Physical examination in an infant or child with upper gastrointestinal bleeding

Physical examination	Diagnostic considerations/implications
Rapid assessment
Tachycardia, hypotension or orthostasis, poor capillary refill, cold extremities, altered sensorium	Shock (eg, due to massive gastrointestinal blood loss)
Skin
Bruising, petechiae	Bleeding disorder (eg, ITP), physical abuse, trauma
Vascular malformations (eg, telangiectasias, hemangiomas)	Disorders with generalized vascular malformations (eg, hereditary hemorrhagic telangiectasia)
Melanosis	Peutz-Jeghers syndrome (with intestinal polyposis)
Nasopharynx
Blood or injury to the nares	Epistaxis with swallowed blood
Pharyngeal bleeding or injury	Posterior nasopharyngeal bleeding with swallowed blood
Abdomen
Hepatomegaly, hard liver edge, and/or splenomegaly	Portal hypertension (eg, from cirrhosis, portal vein thrombosis, or Budd-Chiari syndrome)

ITP: immune thrombocytopenia.

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