QUIZ: Gastrointestinal bleeding

 

🩸 GI Bleeding Quiz: Upper vs Lower

This quiz is designed for medical students to test their understanding of gastrointestinal bleeding. Each case-based question reinforces key clinical features, bleeding sources, and early investigations, with a focus on anatomy and pathophysiology.

 

1. A 55-year-old man presents with sudden onset of vomiting “coffee ground”-like material and reports feeling light-headed. He has a history of heavy alcohol use and recent use of ibuprofen for back pain.

Which of the following most likely explains the appearance of his vomitus?

A. Undigested food mixed with bile
B. Mucus from oesophageal inflammation
C. Fresh blood from a Mallory-Weiss tear
D. Altered blood due to gastric acid exposure
E. Bile-stained vomit due to small bowel reflux

2. A 75-year-old woman presents with fresh red blood mixed with stool. She is haemodynamically stable and reports no pain. She has a history of constipation and diverticulosis. Colonoscopy confirms active bleeding from a diverticulum in the sigmoid colon.

Which of the following best explains the bleeding in diverticular disease?

A. Erosion of a submucosal blood vessel in a diverticulum
B. Tearing of the anal mucosa during defecation
C. Chronic inflammation of the terminal ileum
D. Ischaemic necrosis of the colonic wall
E. Capillary rupture from increased venous pressure

3. A 40-year-old woman presents with black, tarry stools and fatigue. She denies vomiting or abdominal pain. On examination, her conjunctivae are pale. Her haemoglobin is 89 g/L.

Which of the following best explains her symptoms?

A. Acute rectal bleeding
B. Upper GI bleeding with digested blood
C. Iron supplementation
D. Slow chronic bleeding from haemorrhoids
E. Ingestion of charcoal tablets

4. A 60-year-old man presents with black stools and dizziness. He takes aspirin daily. His vitals show mild hypotension and tachycardia. His haemoglobin is 82 g/L. You suspect an upper GI bleed.

What is the most appropriate initial investigation to identify the bleeding source?

A. Colonoscopy
B. CT abdomen
C. Abdominal ultrasound
D. Gastroscopy (upper endoscopy)
E. Abdominal X-ray

5. A 70-year-old man with a history of NSAID use presents with melena and dizziness. On examination, he is pale and his BP is 88/60 mmHg, HR 115 bpm. Capillary refill is 4 seconds.

Which of the following best describes his current condition?

A. Compensated blood loss with stable perfusion
B. Mild postural hypotension only
C. Haemorrhagic shock requiring resuscitation
D. Neurogenic shock from spinal injury
E. Chronic anaemia with no acute blood loss

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Answer Explanations

1. Correct answer: D. Altered blood due to gastric acid exposure
“Coffee ground” vomitus suggests upper GI bleeding in which blood has been exposed to gastric acid, causing it to darken. Common causes include peptic ulcers, gastritis, or mucosal injury from NSAIDs or alcohol.

2. Correct answer: A. Erosion of a submucosal blood vessel in a diverticulum
Diverticula form at points where blood vessels penetrate the muscular layer of the colon. These vessels can be stretched and eroded, leading to painless bleeding. This is a common cause of lower GI bleeding in older adults.

3. Correct answer: B. Upper GI bleeding with digested blood
Melena (black, tarry stools) indicates that blood has been digested during passage through the GI tract, suggesting an upper GI source such as a gastric or duodenal ulcer. The anaemia confirms significant blood loss.

4. Correct answer: D. Gastroscopy (upper endoscopy)
Gastroscopy allows direct visualisation of the oesophagus, stomach, and duodenum and is the investigation of choice for suspected upper GI bleeding. It may also allow therapeutic interventions.

5. Correct answer: C. Haemorrhagic shock requiring resuscitation
Hypotension, tachycardia, and signs of hypoperfusion (e.g. delayed capillary refill) indicate haemorrhagic shock from significant blood loss. This is an emergency requiring fluid resuscitation and transfusion.

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