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Gastroenterology > GIB > Flashcards

GIB Flashcards

1
Q

Overt GI bleed manifested as ___

A

hematemesis or “coffee grounds”

melena
hematochezia

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2
Q

Occult GI bleed manifested as ___

A

symptoms of blood loss or anemia such as lightheadedness, syncope, angina, or dyspnea

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3
Q

Occult GI blood tests

A

Iron deficiency anemia
fecal occult blood test

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4
Q

most common gastrointestinal condition leading to hospitalization

A

GIB

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5
Q

The most common cause of upper GIB (UGIB), accounting for ~50% of UGIB hospitalizations.

A

Peptic ulcer

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6
Q

High-dose, constantinfusion IV proton pump inhibitor (PPI) (_____), designed to sustain intragastric pH ____ and enhance clot stability, decreases further bleeding and mortality in patients with high-risk ulcers (active bleeding, nonbleeding visible vessel, adherent clot) when given after endoscopic therapy.

A

80-mg bolus and 8-mg/h infusion

> 6

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7
Q

High-dose intermittent PPIs are noninferior to constant-infusion PPI therapy T/F

A

T

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8
Q

Prevention of recurrent bleeding focuses on the three main factors in ulcer pathogenesis, _____

A

Helicobacter pylori, nonsteroidal anti-inflammatory drugs (NSAIDs), and acid.

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9
Q

If NSAIDs must be given, a _______ is recommended, based on results of a randomized trial.

A

cyclooxygenase (COX)-2 selective NSAID plus a PPI

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10
Q

Patients with established cardiovascular disease who develop bleeding ulcers while taking low-dose aspirin for secondary prevention should restart aspirin as soon as possible after their bleeding episode (_____days).

A

1–7

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11
Q

Aspirin management:

> Restart low-dose aspirin (for primary/secondary? cardiovascular prevention) 1–7 days after bleeding episode.

*Randomized trial: Lower 8-week mortality (1% vs. 13%; hazard ratio, 0.2; 95% CI, 0.1–0.6).

> Discontinue aspirin in most cases of UGIB for primary/secondary? cardiovascular prevention

A

continue for secondary

discontinue for primary

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12
Q

When should low-dose aspirin for secondary cardiovascular prevention be restarted in patients with bleeding ulcers?
A. Immediately after diagnosis
B. Within 1–7 days
C. After 1 month
D. Never

A

B

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13
Q

In patients taking NSAIDs, what is the recommended management if NSAIDs must be continued after a bleeding ulcer?
A. Discontinue NSAIDs permanently
B. Use COX-2 selective NSAIDs plus PPI
C. Use low-dose aspirin only
D. Use acetaminophen instead of NSAIDs

A

B

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14
Q

The classic history of mallory Weiss tears is ____preceding hematemesis, especially in an alcoholic patient.

A

vomiting, retching, or coughing

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15
Q

Bleeding from these tears, which are usually on the ____ side of the gastroesophageal junction

A

gastric

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16
Q

Bleeding from mallory weiss tears stops spontaneously 80-90%

A

T

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17
Q

Esophageal varices are treated with endoscopic ligation and an IV vasoactive medication (octreotide, somatostatin, vapreotide, terlipressin) for____ days.

A

2–5

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18
Q

_____is recommended in patients who have persistent or recurrent bleeding despite endoscopic and medical therapy.

A

Transjugular intrahepatic portosystemic shunt (TIPS)

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19
Q

TIPS also should be considered in the first ___ days of hospitalization for acute variceal bleeding in patients with advanced liver disease (Child-Pugh class B, Child-Pugh class C with score ____)

A

1–2

10–13

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20
Q

Bleeding gastric varices are treated with endoscopic injection of _____, if available; if not, TIPS is performed.

A

tissue adhesive (e.g., n-butyl cyanoacrylate)

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21
Q

What is the recommended long-term management to prevent recurrent esophageal variceal bleeding?
A. Endoscopic ligation only
B. Nonselective beta blockers only
C. Nonselective beta blockers plus endoscopic ligation
D. Surgical ligation

A

C

“Over the long term, treatment with nonselective beta blockers plus endoscopic ligation is recommended because the combination is more effective than either alone in reduction of recurrent esophageal variceal bleeding.”

