Expert Opinion :
Hepatitis A in this child is responsible for liver disease and jaundice. However, it has not led to any coagulopathy as PT & PTT are normal. Hematemesis in the child with liver disease is either due to portal hypertension or coagulopathy. This child has neither of the two and hence liver disease does not seem to be the cause of hematemesis. Hiatus hernia leads to bringing up of the part of the stomach over the diaphragm. This itself leads to the incompetence of the lower esophageal sphincter which can lead to gastroesophageal reflux. Recurrent GER can predispose to gastritis and in this child, with multiple vomiting episodes, gastritis gets aggravated leading to erosions and hematemesis. Thus, hiatus hernia is the cause of hematemesis and not Hepatitis A.