GASTROINTESTINAL BLEEDING QUIZ

1. What two broad categories can gastrointestinal bleeding be categorized under?

a) Large intestine and small intestine

b) Upper and Lower Gastrointestinal Bleeding
c) Esophagus and Stomach
d) Right and Left Lumbar Region
ANSWER: B. UPPER AND LOWER GASTROINTESTINAL BLEEDING
RATIONALE: Gastrointestinal bleeding can fall into two broad categories: upper and lower
sources of bleeding. GI bleeding can be classified as upper GI bleeding (UGIB) if the site of
hemorrhage is proximal to the ligament of Treitz (e.g., esophageal variceal bleeding, bleeding
peptic ulcer) or as lower GI bleeding (LGIB) if the site of hemorrhage is distal to the ligament of
Treitz (e.g., diverticular bleeding, malignancy, small bowel bleeding).
2. What is gastrointestinal (GI) bleeding also known as?
a) Gastrointestinal hemmorhage
b) Gastrointestinal tract
c) Gastrointestinal system
d) Gastrointestinal disease
ANSWER: A. GASTROINTESTINAL HEMMORHAGE
RATIONALE: Gastrointestinal (GI) bleeding, also known as gastrointestinal hemmorhage
because bleeding, also called hemorrhage, is the name used to describe blood loss.
3. Gastrointestinal (GI) bleeding can be defined as
a) Sores that develop on the lining of the stomach and upper portion of the small intestine.
b) Small bulges or pockets that can develop in the wall of the large intestine (colon).
c) All forms of bleeding in the GI tract, from the mouth to the rectum.
d) Small tears in the lining of the anus
ANSWER: C. ALL FORMS OF BLEEDING IN THE GI TRACT, FROM THE MOUTH
TO THE RECTUM
RATIONALE: Digestive or gastrointestinal (GI) tract includes the esophagus, stomach, small
intestine, large intestine or colon, rectum, and anus. Bleeding can come from any of these areas if
there is a gastrointestinal bleeding.
4. What type of gastrointestinal bleeding that comes and goes over a long time?
a) Acute
b) Chronic
c) Occult
d) Overt
ANSWER: B. CHRONIC
5. What type of gastrointestinal bleeding is sudden, severe, and a sign of a medical
emergency?
a) Obscure
b) Chronic
c) Occult
d) Acute
ANSWER: D. ACUTE
6. It is the most common cause of upper GI bleeding.
a) Crohn's disease
b) Esophageal varices
c) Hemorrhoids
d) Peptic ulcer
ANSWER: D. PEPTIC ULCER
RATIONALE: Peptic ulcer is the most common cause of upper GI bleeding. Peptic ulcers are
sores that develop on the lining of the stomach and upper portion of the small intestine.
7. These are swollen veins in the anus or lower rectum, similar to varicose veins.
a) Hemorrhoids
b) Proctitis
c) Colon polyps
d) Ulcer
ANSWER: A. HEMORRHOIDS
RATIONALE: Hemorrhoids are swollen veins in your anus or lower rectum, similar to varicose
veins. Hemorrhoids cause itching, pain, and sometimes bleeding in your anus or lower rectum.
8. Peptic ulcers are usually caused by what bacteria?
a) Streptococcus
b) Staphylococcus
c) Helicobacter pylori
d) E. coli
ANSWER: C. HELICOBACTER PYLORI
RATIONALE: The most common causes of peptic ulcers are infection with the bacterium