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22
Q

What is the most common clinical history preceding Mallory-Weiss tears?
A. Persistent diarrhea
B. Vomiting, retching, or coughing
C. Abdominal pain radiating to the back
D. Jaundice and fatigue

A

B

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23
Q

What percentage of Mallory-Weiss tear cases resolve bleeding spontaneously?
A. ~10–20%
B. ~50–60%
C. ~80–90%
D. ~95–100%

A

C

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24
Q

What is the first-line intervention for actively bleeding Mallory-Weiss tears?
A. Transfusion of blood products
B. Endoscopic therapy
C. IV proton pump inhibitors
D. Surgical repair

A

B

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25
Q

Which therapy is most effective for reducing recurrent bleeding in patients with esophageal varices?
A. Endoscopic therapy alone
B. Medical therapy alone
C. Combined endoscopic and medical therapy
D. Antibiotic prophylaxis

A

C

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26
Q

When is TIPS (transjugular intrahepatic portosystemic shunt) recommended in patients with esophageal varices?
A. Only in patients with no prior treatments
B. As the first intervention in all variceal bleeding cases
C. For persistent or recurrent bleeding despite standard therapy
D. Only for patients without advanced liver disease

A

C

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27
Q

The most important cause of gastric and duodenal erosions is _____

A

NSAID use

~50% of patients who chronically ingest NSAIDs may have gastric erosions

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28
Q

____ are endoscopically visualized breaks that are confined to the mucosa and do not cause major bleeding because arteries and veins are not present in the mucosa.

A

Erosions

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29
Q

Watermelon stomach

A

Gastric astral vascular ectasia

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30
Q

What is the most common cause of gastric and duodenal erosions?
A. Alcohol intake
B. Stress-related mucosal injury
C. Helicobacter pylori infection
D. NSAID use

A

D

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31
Q

What is the primary population at risk for stress-related gastric mucosal injury?
A. Patients with mild reflux symptoms
B. Patients with chronic alcohol use
C. Critically ill patients (e.g., ventilator-dependent, coagulopathy)
D. Patients on long-term PPI therapy

A

C

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32
Q

What is the likely benefit of PPI prophylaxis in ICU patients with risk factors for gastrointestinal bleeding?
A. No reduction in bleeding but improved mortality
B. Reduction in clinically important bleeding without impact on mortality
C. Significant reduction in both bleeding and infections
D. Complete elimination of overt bleeding

A

B

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33
Q

____ is the most common cause of significant small-intestinal GIB in children

A

Meckel’s diverticulum

34
Q

~75% of GIB previously labeled obscure is now estimated to originate in the _____beyond the extent of a standard upper endoscopic exam.

A

small intestine

35
Q

[SI GIB] The most common causes in adults include _____

A

vascular ectasias, neoplasm (e.g., gastrointestinal stromal tumor, carcinoid, adenocarcinoma, lymphoma, metastases), and NSAID-induced erosions and ulcers.

36
Q

Most common cause of lower GIB (LGIB)

A

Hemorrhoids

37
Q

If these local anal processes, which rarely require hospitalization, are excluded, the most common cause of LGIB in adults is ____

A

Diverticulosis

38
Q

In children and adolescents, the most common colonic causes of significant GIB are inflammatory bowel disease and juvenile polyps.

A

inflammatory bowel disease

juvenile polyps.

39
Q

_____is abrupt in onset, usually painless, sometimes massive, and often from the ____ colon;

A

Diverticular bleeding

right

40
Q

What is the most common cause of lower gastrointestinal bleeding (LGIB) in adults requiring hospitalization when local anal processes are excluded?
A. Hemorrhoids
B. Vascular ectasias
C. Diverticulosis
D. Colitis

A

C

41
Q

What is a characteristic feature of bleeding due to diverticulosis?
A. Chronic and occult bleeding
B. Painless and abrupt onset
C. Associated with significant pain and hematochezia
D. Rarely stops spontaneously

A

B

42
Q

What is a recommended intervention for persistent or refractory diverticular bleeding?
A. Proton pump inhibitors
B. Surgical segmental resection
C. Antibiotic therapy
D. Radiation therapy

