Remember that glucose should be considered the sixth vital sign and any “sick” appearing child should have a point of care glucose done!
The first step in managing an acute upper GI bleed is to stabilize the patient with airway and volume restoration. An acidic environment promotes platelet disaggregation, fibrinolysis, and impairs clot formation, hence the utility of using PPI therapy. There is no proven mortality benefit to using PPI therapy, although it is still commonly used in practice. Early upper endoscopy within 24 hours of presentation is recommended in most patients because it confirms the diagnosis and allows for targeted treatment.
Determining the presence or absence of peritonitis is a primary objective of the abdominal examination. All the methods alone are inaccurate. Thoracic inflammatory process adjacent to the diaphragm, a voluntary contraction of the abdominal wall in apprensive patients, a rough painful examination, may be misleading. But what is more interesting is that NO TEST ALONE is useful in ruling out a diagnosis of peritonitis. Furthermore a gentle percussion is as inaccurate as the rebound test is, but it saves unnecessary pain.