GI Bleeding

Question 1

Bleeding is more common in which inflammatory bowel disease?

Answer 1

More common in UC than Crohns

Question 2

Area of lower GI bleds

Answer 2

Distal to ligament of treitz

(jejunum to anus)

Question 3

Three symptoms of anorectal abscess

Answer 3

Perianal pain

Fever

Bright red blood

Question 4

Which condition is associated with “watermelon stomach”?

Answer 4

Gastric antral vascular ectasia

Question 5

Which patients are most likely to have lower GI bleeds caused by angiodysplasia?

Answer 5

Elderly

Angiodysplasia = thin walled vessels, collagen degradation in elderly

Question 6

Most common causes of peptic ulcer disease

Answer 6

US = NSAIDs

World = H. pylori

Question 7

First test normally done in assessment of a GI bleed

Answer 7

Endoscopy

Question 8

Most common cause of upper GI bleeds

Answer 8

Peptic ulcer disease

Question 9

Three factors that make post-polypectomy bleeding more likely

Answer 9

Elderly

Polyp removed was larger than 1cm

Polyp was in cecum

Question 10

Symptoms in diverticulosis caused by lower GI bleeds

Answer 10

Painless, large bloody stools

Question 11

Diagnostic test of choice in an active GI bleed

Answer 11

CT angiography

Question 12

Gold standard treatment for perianal abscess

Answer 12

Incision and drainage

Question 13

Gold standard for diagnosis of peptic ulcer disease

Answer 13

EGD - endogastrodudodenoscopy

Question 14

Location of Dieulafoy lesions

Answer 14

Upper stomach

Question 15

Condition causing longitudinal lacerations of esophageal mucosa at gastrointestinal junction

Answer 15

Mallory-Weiss tears

Question 16

Four risk factors for diverticulosis

Answer 16

Low fiber diet leading to constipation

NSAIDs/aspirin

Ischemic heart disease

Hypertension

Question 17

Most common location of rectal fissures

Answer 17

Posterior anal canal

Question 18

Treatment for proctitis

Answer 18

Steroid enemas

Question 19

Name of procedure to shunt blood from portal vein to avoid the liver

Answer 19

TIPS

Trans-jugular intrahepatic portosystemic shunt

Question 20

This painful condition is referred to as a “stroke of the colon”

Answer 20

Ischemic colitis

Question 21

Rectal damage from radiation therapy can cause lower GI bleeds. This condition is known as …

Answer 21

Proctitis

Question 22

How long does bleeding show up after a polypectomy?

Answer 22

7-10 days

Question 23

Severe anal pain with passing of a bright red bloody stool in a patient with a history of constipation might suggest …

Answer 23

Rectal fissure

Question 24

CT angiography can only be used to diagnose these GI bleeds

Answer 24

Active GI bleeds

Question 25

Most common cause of occult GI bleeding

Answer 25

Inflammation

Question 26

Symptoms of proctitis

Answer 26

Lower GI bleed 9 months to a year after radiation therapy

Question 27

Symptoms in angiodysplasia caused lower GI bleeds

Answer 27

Intermittent, low grade bleeding

Question 28

Symptoms in variceal bleeds

Answer 28

Sudden overt bleeding Large volume hematemesis

Question 29

Cause of Dieulafoy lesions

Answer 29

Large-caliber tortuous artery in stomach wall that erodes and bleeds

Question 30

Most common location for angiodysplasia in lower GI bleeds

Answer 30

Cecum or ascending colon

Question 31

Treatments for a hemodynamically unstable GI bleed

Answer 31

Large bore IV for fluid resuscitation with normal saline or lactated ringer Transfusion for active, brisk bleeding - Keep Hgb above 7

Question 32

Landmark used to distinguish upper from lower GI bleeds

Answer 32

Ligament of Treitz

Question 33

Bright red blood on the outside of stool is suggestive of

Answer 33

Hemorrhoids

Question 34

Cause of Mallory-Weiss tears

Answer 34

Retching/vomiting Common in alcoholics

Question 35

Two common symptoms with upper GI bleeds

Answer 35

Melena Hematemesis

Question 36

Medications for a GI bleed in a patient with a history of liver cirrohsis

Answer 36

IV ceftriaxone or ciprofloxacin Octreotide to lower splanchnic blood flow and portal bp in varices

Question 37

Cause of Cameron lesions

Answer 37

Linear erosions due to hiatal hernia

Question 38

Describe "melena"

Answer 38

Black, tarry stool

Question 39

Cause of variceal bleeds

Answer 39

Dilation of small (distal) esophageal veins due to portal hypertension (alcoholism)

Question 40

Two most common causes of lower GI bleeds

Answer 40

Diverticulosis (most common) Angiodysplasia

Question 41

Location of diverticulosis caused lower GI bleeds

Answer 41

Descending/left colon

Question 42

Treatment of variceal bleeds

Answer 42

Urgent IV fluids and transfusions EG banding Lower portal BP with non-selective beta-blocker

Question 43

Biggest risk factor for anorectal abscess

Answer 43

Diabetes (also IBD, HTN, HIV, heme disorders)

Question 44

Reason for increased BUN/Cr in upper GI bleeds

Answer 44

From digestion of protein in red blood cells

Question 45

Signs in upper GI bleeds, in order

Answer 45

First sign: tachycardia 15% blood loss: orthostatic hypotension 40% blood loss: resting hypotension

Question 46

New iron deficiency anemia in a patient aged 50+ should be screened for this disease

Answer 46

Colorectal cancer