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Lower GI Bleeding

Drug Profile
Prothrombin Complex Concentrate
Drug Profile
Idarucizumab
Rishika Chugh, MD Assistant Professor of Medicine, Division of Gastroenterology, Department of Medicine, University of California, San Francisco

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Case Study thumbnail 255

Lower GI Bleeding - Case 1

Case Study thumbnail 256

Lower GI Bleeding - Case 2

1. What is the definition of lower gastrointestinal (GI) bleeding?

Select only 1 answer.

  1. A. Bleeding from the stomach and duodenum
  2. B. Bleeding from the colon or rectum
  3. C. Bleeding from the esophagus
  4. D. Bleeding from the liver

2. Which clinical presentation is most indicative of lower GI bleeding?

Select only 1 answer.

  1. A. Hematemesis
  2. B. Melena
  3. C. Hematochezia
  4. D. Epistaxis

3. What is the most common cause of acute lower GI bleeding in the United States?

Select only 1 answer.

  1. A. Hemorrhoids
  2. B. Angiodysplasia
  3. C. Diverticulosis
  4. D. Inflammatory Bowel Disease (IBD)

4. Which diagnostic test is least useful in the initial evaluation of a patient with suspected lower GI bleeding?

Select only 1 answer.

  1. A. Complete blood count (CBC)
  2. B. Fecal occult blood test (FOBT)
  3. C. Basic metabolic panel (BMP)
  4. D. Coagulation markers (INR, PTT)

5. In the management of hemodynamically unstable lower GI bleeding, what is the first step?

Select only 1 answer.

  1. A. Elective colonoscopy
  2. B. IV fluids and packed red blood cells (PRBCs)
  3. C. Capsule endoscopy
  4. D. Nasogastric (NG) tube placement

6. Which statement is true regarding the role of CT angiography in lower GI bleeding?

Select only 1 answer.

  1. A. It requires bowel preparation.
  2. B. It has a sensitivity of 28% for detecting active bleeding.
  3. C. It can detect bleeding rates as slow as 0.3 to 0.5 mL/min
  4. D. It is primarily used for therapeutic intervention.

7. Which of the following is a poor prognostic factor in lower GI bleeding?

Select only 1 answer.

  1. A. Age < 40 years
  2. B. Low systolic blood pressure (< 100-115 mmHg)
  3. C. Stable mental status
  4. D. Controlled comorbid conditions

8. Which intervention is preferred for a patient with diverticular bleeding who is hemodynamically stable?

Select only 1 answer.

  1. A. Emergent colonoscopy without bowel preparation
  2. B. CT angiography followed by standard angiography if needed
  3. C. Immediate surgical resection
  4. D. Nasogastric tube aspiration

9. What is the pathogenesis of angiodysplasia as a cause of lower GI bleeding?

Select only 1 answer.

  1. A. Acute rupture of vasa recta
  2. B. Venous bleed due to stretching of blood vessels
  3. C. Arterial bleed from diverticula
  4. D. Immune-mediated inflammation

10. In a patient with a suspected upper GI bleed, what BUN/creatinine ratio is highly predictive of this diagnosis?

Select only 1 answer.

  1. A. 10:1
  2. B. 20:1
  3. C. 30:1
  4. D. 40:1

11. Which treatment is recommended for ischemic colitis in a hemodynamically stable patient?

Select only 1 answer.

  1. A. Emergent colonoscopy
  2. B. Surgical resection
  3. C. Supportive care with volume repletion
  4. D. Endoscopic thermal therapy