Upper Gi Bleeding

Question 1

Q1: What is upper gastrointestinal (GI) bleeding?

Answer 1

A: Bleeding from the esophagus, stomach, or duodenum, characterized by hematemesis and melena.

Question 2

Q2: What are the major causes of lower GI bleeding?

Answer 2

A: Diverticulosis, angiodysplasia, inflammatory bowel disease, colorectal carcinoma, and hemorrhoids.

Question 3

Q3: What is the Rockall Score used for?

Answer 3

A: Estimating the risk of rebleeding or death in patients with upper GI bleeding.

Question 4

Q4: What percentage of lower GI bleeding cases stop spontaneously?

Answer 4

A: More than 75%.

Question 5

Q5: What is the main cause of esophageal varices?

Answer 5

A: Portal hypertension.

Question 6

Q6: Name a medication that can cause GI ulcers and hemorrhage.

Answer 6

A: Aspirin and NSAIDs

Question 7

Q7: What are some risk factors for lower GI bleeding?

Answer 7

A: Low fiber diet, obesity, physical inactivity, advancing age, and NSAID use.

Question 8

What increases the risk of rebleeding and mortality in GI bleeding?

Answer 8

A: Age, co-morbidities, shock, and active bleeding ulcers.

Question 9

What symptom often suggests chronic GI bleeding?

Answer 9

A: Iron-deficiency anemia.

Question 10

What is the significance of red signs on varices?

Answer 10

A: They indicate an increased risk of bleeding.

Question 11

What are red flag symptoms of lower GI bleeding?

Answer 11

A: Weight loss, change in bowel habits, iron-deficiency anemia, and abdominal masses.

Question 12

What symptom is associated with diverticulitis?
.

Answer 12

A: Painful cramps in the lower abdomen

Question 13

What are signs of shock in GI bleeding?

Answer 13

A: Pallor, cold extremities, systolic BP < 100 mmHg, and pulse > 100/min.

Question 14

What are typical symptoms of angiodysplasia?

Answer 14

A: Lower-grade bleeding, but can lead to massive hemorrhage if veins rupture.

Question 15

How does upper GI bleeding differ from lower GI bleeding in stool appearance?

Answer 15

A: Upper GI bleeding can cause melena, while lower GI bleeding often leads to bright red blood.

Question 16

Q16: What diagnostic test is preferred for detecting lower GI bleeding?
A:.

Answer 16

Colonoscopy

Question 17

What is a hallmark feature of diverticular bleeding?

Answer 17

A: Painless rectal bleeding.

Question 18

What test is recommended for diagnosing H. pylori in peptic ulcer disease?
.

Answer 18

A: Antral biopsy during endoscopy

Question 19

When is video capsule endoscopy used?

Answer 19

A: For detecting bleeding in the small bowel when other endoscopies fail.

Question 20

What does an elevated BUN-to-creatinine ratio indicate?

Answer 20

A: Likely upper GI bleeding.

Question 21

What is the first step in managing a significant GI bleed?

Answer 21

A: Restoring blood volume through transfusion and IV fluids.

Question 22

When should urgent endoscopy be performed for upper GI bleeding?

Answer 22

A: Within 24 hours for significant bleeding, or immediately for varices.

Question 23

What are the indications for blood transfusion in GI bleeding?

Answer 23

A: Shock and hemoglobin < 10 g/dL with active bleeding.

Question 24

How are bleeding varices typically treated during endoscopy?

Answer 24

A: With banding or injection of a sclerosing agent.

Question 25

What is the role of proton pump inhibitors (PPIs) in GI bleeding?

Answer 25

A: They reduce rebleeding rates in ulcer patients.

Question 26

What is a Mallory-Weiss tear?

Answer 26

A: A mucosal tear at the gastroesophageal junction caused by sudden increased abdominal pressure.

Question 27

What is the main symptom of a Mallory-Weiss tear? .

Answer 27

A: Hematemesis, often after vomiting

Question 28

What is angiodysplasia?

Answer 28

A: Tortuous, dilated veins in the colon, often causing bleeding.

Question 29

What is the treatment for diverticulitis?

Answer 29

A: Antibiotics for uncomplicated cases, and surgery for complications.

Question 30

How is chronic gastrointestinal bleeding often treated?

Answer 30

A: By addressing the underlying cause and administering oral iron.

Question 31

What is dual endoscopic therapy for peptic ulcers?

Answer 31

A: Combining epinephrine injection with thermal coagulation or clipping.

Question 32

Why is banding preferred over sclerotherapy for varices?

Answer 32

A: It is more effective in reducing rebleeding with fewer complications.

