Question 1

A patient has both occasional &#34;coffee ground&#34; emesis and melena stools. What is the most probably source of bleeding in this patient?&#10;A) Hepatic&#10;B) Lower gastrointestinal (GI) tract&#10;C) Rectal&#10;D) Upper gastrointestinal (GI) tract

Accepted Answer

The presence of both coffee ground emesis (vomiting of partially digested blood) and melena stools (dark, tarry stools indicating digested blood) suggests a source of upper gastrointestinal (GI) tract bleeding, most commonly from a gastric or duodenal ulcer. Hepatic bleeding would typically present with hematemesis (vomiting of fresh blood), while lower GI bleeding would result in bright red blood per rectum. Rectal bleeding alone would not cause coffee ground emesis.

Question 2

What initial action is appropriate when admitting a patient who has a gastrointestinal (GI) tract bleed, hypotension, and a hematocrit decrease of 6% from baseline?&#10;A) Administer packed red blood cells.&#10;B) Place a Foley catheter to monitor output.&#10;C) Place two large-bore intravenous lines.&#10;D) Prepare for surgical repair of the bleed.

Accepted Answer

Placing two large-bore intravenous lines will allow for administration of fluid resuscitation and potentially blood transfusions to address the hypotension and hematocrit decrease. Administering packed red blood cells may be necessary, but should be done after the IV lines are in place. Placing a Foley catheter to monitor output is important, but not urgent in comparison to addressing the hypotension and GI bleed. Surgical repair may be necessary in the future, but initial stabilization is the priority.

Question 3

A 50-year-old, previously healthy patient has developed gastritis. What is the most likely cause of this condition?&#10;A) H. pylori infection&#10;B) NSAID use&#10;C) Parasite infestation&#10;D) Viral gastroenteritis

Accepted Answer

Gastritis is commonly caused by H. pylori infection, which can result in inflammation and damage to the stomach lining. NSAID use can also cause gastritis, but the patient's history does not indicate any use of these medications. Parasite infestation and viral gastroenteritis are less common causes of gastritis.

Deck 118: Gastrointestinal Hemorrhage