A

B

43
Q

Which condition involves colonic vascular ectasias and aortic stenosis, and what intervention is beneficial?
A. Heyde’s syndrome; aortic valve replacement
B. Crohn’s disease; infliximab therapy
C. Radiation proctopathy; endoscopic therapy
D. Aortocolic fistula; angiographic embolization

A

A

44
Q

What is the most common cause of significant small-intestinal bleeding in children?
A. Crohn’s disease
B. Meckel’s diverticulum
C. NSAID-induced erosions
D. Vascular ectasias

A

B

45
Q

Which treatment is NOT recommended for prevention of recurrent bleeding from small-intestinal vascular ectasias?
A. Octreotide
B. Estrogen/progesterone compounds
C. Thalidomide
D. Endoscopic therapy

A

B

46
Q

What is the management of small-intestinal tumors causing bleeding?
A. Endoscopic therapy
B. Radiation therapy
C. Surgical resection
D. Proton pump inhibitors

A

C

47
Q

Measurement of the _____ is the best way to initially assess a patient with GIB.

A

heart rate and blood pressure

48
Q

Thus, hemoglobin may be normal or only minimally decreased at initial presentation of a severe bleeding episode. As extravascular fluid enters the vascular space to restore volume, the hemoglobin falls, but this process may take up to ___ h.

A

72 (3 days)

49
Q

Melena indicates blood has been present in the gastrointestinal (GI) tract for _____ h and a s long as 3-5 days

A

≥14

50
Q

Transfusion is recommended when the hemoglobin drops ____g/dL

A

below 7

51
Q

When _____ is the presenting symptom of UGIB, it is associated with hemodynamic instability and dropping hemoglobin

A

hematochezia

52
Q

What is the most reliable initial method to assess a patient with gastrointestinal bleeding (GIB)?
A. Monitoring hemoglobin levels
B. Measuring heart rate and blood pressure
C. Performing immediate colonoscopy
D. Checking stool for occult blood

A

B

53
Q

When is transfusion recommended for a patient with acute upper gastrointestinal bleeding (UGIB)?
A. Hemoglobin <9 g/dL
B. Hemoglobin <8 g/dL
C. Hemoglobin <7 g/dL
D. Any signs of blood loss

A

C

54
Q

What does the presence of melena in a patient suggest about the bleeding site and timing?
A. Recent LGIB within the last 6 hours
B. Proximal GI bleeding, with blood present for ≥14 hours
C. Small-bowel bleeding with blood present for ≤12 hours
D. Recent UGIB with brisk transit of blood through the bowel

A

B

55
Q

In a patient with hematochezia, which condition is most likely if it originates from an upper GI source?
A. Hemodynamically stable with normal hemoglobin
B. Hyperactive bowel sounds with elevated BUN
C. Brisk bleeding with hemodynamic instability and dropping hemoglobin
D. Chronic anemia with low mean corpuscular volume

A

C

56
Q

Baseline characteristics predictive of rebleeding and death include _____

A

hemodynamic compromise (tachycardia or hypotension), increasing age, and comorbidities.

57
Q

Discharge from the emergency room with outpatient m ment has been suggested for patients with a Glasgow-Blatchford score of ____

A

0–1

58
Q

[Cirrhosis presenting with UGIB] ____ decrease bacterial infections, rebleeding, and mortality, and vasoactive medications may improve control of bleeding in the ____ h after presentation.

A

Antibiotics

12

59
Q

Upper endoscopy should be performed within ____ h in most patients hospitalized with UGIB

A

24

60
Q

Even in high-risk patients, more urgent endoscopy (performed within 6 h of gastroenterology consultation) does not improve clinical outcomes T/F

A

T

61
Q

Patients with hematochezia and hemodynamic instability should have ____ to rule out an upper GI source before evaluation of the lower GI tract.

A

upper endoscopy

62
Q

_______ is the procedure of choice in most patients admitted with LGIB unless bleeding is too massive, in which case ____ is recommended.

A

Colonoscopy after an oral lavage solution

angiography

63
Q

_____ is often suggested prior to angiography to document evidence and location of active bleeding.

A

Computed tomography (CT) angiography

64
Q

Sigmoidoscopy is used primarily in patients ____ years old with minor bleeding.

