Surgical MCQ In GI Home Jejunum Sclerotherapy Appendix MCQ

Bleed Exam Questions in

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Surgical MCQ (Multiple Choice Questions) on Upper GI bleeding. Upper GI bleed is a fatal
condition in any gastro clinic. Timely intervention and management is the key to successful
management.

Bleeding Varices Cecal Volvulus

Perio Protect
1. If esophageal varices are
Cecal Volvulus is responsible
Treatment
not treated in hospital , the
chances of recurrent bleeding for 1-3% of all large bowel Non-surgical, Painless, Easy
obstructions. Embryologically
is more than 75%.
cecum rotates counter
Method Using an FDA-Cleared
clockwise from left to its Medical Device
2. In resuscitation of bleeding
position in right lower
varices maintain CVP
quadrant. Arrest in this
between 2-5 cm of water.
development leads to cecal
volvulus.
3. Do not give sedatives in
resuscitation of bleeding
varices.

GI Bleed Questions
Related Surgical Questions

Q1 In Obscure GI Bleed which is not true Gastric Surgery MCQ

a) 10-20% of patients will have no cause found despite all modern investigations
b) Of all GI Bleeds Obscure overt is only 1%
c) These types of bleed are missed because the lesions bleed so much that nothing
Esophagus
can be visulaized during endoscopy/colonoscopy
d) The lesion might bleed slowly and intermittently Liver

Q2.Not an important feature in taking history of patients with obscure GI Bleed Spleen
a) Age of the patient
b) History of jaundice
c) HIstory of haematemesis/melena Pancreas
d) Recent Surgery

Q3 Least sensitive in detecting a source of obscure Gi Bleed from small bowel

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 a) Barium Meal Follow through
b) Enteroclysis
c) Technitium Labelled Nuclear scan
d) Angiography

Q4. What is not true about Technetium labelled nuclear scans ?

a) They are helpful only during active bleeding
b) There are two types of scans done commonly Sulphur colloid and RBC scan
c) Diagnostic yield of these scans has a wide variation from 15-70% Chassin's SURGERY
d) They can identify the etiology correctly if they are positive Operative... SHELF EXAM...
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Q5. What is not true about the role of Angiography in Obscure GI Bleed
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a) It is a useful diagnostic and therapeutic tool in patients who are actively bleeding Shop now
b) The Sensitivity of angiography is less than nuclear medicine scans
c) Diagnostic yield is about 40%
d) It can identify smaller arterial lesions such as vascular ectasia and even venous
bleeding

Answers
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1. c
Obscure GI bleed is a one in which no source could be found despite endoscopy and
colonscopy. These can be obscure occult or obscure overt. Interesting Pages
Approximately 10% to 20% of these patients,do not have an identifiable bleeding
source. A small proportion (approximately 5% overall) of these patients have Famous Surgeons
recurrent bleeding of unclear etiology leading to extensive and repetitive testing
The source of bleeding is generally not found because of the
a. Slow and intermittent nature of bleeding Books in Surgical Residency

b. Anemia and volume contraction has caused it to stop at that time Surgery Photos
c. Lesions in small bowel are difficult to detect
USMLE Questions
2) b

Although all of these are important and should be asked, jaundice is last on the list.
People with hemobilia will give history of jaundice.
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Age is important beacuse in older people malignany and in younger Meckel's
Diverticulum is common
In patients with haematemesis generally the lesion in proximal to the ligament of
treitz.he appearance of the stool, which is largely dependent on blood transit time,
may also be suggestive of location of the bleeding. Blood that has been in the GI
tract for less than 5 hours is usually red, whereas blood present for more than 20
hours is usually melenic.
patients with slow oozing from the distal small bowel or cecum may have melena and
occasional patients with aggressive bleeding from an upper GI source may present
with hematochezia.
Recent surgery might be an indicator of anastomotic site bleeding or Aorto Enteric
fistula

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 3. a
Small Bowel Follow through (BMFT) can pick up Diverticulosis, Malignant lesion or
Crohn's disease. The mere presence of diverticuli does not mean they are bleeding.
The sensitivity of BMFT is very low
Diagnostic yield of Enteroclysis can be 12-30%. Mostly they can detect small bowel
tumors. Crohn's disease
With the advent of capsule endoscopy, however, the use of SBFT or enteroclysis for
obscure GI bleeding has declined substantially.

4. d
Because of their mode of action, bleeding scans are only useful in the setting of
active GI bleeding. Two types of nuclear scans are used technetium 99m-labeled red
blood cell scan and the technetium 99m-labeled sulfur colloid scan
It can reportedly detect active bleeding at a rate of 0.10 mL/min.
In patients with obscure GI bleeding, there are several drawbacks to nuclear
scanning. First, nuclear scanning localizes active bleeding to a region of the
abdomen, not a specific site; even a positive scan cannot provide an etiology for the
bleeding..
Scanning is not therapeutic, a follow-up study, such as arteriogram or endoscopic
examination, must be subsequently performed

5. d
Angiography does not pick up venous bleeding
The rate of bleeding should be 0.5 ml/min - 1 ml/min to be detected on angiography
Angiography has a high incidence of complications such as contrast induced and
mechanical complications

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