Helicobacter pylori (H. pylori).
9. It is an IV drug used to suppress stomach acid production.
a) ACE inhibitors
 b) Proton pump inhibitor
c) Beta blockers
d) Hydromorphone
ANSWER: B. PROTON PUMP INHIBITOR
RATIONALE: If you have an upper GI bleed, you might be given an IV drug known as a
proton pump inhibitor (PPI) to suppress stomach acid production.
10. Aspirin, or a nonsteroidal anti-inflammatory drug, is a kind of medication called?
a) Beta-adrenergic blocking agents
b) Angiotensin-converting enzyme
c) Blood-thinning medications
d) Tranexamic acid
ANSWER: C. BLOOD-THINNING MEDICATIONS
RATIONALE: Aspirin is an NSAID with 'blood-thinning' properties.
11. What color is lower GI bleed?
a) Black or tarry stools
b) Green or yellow
c) Brown
d) Bright red blood or maroon blood
ANSWER: D. BRIGHT RED BLOOD OR MAROON BLOOD
RATIONALE: Lower GI bleeding presents bright red blood per rectum or maroon blood and
rarely as black tarry stools. Sometimes blood can be invisible and present as anemia. It can occur
with or without pain, can be mild or severe. Unfortunately, it can also be sometimes life-
threatening.
12. What color is Upper GI bleed?
a) Black or tarry stools
b) Green or yellow
c) Brown
d) Bright red blood or maroon blood
ANSWER: A. BLACK OR TARRY STOOLS
RATIONALE: Black or tarry stool typically indicates upper Gl bleeding, but bleeding from a
source in the small bowel or right colon may also be the cause. About 100 to 200 mL of blood in
the upper Gl tract is required to cause melena (black, tarry stool) which may persist for several
days after bleeding has ceased.
13. What is an obvious sign of upper Gl bleeding?
 a) Hematemesis
b) Abdominal pain
c) Upset stomach
d) Weight loss
ANSWER: A. HEMATEMESIS
RATIONALE: Upper GI bleeding usually presents with hematemesis (vomiting of fresh blood),
“coffee-ground” emesis (vomiting of dark altered blood), and/or melena (black tarry stools).
14. Blood loss from an upper Gl bleed can cause what change in consciousness?
a) Melena
b) Syncope
c) Weakness
d) Low blood pressure
ANSWER: D. LOW BLOOD PRESSURE
RATIONALE: Severe bleeding may reduce the flow of blood to the brain, causing confusion,
disorientation, sleepiness, and even extremely low blood pressure (shock).
15. In patients with upper gastrointestinal bleeding who are predicted to be at high risk for
further bleeding or death, when should endoscopy be performed following
gastroenterologic consultation?
a) within 6 hours
b) between 6 and 24 hours
c) between 24 and 48 hours
d) within 72 hours
ANSWER: B. BETWEEN 6 AND 24 HOURS
RATIONALE: It is recommended that patients with acute upper gastrointestinal bleeding
undergo endoscopy within 24 hours after gastroenterologic consultation. In patients with acute
upper gastrointestinal bleeding who were at high risk for further bleeding or death, endoscopy
performed within 6 hours after gastroenterologic consultation was not associated with lower 30-
day mortality than endoscopy performed between 6 and 24 hours after consultation.

