Self evaluation exercise for the topic of GI bleeding
Dr A.J. Chandrasekhar

What amount of GI blood loss is required to produce occult positive stool?

1. 1 cc
2. 3 cc
3. 5 cc
4. 10 cc

Answer B. 3 cc

What amount of GI blood loss is required to produce melena?

1. 100-200 cc
2. 200-300 cc
3. 300-400 cc
4. 400-500 cc

Answer A. 100-200 cc

What amount of circulating blood volume loss is required to produce orthostasis?

1. 10%
2. 20%
3. 30%
4. 40%

Answer:  B. 20% (about 1000 cc)

All of the following can present with acute upper GI bleed resulting in melena except:

1. Peptic ulcer
2. Esophageal varices
3. Mallory-Weiss tear
4. Cancer colon

Answer  D. Cancer colon

• Bleeding above ligament of Treitz is associated with melena. You need acid to produce melena. 

Melena can be seen in patients with hemoptysis.

1. True
2. False

Answer A. True

• If the blood is swallowed, it can present as melena.

Stool can be black following eating licorice.

1. True
2. False

Answer  A. True

• Intake of iron, Pepto-Bismol or licorice can cause black stools. These are the causes for non-bloody black stools.

Bleeding distal to ligament of Treitz does not give rise to melena.

1. True
2. False

Answer  A. True

• You need acid to produce melena. 

Bile stained nasogastric return indicates that there is no active bleeding proximal to the third portion of duodenum.

1. True
2. False

Answer  A. True

Coffee ground nasogastric return indicates that there is active ongoing bleeding.

1. True
2. False

Answer  B. False

• Coffee ground nasogastric return indicates that there is slow bleeding or oozing. Red blood or clots would indicate active ongoing bleeding.

What will be the ideal procedure to confirm the location of upper GI bleeding site?

1. Upper GI
2. EGD
3. Angiogram
4. Nasogastric tube aspiration

Answer  B. EGD

• Esophagogastroduodenoscopy  (EGD) is ideal to evaluate and treat upper GI bleeding. Angiogram is done only when EGD fails to identify the source of bleed.

The best first approach to control upper GI bleeding is with EGD and a cautery procedure.

1. True
2. False

Answer  A. True

The role of  surgery in bleeding peptic ulcer is indicated:

1. In all cases
2. Age > 65
3. When requiring > 6 units of blood transfusion
4. All of the above
5. None of the above

Answer  D. All of the above

Chronic GI blood loss leads to normochromic normocytic anemia.

1. True
2. False

Answer  B. False

• Chronic GI blood loss leads to microcytic hypochromic anemia.

The following  lesions can cause chronic GI bleeding except:

1. Cancer Stomach
2. Cancer Colon
3. Peptic ulcer
4. Hereditary hemorrhagic telengiectasia

Answer  C. Peptic ulcer

• Peptic ulcer bleeds acutely and does give rise to chronic bleeding.

Cancer of esophagus can present as:

1. Iron deficiency anemia.
2. Folate deficiency anemia
3. B12 deficiency anemia

Answer  B. Folate deficiency anemia

• Cancer of esophagus presents as folate deficiency anemia due to deficient intake of food (dysphagia). Patients never live long enough to present with iron deficiency anemia.

Select the incorrect statement for hematochezia.

1. Passage of bright red blood per rectum
2. Hemorrhage from colon or distal ileum
3. AV malformation can give rise to large volume hematochezia
4. Bleed from esophageal varices is one of the possible etiology

Answer  D. Bleed from esophageal varices is one of the possible etiology

• Upper GI bleed will give rise to melena and not bright red blood