A

<40

65
Q

What is the initial step for a patient presenting with hematochezia and hemodynamic instability?
A. Perform colonoscopy
B. Perform sigmoidoscopy
C. Perform upper endoscopy
D. Proceed directly to angiography

A

C

66
Q

What is the procedure of choice for most patients admitted with lower gastrointestinal bleeding (LGIB)?
A. Colonoscopy after oral lavage
B. Sigmoidoscopy
C. CT angiography
D. 99m Tc-labeled red cell scan

A

A

67
Q

Which imaging modality is increasingly preferred over 99m Tc-labeled red cell scanning in patients with LGIB?
A. Magnetic resonance angiography (MRA)
B. Positron emission tomography (PET) scan
C. CT angiography
D. Duplex ultrasonography

A

C

68
Q

When is sigmoidoscopy most appropriately used in the evaluation of LGIB?
A. In patients with massive bleeding and hemodynamic instability
B. In patients with hematochezia and suspected upper GI source
C. In patients <40 years old with minor bleeding
D. In patients with no source identified after colonoscopy

A

C

69
Q

What therapeutic option is available for active LGIB detected during angiography?
A. Endoscopic therapy with clipping
B. IV vasopressin infusion
C. Transcatheter arterial embolization
D. Surgical bowel resection

A

C

70
Q

A positive test necessitates colonoscopy.

A

FOBT

71
Q

____testing is recommended only for colorectal cancer screening, beginning at age 45–50 years in average-risk adults.

A

Fecal occult blood

72
Q

What is the recommended initial diagnostic test for patients with massive bleeding suspected to originate from the small intestine?
A. Video capsule endoscopy
B. CT enterography
C. Angiography
D. Push enteroscopy

A

C

“In patients with massive bleeding suspected to be from the small intestine, current guidelines suggest angiography as the initial test.”

73
Q

What is the next step if video capsule endoscopy is negative in a clinically stable patient with suspected small-intestinal bleeding?
A. Deep enteroscopy
B. Observation and treatment with iron
C. CT angiography
D. Second capsule endoscopy

A

B

74
Q

What is the recommended hospital stay for a patient with Mallory-Weiss tear and active bleeding who underwent endoscopic therapy?
A. Discharge after endoscopy
B. ~1–2 days hospitalization
C. ~3 days hospitalization
D. ~3–5 days hospitalization

A

B

75
Q

What is the dietary recommendation for a patient with erosions and no active bleeding following endoscopy?
A. Regular diet
B. Clear liquids for ~2 days
C. Clear liquids for ~1 day
D. NPO (nothing by mouth)

A

A

76
Q

What is the recommended next step for a patient with an ulcer showing a clean base during endoscopy?
A. Intensive PPI therapy
B. Endoscopic therapy
C. Once-daily PPI therapy
D. Vasoactive therapy

A

C

77
Q

What is the first diagnostic step in a patient with hematochezia and hemodynamic instability?
A. Colonoscopy
B. Upper endoscopy
C. CT angiography
D. Flexible sigmoidoscopy

A

B

78
Q

What diagnostic procedure is recommended for a stable patient aged <40 years with minimal rectal bleeding?
A. Colonoscopy
B. Flexible sigmoidoscopy
C. Angiography
D. CT angiography

A

B

79
Q

For patients aged ≥40 years with no hemodynamic instability, what is the initial diagnostic procedure?
A. Flexible sigmoidoscopy
B. Colonoscopy
C. CT angiography
D. Surgery

A

B

80
Q

What is the next step if colonoscopy fails to identify a bleeding site in a patient with acute LGIB?
A. Repeat colonoscopy
B. Workup for small-intestinal or obscure bleeding site
C. Immediate surgery
D. Endoscopic therapy

A

B

81
Q

What is the appropriate management for a patient with acute LGIB who is too unstable to undergo bowel preparation?
A. Surgery
B. Flexible sigmoidoscopy
C. Angiography (or CT angiography first)
D. Workup for small-intestinal bleeding

A

C

82
Q
A

Gastroenterology (10 decks)

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