Post rectal bleeding Flashcards
Lower GI bleeds can often be a sign of pathophysiology. What is the incidence of lower GI bleeds?
1 - 0.33 - 0.87 / 100,000
2 - 3.3 - 8.7 / 100,000
3 - 33 - 87 / 100,000
4 - 330 - 870 / 100,000
3 - 33 - 87 / 100,000
Around 3% of lower GI bleeds are emergency referrals. What is the mortality rate of lower GI bleeds?
1 - 0.34%
2 - 3.4%
3 - 34%
4 - 68%
2 - 3.4%
- generally due to current comorbidities
- NOT exsanguination (drainage of bodily fluids
What % of the adult population have an episode of PR bleed in any year?
1 - 0.1%
2 - 1%
3 - 10%
4 - 30%
3 - 10%
- likely to be under reported
10% of the adult population have an episode of PR bleed in any year. Which of the 2 below are the most likely causes of PR bleeds?
1 - colorectal cancer
2 - haemorrhoids
3 - fissures
4 - diverticular disease
2 - haemorrhoids
3 - fissures
10% of the adult population have an episode of PR bleed in any year. In patients >50 y/o, 2-3% will have what?
1 - colorectal cancer
2 - haemorrhoids
3 - fissures
4 - diverticular disease
1 - colorectal cancer
In a patient who is having or has had a PR bleed, or potentially loss of blood elsewhere we would do a FBC, specifically looking at haemoglobin. What is haemoglobulin?
1 - primary protein of RBCs
2 - heme group of RBCs
3 - iron content of RBCs
4 - O2 of RBCs
1 - primary protein of RBCs
- contains 4 globin subunits
- each globin subunit has 1 heme group
- each heme group can carry 1 molecule of O2
How many molecules of oxygen is haemoglobin able to bind?
1 - 1
2 - 2
3 - 3
4 - 4
4 - 4
- 4 globin and 4 haem
- each haem can bind 1 molecule of O2
When deciding if a patient needs a transfusion of whole blood, what is the haemoglobin cut off in a patient without cardiac or CKD, where the normal level is between 120-160 g/L?
1 - 60
2 - 70
3 - 80
4 - 90
2 - 70
When deciding if a patient needs a transfusion of whole blood, what is the haemoglobin cut off in a patient with cardiac disease, where the normal level is between 120-160 g/L?
1 - 60
2 - 70
3 - 80
4 - 90
3 - 80
When deciding if a patient needs a transfusion of whole blood, what is the haemoglobin cut off in a patient with CKD, where the normal level is between 120-160 g/L?
1 - 60
2 - 70
3 - 80
4 - 90
1 - 60
10% of the adult population have an episode of PR bleed in any year. In patients >50 y/o, 2-3% will have what colorectal cancer. Which of the following is NOT a common suspicious feature of PR bleeds?
1 - older age at first onset
2 - melena
3 - change in bowel habits
4 - PR bleed without defection
5 - chronic and continuous
2 - Melena
- generally associated with upper GI bleed (peptic ulcer)
What is the first examination that we would perform in a patient who has PR bleed?
qFIT = Quantitative Faecal Immunochemical Test
1 - sigmoidoscopy
2 - qFIT
3 - digital rectal examination
4 - colonoscopy
3 - digital rectal examination
- exam for masses, fissures and/or haemorrhoids
In a patient who has PR bleed, the first examination is often a digital rectal examination. Which 2 of the following would this normally be followed up by?
qFIT = Quantitative Faecal Immunochemical Test
1 - sigmoidoscopy
2 - qFIT
3 - proctoscopy
4 - colonoscopy
1 - sigmoidoscopy (rectum and sigmoid)
3 - proctoscopy (rectum only)
If a patient has a lower GI bleed, what must their Hb drop by before they will be considered for a 2 unit of blood transfusion?
1 - drop of >5g/L
2 - drop of >10g/L
3 - drop of >20g/L
4 - drop of >50g/L
3 - drop of >20g/L
If you suspect a patient is losing blood and has colorectal cancer, but there is no clear signs of blood loss, what test can be performed that has a 99.6% negative predictive value? (essentially says you do not have disease)?
1 - Hb
2 - RBCs and Hb
3 - qFIT
4 - faecal calprotectin
3 - qFIT
- measures microscopy blood in stool indicating presence of Hb
- NOT used if blood is clearly present
What is the gold standard for investigating a lower GI bleed in a patient?
1 - sigmoidoscopy
2 - qFIT
3 - digital rectal examination
4 - colonoscopy
4 - colonoscopy
- can reach the ileocaecal valve
- can be diagnostic and therapeutic
Colonoscopy is the gold standard for investigating a lower GI bleed in a patient. However, this does require a bowel prep and sedation, and has what risk of perforation?
1 - 1 / 2
2 - 1 / 20
3 - 1 / 200
4 - 1 / 2000
4 - 1 / 2000
In addition to a colonoscopy, patients can have a sigmoidoscopy. Why is sigmoidoscopy, which is able to reach the splenic flexure, often a good choice to diagnose colon cancer?
1 - camera is more accurate than in colonoscopy
2 - bowel prep is better
3 - requires more sedation
4 - 75% of colon cancers are located in left colon and rectum
4 - 75% of colon cancers are located in left colon and rectum
- depends if the clinician suspects transverse or right sides tumour based on CT
- requires enema, but often doesn’t need sedation
Which imaging techniques offers similar accuracy (except in small polyps <6mm) to colonoscopy for diagnosing colorectal cancer?
