Lower Gastrointestinal Haemorrhage

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Question 1 of 10

1. Question
A 60-year-old women is brought into the emergency department having had a number of episodes of fresh PR bleeding.

Which one of the following statements is true?
- Acute, lower GI haemorrhage accounts for 20% of all cases of GI haemorrhage
- Evidence of fresh blood on PR confirms that the bleeding site is in the lower GI tract
- The mortality from all causes of lower GI bleeds is approximately 20%
- 5% of patients with fresh blood on PR examination are found to have an upper GI source
- The majority of cases continue to bleed without treatment
Correct

Incorrect
Question 2 of 10

2. Question
A 76-year-old male patient presents with a five hour history of passing large volumes of blood per rectum. Initial observations show a pulse of 120bpm, blood pressure 70/40mmHg, respiratory rate 20/min and oxygen saturations 95%.

Which of the following is the most likely cause of the bleeding?
- Diverticular disease
- Angiodysplasia
- Inflammatory bowel disease
- Oesophageal varices
- Colonic carcinoma
Correct

Incorrect
Question 3 of 10

3. Question
With reference to the patient described in the previous question, which initial action is the best option?
- Insert an NG tube and aspirate through it to confirm whether the source is upper or lower GI
- Insert a large bore IV cannula and immediately transfuse two units O negative blood
- Insert a large bore cannula and transfuse 1L of gelofusin over 2h
- Insert a large bore cannula and immediately infuse a fluid bolus of saline with a view to arranging blood transfusion
- Arrange urgent colonoscopy
Correct

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Question 4 of 10

4. Question
The same patient receives appropriate initial resuscitation, but remains unstable with a blood pressure of 80/30mm Hg, pulse 110bpm and evidence of ongoing bleeding.

Having involved the surgical team, the most appropriate and potentially definitive investigation for this patient is?
- Upper GI endoscopy
- Colonoscopy
- Nuclear scan
- Capsule enteroscopy
- Angiography
Correct

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Question 5 of 10

5. Question
A 35-year-old women presents with a history of passing small amounts of fresh PR blood associated with pain and is diagnosed with an anal fissure. With regard to perianal conditions, which one of the following statements is correct?
- Haemorrhoids typically present with fresh bleeding noted on the toilet paper
- Patients with bleeding from haemorrhoids should all be admitted
- Anal fissures are normally easily visualised in the posterior midline
- Patients with anal fissures typically present with a history of constipation, straining and pain on defecation and blood on the toilet paper
- Patients with symptoms and signs of an anal fissure all require admission and further investigation
Correct

Incorrect
Question 6 of 10

6. Question
A patient presents with features suggesting a lower GI bleed. You are trying to make an assessment of the severity of the bleed.

Which one of the following is not one of the BLEED criteria?
- On-going bleeding
- Hypotension
- Abnormal clotting
- Tachycardia
- Co-morbidities
Correct

Incorrect
Question 7 of 10

7. Question
A 50-year-old lady presents with a history of fresh PR bleeding.

Which one of the following is true with regards to your initial history and examination ?
- Abdominal pain is common with lower GI bleeding
- A drug history is of little relevance
- A recent history of cardiac arrhythmia may help guide towards the likely source of bleeding
- Fresh PR bleeding always indicates a lesion in the left side of the colon
- Abdominal pain suggests angiodysplasia as the cause of bleeding
Correct

Incorrect
Question 8 of 10

8. Question
A 65-year-old female presents with a history of fresh PR bleeding. After initial resuscitation, the surgeons admit the patient and arrange a colonoscopy.

Which one of the following is correct?
- Systemic vasopressin infusions should be used to limit bleeding during the procedure
- Colonoscopic therapy will control bleeding in 20% of patients
- Thermal contact therapy is often employed
- Colonoscopy should be delayed until 24h after the acute bleed
- Angiography should be performed prior to colonoscopy to identify the bleeding point
Correct

Incorrect
Question 9 of 10

9. Question
Colonoscopy fails to identify and control the bleeding in the patient from the previous question.

Which is the next best option?
- Systemic vasopressin infusion
- Angiography with super-selective embolisation of bleeding point
- IV pantoprazole 40mg
- Total colectomy
- Technetium labelled red blood cell scanning
Correct

Incorrect
Question 10 of 10

10. Question
Angiography and super-selective embolisation is performed in the patient from the previous question. Unfortunately, on the following day the bleeding restarts and the patient again becomes unstable.

A decision is made to take the patient to theatre: which one of the following is true regarding surgery in a lower GI haemorrhage?
- Up to 50% of patients require surgery
- Generally surgery is not required even if massive transfusions of red cells are required
- Patients with massive lower GI bleeds should undergo surgery as a primary therapy
- Subtotal colectomy is often performed
- The bleeding point is normally easily identified at laparotomy
Correct

Incorrect

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