Gastrointestinal Bleeding Trivia Quiz

Answer: upper and lower

The general classification used for GI bleeding is upper GI bleed (UGIB) and lower GI bleed (LGIB). The ligament of Treitz located between the duodenum and the jejunum is the point of reference used when distinguishing upper from lower GI bleed. Put another way, UGIB includes bleeding anywhere along the esophagus, stomach and duodenum, while LGIB includes bleeding along the lower portion of the small intestine, the colon, rectum and anus. Upper GI bleed is much more common than lower GI bleed. The diagnostic tests/procedures, causes and treatment modalities vary depending on the location of the bleed, that is, whether UGIB or LGIB.

Hemetemesis means vomiting of blood whereas hematochezia means bloody stools. These are clinical features of GI bleed rather than classification. Since the GI tract is located internally, GI bleeding is not classified as external. Acute and chronic classifies bleeding according to time of onset, presentation and duration.

Answer: colitis

The answer is colitis, which refers to inflammation of the colon. Causes of colitis include infection with bacteria and viruses, food poisoning, inflammatory bowel disease (ulcerative colitis and Crohn's disease), and introduction of strong chemicals into the colon.

Gastritis is inflammation of the stomach lining. This can be caused by excessive use of alcohol, use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin and indomethacin, smoking, stress and infection with helicobacter pylori.

Peptic ulcers are ulcers which develop in the stomach, duodenum and in rare cases, the lower portion of the small intestine. The causative factor causes a break in the protective mucosa of the stomach, duodenum or lower esophagus. This exposes the underlying structures to the action of the harsh stomach acid and pepsin. Causes are similar to those of gastritis.

Mallory-Weiss tears are tears in the mucosal layer at the junction of the stomach and esophagus. These tears can be caused by forceful coughing or vomiting, seizures or conditions which cause increased pressure in the abdomen.

Answer: peptic ulcers

About fifty percent of the cases of upper gastrointestinal bleeding are due to peptic ulcer disease (PUD). Although gastric juice has a pH of about 1.5, several mechanisms come into play to keep the pH of the gastric and duodenal mucosa higher than 6. If for some reason, these protective mechanisms are destroyed, the stomach or duodenal lining becomes exposed to gastric juices and auto-digestion takes place.

When underlying blood vessels are eroded, bleeding occurs. The factors which predispose to PUD include excessive use of alcohol, smoking, infection with helicobacter pylori, use of non-steroidal anti-inflammatory drugs and stress caused by severe illness. Since so many factors predispose to these ulcers, PUD is the most common cause of UGIB.

Answer: esophageal varices

The esophagus is a part of the upper GI tract. Esophageal varices are enlarged, engorged veins in the lower portion of the esophagus. Consider varicose veins of the legs for a comparison. People with chronic liver disease are predisposed to esophageal varices.
Hemorrhoids, diverticular disease and colorectal cancer are all causes of lower GI bleed.

Answer: upper

When discussing GI bleeding with your doctor, it's important to note the color of stools since this gives a rough idea regarding the site of origin of the bleed. When bleeding occurs in the stomach and upper portions of the small intestine, the iron in the hemoglobin becomes oxidized due to chemical reaction between the blood and digestive enzymes. This causes the stool to be black, foul smelling and pasty in consistency.

Bleeding from the lower GI tract is usually red or maroon in color because the distance to the anus is shorter allowing for less contact with digestive enzymes. It should be noted however that massive bleeding hastens peristaltic activity so the transit time is much shorter. For this reason, a person with severe upper GI bleeding may actually have red instead of black stools.

Answer: hematemesis

Hematemesis is the term for vomiting of blood. Depending on the amount of blood and length of time the blood has been in contact with gastric juice, the vomitus may be red or coffee ground in appearance. When blood has been in the stomach for a while, the gastric juices react with the heme in the blood causing it to become oxidized. Once this happens, the vomitus looks like coffee grounds. The causes of hematemetis include gastritis, ulcers, ruptured varices (engorged veins in the esophagus) and Mallory-Weiss tears which are tears in the mucosa at the junction where the stomach and esophagus join. When hematemesis is significant, the blood pressure drops and the patient may go into shock if quick action is not taken.

Hematochezia is the medical term for bloody stools. Hemoptysis refers to coughing up of blood. The place of origin in that case is usually the lung and not the GI tract. Hematuria is a term for blood in the urine.

Answer: esophageal varices

The most common cause of esophageal varices is cirrhosis of the liver. When there's chronic liver disease, scarring of the liver tissue takes place. This interferes with proper flow of blood through the liver. The blood vessels which empty blood into the liver either directly or indirectly become backed up with blood. For this reason, the veins in the lower esophagus become engorged with blood and can rupture easily. Once diagnosed, usually through EGD, necessary steps can be taken to prevent rupture of the varices.