Question 33

What is the treatment of choice for gastric varices?

Answer 33

A: Injection of tissue glue.

Question 34

What findings on endoscopy suggest a high risk of rebleeding?

Answer 34

A: Spurting artery, active oozing, and exposed blood vessels.

Question 35

What is the role of thermal therapy in chronic GI bleeding?

Answer 35

A: It treats vascular lesions in the small bowel.

Question 36

What is a Transjugular Intrahepatic Portosystemic Shunt (TIPS)?

Answer 36

A: A stent placed to reduce portal hypertension, used if other therapies fail.

Question 37

What is the mortality rate of variceal hemorrhage in severe liver disease?

Answer 37

A: Up to 50% in Child’s grade C liver disease.

Question 38

How does somatostatin help in variceal bleeding?

Answer 38

A: It reduces bleeding by decreasing splanchnic blood flow.

Question 39

What is the prognosis for GI bleeding overall? .

Answer 39

A: Mortality rates range from 5–12%, depending on age and co-morbidities

Question 40

What therapy reduces portal pressure in variceal bleeding?

Answer 40

A: Non-selective beta-blockers like propranolol.

Question 41

What fluids are initially used while awaiting blood transfusion?

Answer 41

A: Plasma expanders or 0.9% saline.

Question 42

Why is hemoglobin not immediately a reliable indicator of bleeding severity?

Answer 42

A: Anemia does not develop immediately due to lack of hemodilution

Question 43

What is the treatment for active lower GI bleeding caused by angiodysplasia?

Answer 43

A: Colonoscopic coagulation, or segmental resection if bleeding persists.

Question 44

When is surgery indicated for diverticular disease?

Answer 44

A: For recurrent hemorrhage or failure to respond to medical treatment.

Question 45

What are the two main forms of management for acute variceal bleeding?

Answer 45

A: Endoscopic techniques (banding or sclerotherapy) and vasoconstrictor therapy.

Question 46

What is the most common worldwide cause of chronic GI bleeding? .

Answer 46

A: Hookworm infection

Question 47

What diagnostic tests are used to investigate chronic GI bleeding?

Answer 47

A: Upper and lower GI endoscopies, duodenal biopsies, and video capsule endoscopy.

Question 48

What should be excluded in cases of chronic bleeding with iron deficiency anemia?

Answer 48

A: Cancer, especially stomach or right colon cancer, and celiac disease.

Question 49

When should celiac axis and mesenteric angiography be considered?

Answer 49

A: When other investigations fail to reveal the bleeding source.

Question 50

What maintenance treatment may be required in chronic bleeding?

Answer 50

A: Regular transfusions if anemia is transfusion-dependent.

Question 51

What are common complications of diverticulitis? A:.

Answer 51

Abscess, fistula, perforation, peritonitis, and intestinal obstruction

Question 52

What is the first diagnostic test for suspected diverticulitis?

Answer 52

A: CT scan.

Question 53

What dietary recommendation can help prevent diverticulosis complications?

Answer 53

A: A high-fiber diet.

Question 54

How does diverticulitis differ from diverticulosis?

Answer 54

A: Diverticulitis involves inflammation or infection, while diverticulosis typically has no symptoms.

Question 55

What are typical symptoms of diverticulitis?

Answer 55

A: Fever, abdominal pain, vomiting, and altered bowel habits.

Question 56

What is the first-line treatment for a bleeding peptic ulcer with active bleeding?

Answer 56

A: Endoscopic therapy with dual hemostatic methods.

Question 57

What long-term therapy is recommended after treating H. pylori in ulcers?

Answer 57

A: Proton pump inhibitor therapy for 4 weeks to ensure ulcer healing.

Question 58

Q58: What should be done if H. pylori eradication fails in peptic ulcer patients?

Answer 58

A: Consider long-term acid suppression therapy.

Question 59

Why should gastric histology always be performed in ulcers?

Answer 59

A: To exclude malignancy.

Question 60

What is the role of surgery in recurrent bleeding ulcers?

Answer 60

A: Ligation of the bleeding vessel if medical and endoscopic therapies fail.

Question 61

Why has the mortality from GI hemorrhage not decreased significantly over the years?

Answer 61

A: Due to an aging population with more co-morbidities.

Question 62

How effective is early therapeutic endoscopy for upper GI bleeding? .

Answer 62

A: It diagnoses the cause in over 80% of cases and reduces rebleeding rates

Question 63

What percentage of lower GI bleeding originates from the colon?

Answer 63

A: 90%.

Question 64

What is the typical mortality rate for lower GI bleeding?

Answer 64

A: Less than 5%.