a emetic type of food poisoning and this is usually self limiting and needs only symptomatic treatment with antiemetics and hydration
However a rare heriditary disorder which can explain both epistaxis and blood in vomitus is Heriditary hemorrhagic telengiectasia - Classically presents with recurrent epistaxsis, Bleeding from the gut, redspots or petichae on the skin and renal manifestations. Diagnosis is mainly by clinical and endoscopic visualisation of the bleeding lesions
Above answer was peer-reviewed by
Follow-up: Child has chronic constipation, increase in epistaxis. Vomiting, emesis with blood clots. How worried should I be? 2 hours later
Thanks! Since my enquiry my son has had about 10 more bouts of emesis, all blood free. It seems the illness has declared itself and it's a garden variety gastroenteritis. We gave him 15 mg of Gravol and pedialyte ice cubes. He feels a tad better. Watching the Smurfs may have also helped :-)
Answered by Dr. Poorna Chandra K.S 3 days later
Hello again,

Thank you for writing back.

I am happy that your son is feeling much better now. Continue with what you have been giving him, avoid spicy foods for the time being.

If these episodes of epistaxis or blood in the vomitus recurs, you should take him to the ER.

Your son should be fine.

Wishing your son good health.

Please accept my answer if you do not have any more queries.

Above answer was peer-reviewed by
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