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Gastrointestinal bleeding is not rare in children. In an office practice,mucosal bleeding from an anal fissure, infectious or milk protein colitis, oral trauma, or prolapse gastropathy following a bout of vomiting is diagnosed with some regularity. Fortunately, torrential,hemodynamically significant bleeding is uncommon. Parental and physician anxiety over the latter occurs,however, with each new report of blood in emesis or stool. Therefore,a systematic approach to the various diagnostic and therapeutic options is critical.

The evaluation should focus on four areas of concern. First,establish whether the child is stable hemodynamically. A child who has hypovolemic shock precipitated by a ruptured esophageal varix commands different diagnostic and management strategies than an otherwise healthy child who has passed a bloody stool from an ulcerated colonic polyp. Second, ensure that blood is present. Potentially hazardous and uncomfortable tests can be avoided if stool discoloration...

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