1 - MRI
2 - CT with contrast
3 - ultrasound
4 - X-ray
2 - CT with contrast
- requires less sedation than colonoscopy
In patients who are unable to have a colonoscopy, which imaging technique us often used with an 80% sensitivity to detecting colorectal cancer?
1 - MRI
2 - CT
3 - ultrasound
4 - X-ray
2 - CT
- MRI and capsule colonoscopy all have a place
What scoring tool is used in lower GI bleeds?
1 - Chicago score
2 - CURB score
3 - Modified Glasgow score
4 - Oaklands score
4 - Oaklands score
What is the incidence of an acute lower GI bleed?
1 - 0.18 - 0.20 / 100,000
2 - 1.8 - 2 / 100,000
3 - 18 - 20 / 100,000
4 - 180 - 200 / 100,000
3 - 18 - 20 / 100,000
- majority of these stop spontaneously
When transfusing a unit of blood, how much does Hb rise when patients are given one unit of blood?
1 - 1g/L
2 - 5g/L
3 - 10g/L
4 - 20g/L
3 - 10g/L
All of the options below are causes of acute lower GI bleeds. Of these which has the highest % for causing hospital admissions?
1 - haemorrhoids
2 - IBD
3 - diverticular disease
4 - ischaemic colitis
5 - colorectal cancer
6 - iatrogenic
7 - rectal ulcer
8 - vascular abnormality
9 - radiation proctitis
10 - other (fissures etc)
3 - diverticular disease
- presence of diverticulosis with symptoms
In a patient who has presented with an acute lower GI bleed, what is the first thing we are going to do when they are admitted?
1 - qFIT
2 - colonoscopy
3 - medical history
4 - assess ABCDE
4 - assess ABCDE
In a patient presenting with an acute lower GI bleed, we will assess ABCDE. Then we will perform some of the following. Which one would NOT be done at this time?
1 - history of known lower GI pathology
2 - associated symptoms (weight loss, change of bowel habits)
3 - qFIT to detect Hb
4 - Previous pelvic radiation
5 - vascular history
6 - anti-coagulant therapy
3 - qFIT to detect Hb
In a patient presenting with an acute lower GI bleed, we will assess ABCDE and then perform a history if safe to do so. What would be the next 2 main examinations?
1 - colonscopy
2 - X-ray
3 - digital rectal examination
4 - abdominal examination
3 - digital rectal examination
4 - abdominal examination
When giving a patient fluids, which of the following doesn’t typically rise?
1 - cardiac output
2 - SV
3 - Sats %
4 - Hb
4 - Hb
All of the following are investigations that can be performed in a patient who continues to have a lower GI bleed. Which 2 of the following have have the best detection rates and even therapeutic effects?
1 - colonoscopy
2 - CT mesenteric angiography
3 - red cell scan (nuclear medicine)
4 - Mesenteric angiography
2 - CT mesenteric angiography
- requires >0.3ml/min bleeding
- high accuracy
4 - Mesenteric angiography
- requires >0.5ml/min bleeding
- can embolize as well
Mesenteric angiographyIf an ongoing bleed can be identified and embolized using mesenteric angiography, the mortality rate is <10% with a re-bleed incidence of <20%. If the bleed cannot be identified surgery is required. A segmental colonic resection of localised bleeding is the optimal surgical choice. What is the mortality and re-bleed rate of this?
M = mortality
RB = Re-bleed
1 - M <5% and RB <20%
2 - M <10% and RB <14%
3 - M <20% and RB <20%
4 - M <30% and RB <10%
2 - M <10% and RB <14%
Mesenteric angiographyIf an ongoing bleed can be identified and embolized using mesenteric angiography, the mortality rate is <10% with a re-bleed incidence of <20%. If the bleed cannot be identified surgery is required. If a blind colonic resection is required as they cannot identify the bleed, what is the mortality and re-bleed rate of this?
M = mortality
RB = Re-bleed
1 - M <5% and RB <20%
2 - M <60% and RB <75%
3 - M <50% and RB <20%
4 - M <60% and RB <10%
2 - M <60% and RB <75%
Mesenteric angiographyIf an ongoing bleed can be identified and embolized using mesenteric angiography, the mortality rate is <10% with a re-bleed incidence of <20%. If the bleed cannot be identified surgery is required. If a blind colonic resection is required as they cannot identify the bleed, what is the mortality and re-bleed rate of this?
M = mortality
RB = Re-bleed
1 - M <5% and RB <20%
2 - M <60% and RB <75%
3 - M <50% and RB <20%
4 - M <60% and RB <10%
2 - M <60% and RB <75%
Mesenteric angiographyIf an ongoing bleed can be identified and embolized using mesenteric angiography, the mortality rate is <10% with a re-bleed incidence of <20%. If the bleed cannot be identified surgery is required. If an emergency blind subtotal colectomy is required what is the mortality?
1 - <10-15%
2 - <10-33%
3 - <25-50%
4 - <25-70%
2 - <10-33%
Which of the following is NOT typically a red flag in a patient who has had a recent change of bowel habits?
1 - intermittent symptoms
2 - associated symptoms (weight loss, bleeding)
3 - continuous symptoms
4 - onset at old age
1 - intermittent symptoms
