GI Bleeding

Question 1

Hematochezia =

Answer 1

stools w/ obvious blood (bright red, maroon, currant jelly)

Question 2

Loss >40% blood volume will cause ____

Answer 2

supine hypotension

Question 3

Loss ~15% blood volume will cause ____

Answer 3

orthostatic drop in SBP > 20 mmHg +/- increase HR of >20 bpm

Question 4

T/F: Hemoccult/gastroccult is helpful in diagnosing an acute GI bleed.

Answer 4

False. Not helpful acutely

Question 5

T/F: Hemoglobin/hematocrit is NOT reliable in acute bleed

Answer 5

True

Question 6

_____mL of blood in UGI tract causes melena

Answer 6

50-100 mL

Question 7

BUN/creatinine >20 → (UGI/LGI) source

Answer 7

UGI

Question 8

Blood clots in stool → (UGI/LGI) source

Answer 8

LGI

Question 9

T/F: Varices are painful

Answer 9

False. Ulcers are painful

Question 10

Secondary Aortoenteric Fistula is most common when?

Answer 10

Post repair of aortic aneurysm

Question 11

Herald bleed = a warning sign of what?

Answer 11

exsanguinating hemorrhage if AEF is not identified in timely fashion

Question 12

Which of the following is NOT a cause of massive bleeding?
A. Diverticular bleed
B. Hemorrhoids
C. Ischemia
D. Arteriovenous malformation

Answer 12

B. Hemorrhoids are chronic, less dramatic bleeding. So are colon cancers and IBD

Question 13

History of diarrhea suggests ____

Answer 13

IBD

Question 14

“Wipe” bleeding, anal discomfort suggests ____

Answer 14

hemorrhoids

Question 15

Most common anomaly of GI tract

Answer 15

Meckel’s diverticulum

Question 16

Protrusion of mucosa and submucosa through weak spots in circular muscle =

Answer 16

Diverticula

Question 17

Occult GI bleeding is detected by ____ (2)

Answer 17

iron deficiency or + fecal occult blood test

Question 18

Occult GI bleeding is typical of ____

Answer 18

early colon cancers

Question 19

Overt or occult bleed that persists or recurs after initial negative endoscopic/colonoscopic evaluation =

Approach for evaluation?

Answer 19

Obscure GI bleeding
Confirm negative endoscopies → focus on potential small bowel source via video capsule endoscopy, deep enteroscopy, angiography, CT enterography

Question 20

Which of the following is/are NOT a characteristic(s) of iron deficiency in adults?
A. Iron supplementation is sufficient approach
B. Decreased ferritin
C. Low MCV
D. Decreased transferrin

Answer 20

A. MUST work up for occult blood loss

D. compensatory increase in transferrin/TIBC

Question 21

Treatment for acute variceal bleeding

Answer 21

IV octreotide

Question 22

Laser, argon plasma coagulators, injection of epinephrine, ligation or gluing of varices are treatment options for ____

Answer 22

superficial mucosal lesion

Question 23

T/F: Surgery for ulcer bleeding is a first line option of treatment.

Answer 23

False. Only for failure of nonsurgical RX for ulcer bleeding

Question 24

T/F: Urgent colonoscopy in LGI bleeding reduces mortality, hospital stay, transfusion requirements… etc.

Answer 24

False. Statement true for urgent UPPER endoscopy in UGI. Urgent colonoscopy in LGI bleeding not as helpful

Question 25

T/F: If massive bleeding and can’t stabilize, perform an endoscopy to find out the source of the bleed.

Answer 25

False. Do NOT do endoscopy, consider alternatives.

Question 26

Which of the following is TRUE about angiography? A. REQUIRES active bleeding of at least 0.1 - 0.5 ml/min to identify bleeding site B. Requires bowel prep C. Procedure of choice in hemodynamically unstable pts

Answer 26

C A. 0.5-1.0 ml/min B. Does NOT require bowel prep

Question 27

T/F: Angiography is more sensitive that tagged RBC scan.

Answer 27

False. RBC scan requires less active bleeding (0.1-0.5 ml/min vs 0.5-1.0 ml) than angiography

Question 28

Which of the following is FALSE about the tagged RBC scan? A. REQUIRES active bleeding of at least 0.1-0.5 ml/min B. Useful in localizing bleeding site C. Helpful for evaluating intermittent bleeding D. Can re-image every few hours as needed

Answer 28

B. Difficult to localize.

Question 29

``` Which of the following is NOT a cause of small bowel bleeding? A. Angioectasias B. IBD C. NSAID enteropathy D. Gastroantral vascular ectasia E. Meckel's diverticulum ```

Answer 29

D. GAVE is a cause of upper GI bleed. Angioectasia = arteriovenous malformation (common in older pts)

Question 30

``` Which of the following is NOT a cause of upper GI bleeding? A. Vascular ectasias B. Arterial venous malformation C. Dieulafoy's lesion D. Meckel's diverticulum ```

Answer 30

D. Meckel's diverticulum is a cause of small bowel bleeding