16. Hematochezia (the passage of gross blood from the rectum) usually indicates lower Gl
bleeding but may result from which of the following?
a) Bleeding from a source in the right colon
b) Ingestion of bismuth
c) Ingestion of supplemental iron
d) Upper Gl bleeding with rapid transit of blood through the intestines
ANSWER: D. UPPER GL BLEEDING WITH RAPID TRANSIT OF BLOOD THROUGH
THE INTESTINES.
RATIONALE: Upper Gl bleeding with rapid transit of blood through the intestines.
A: Melena is black, tarry stool and typically indicates upper Gl bleeding, but bleeding from a
source in the small bowel or right colon may also be the cause. B and C: Black stool that does
not contain occult blood may result from ingestion of iron or bismuth.
17. Which of the following may be done acutely for patients with symptoms typical of
hemorrhoidal bleeding?
a) Angiography
b) B. Colonoscopy
c) Flexible sigmoidoscopy or anoscopy
d) Radionuclide scanning
ANSWER: C. FLEXIBLE SIGMOIDOSCOPY OR ANOSCOPY
RATIONALE: Flexible sigmoidoscopy or anoscopyMmay be all that is required acutely for
patients with symptoms typical of hemorrhoidalMbleeding. B: All other patients with
hematochezia should have colonoscopy. A and D: If colonoscopy cannot visualize the source and
ongoing bleeding is sufficiently rapid, angiography may localize the source. Some angiographers
first take a radionuclide scan to focus the examination because angiography is less sensitive than
the radionuclide scan.
18. A 42-year-old woman complains of hematemesis and recurrent midepigastric
abdominal pain that is somewhat relieved by eating. She has been taking an NSAID daily
for 3 weeks to relieve her low back pain. Her vital signs and laboratory tests are normal.
Peptic ulcer disease is suspected. What would be the most appropriate evaluation and
management of this patient?
a) Immediate upper endoscopy and an oral histamine-2 receptor blocker.
b) Immediate oral PP| and later upper endoscopy.
c) Immediate oral PPl and no endoscopy.
d) Immediate oral histamine-2 receptor blocker and no endoscopy.
ANSWER: B. IMMEDIATE ORAL PPI AND LATER UPPER ENDOSCOPY.
RATIONALE: Patients with an UGI bleed who are hemodynamically stable with normal
laboratory results do not require urgent endoscopy. Upper endoscopy can be scheduled
electively. Guidelines recommend a PPl should be started immediately for a UGl bleed and
should not be delayed until after endoscopy.
Oral PPIs are as effective as intravenous (IV) PPls for preventing recurrent bleeding, surgery, or
death. For patients with a history of peptic ulcer bleeding, the PPI should be continued for 4 to 8
weeks.
19. A 36-year-old man presents to your clinic, saying he had bright red rectal bleeding 2
hours ago. His vital signs and complete blood count (CBC) are normal. The patient says he
has no rectal pain or trauma, and has never had hematochezia before. What would be the
most appropriate evaluation for this patient?
a) Initiate nasogastric lavage and monitor vital signs every 4 hours.
b) Order an Immediate colonoscopy.
c) Schedule a colonoscopy after he completes an adequate bowel prep.
d) Monitor the patient's vital signs every 4 hours and repeat a CBC in 4 hours; do not order
a colonoscopy.
ANSWER: C. SCHEDULE A COLONOSCOPY AFTER HE COMPLETES AN
ADEQUATE BOWEL PREP.
RATIONALE: Hematochezia is more likely the result of lower gastrointestinal (LG1) bleeding.
LG bleeding is defined as bleeding originating distal to the ligament of Treitz. 1,2 Diverticular
disease is the most common etiology of LG bleeding. Endoscopy is indicated to evaluate LG
bleeding, but in hemodynamically stable patients such as this one, immediate colonoscopy
(within 24 hours of presentation) is not necessary. Patients should be hemodynamically stable
and the colon adequately prepped before proceeding with colonoscopy. Nasogastric lavage is not
recommended for the management of LG bleeding.
20. A 46-year-old man comes to your clinic with intermittent burning epigastric pain for
the past 2 months and early satiety. He has no other medical problems and does not take
any medications. He has never smoked and rarely drinks coffee. His weight has been stable.
Physical examination reveals his vital signs are normal. What would be the most
appropriate evaluation and treatment for this patient?
a) Upper endoscopy and 8 weeks of an oral histamine-2 receptor blocker.
b) Upper endoscopy and 8 weeks of an oral PPI.
c) No endoscopy and a test-and-treat strategy for Helicobacter pylori.
d) No endoscopy and measure serum H pylori antibodies.
ANSWER: C. NO ENDOSCOPY AND A TEST-AND-TREAT STRATEGY FOR
HELICOBACTER PYLORI.

RATIONALE: This patient has symptoms of dyspepsia, which is defined as at least 1 month of
epigastric discomfort with no evidence of organic disease after upper endoscopy. Since the
patient is younger than 60, upper endoscopy is not routinely recommended due to the low
prevalence of malignancy in younger patients. The prevalence of one alarm symptom (eg,
dysphagia in the case of this patient) should not be used to justify endoscopy because the positive
predictive value is < 1% for malignancy.
Hpylor is a frequent cause of dyspepsia. A test-and-treat strategy (performing a test to detect H
pylori and its subsequent eradication when detected) is safe, effective, and cost-effective
compared to endoscopy. Recommended test options to assess for active H pylori infection are the
urea breath test and the stool antigen test. A positive serum test for H pylori antibodies would not
prove if active infection was present, only that the patient had been infected in the past. The
primary treatment of dyspepsia is acid suppression with an oral PPl for 2 to 8 weeks.