Answer: Use of iron pills, Pepto-Bismol or blueberries.

Iron, lead, bismuth-containing drugs, (for example, Pepto-Bismol) and certain foods can cause stools to appear black although the stool isn't as foul smelling as in GI bleed nor is it pasty in consistency. Certain food dyes and vegetables such as beets on the other hand may cause food to appear red in color.

Bile is responsible for giving stool its golden brown color. If gall stones obstruct the emptying of bile into the gastrointestinal tract, the stool will appear pale or clay colored.

Green stool is usually the result of rapid transit of stool along the GI tract which prevents bile from undergoing its usual changes, for example, in cases of diarrhoea.

Answer: ibuprofen

Aspirin, naproxen, indomethacin and ibuprofen (Advil, Motrin) are all examples of medications which fall into a category of drugs called non-steroidal anti inflammatory drugs (NSAIDs). These drugs are used by many to treat inflammation, for pain relief and for temperature reduction. Because they can be obtained over the counter, people commonly use them to treat menstrual cramps, arthritis and headaches. Aspirin is used in stroke and heart disease treatment as well. One of the main adverse effects of NSAIDs is gastrointestinal irritation and bleeding. To offset GI problems, take NSAIDs on a full stomach. Should abdominal pain or black, tarry stool become a feature, a doctor should be notified. Colace, dulcolax and milk of magnesia are laxatives.

Answer: helicobacter pylori (H-Pylori)

More than half of the world's population has H. pylori infection. The organism is prevalent in overcrowded unsanitary conditions and can be transmitted in food and water as well as person to person contact. H. pylori predisposes to gastritis, peptic ulcers and certain types of stomach cancers. Symptoms of H. pylori infection include heartburn, diarrhea, constipation, bloating, flatus, nausea, vomiting and fatigue. Halitosis, gum disease and oral infections are also features.

The infection is treatable.

Answer: true

In some cases, people with gastrointestinal bleeding visit the doctor because of generalised weakness, fatigue and lightheadedness. A complete blood count reveals anemia and a test of the stool for fecal occult blood is positive. Stool for this test can be obtained via rectal examination.

Answer: esophagogastroduodenoscopy

A person who presents with black, tarry stools, vomiting of frank blood or coffee ground stomach contents may have an EGD done to locate the bleeding site and where possible, treat the underlying cause. Treatment may take the form of instillation of medication to stop bleeding, banding of varices or coagulation.

A colonoscopy is an endoscopic procedure which allows for assessment of the lower gastrointestinal tract. A sigmoidoscopy allows for assessment of the rectum, sigmoid and proximal colon.

A bronchoscopy is a procedure used to examine the airway and lungs.

Answer: colon polyps

A colon polyp is a small fleshy growth attached to the colon by a stalk. Most polyps are benign initially but can become cancerous. The incidence of colon polyps tends to increase over age fifty. Other predisposing factors for colon polyps include high fat diet and a personal or family history of colon polyps. Because the incidence of colon polyps increases at age fifty, it's recommended that people gets a colonoscopy at this age or earlier if there's a family history of colon polyps or an ethnic predisposition to develop colon cancer. During a colonoscopy, polyps can be clipped and removed for testing. The doctor then follows up with subsequent colonoscopy to monitor the status of the colon. In this way, cancer if present can be detected and treated early.

Colon polyps are mostly asymptomatic. When symptoms present they may include bleeding blood in stools or on toilet tissue after a bowel movement, constipation or diarrhoea.

Answer: antihypertensive medication

Massive gastrointestinal bleeding is an emergency. The individual may be alert and talking initially but quickly goes into a state of shock after vomiting up blood or passing blood in the stool. The person becomes tachycardic and the blood pressure falls.

Treatment entails obtaining intravenous access quickly and starting fluid replacement until blood is available. Endoscopic studies can be done to diagnose and treat the underlying cause of bleeding where necessary. Drugs which cause constriction of the blood vessels, for example octreotide or vasopressin can be administered to slow down the bleeding. Protonix may also be used intravenously to curtail production of stomach acids. Emergency surgery may be needed. Even if the client has a history of hypertension, antihypertensive medication should not be administered.

Answer: Use of non steroidal anti inflammatory drugs before meals.

Preventive measures include:

Diet modification to prevent constipation and straining on defecation as this may predispose to formation of diverticulosis and hemorrhoids. Increase in dietary fiber and water will help to improve movement of stool along the bowel and keep the stool soft. Spicy foods should be avoided.

Life style changes which include avoidance of alcohol, smoking and use of caffeine as these tend to increase secretion of acid in the stomach.

Treatment of Helicobacter pylori infections to prevent peptic ulcers.

Prophylactic treatment with antacids and other medications during stressful illnesses to reduce the incidence of stress ulcers.

Avoiding or using non-steroidal anti inflammatory drugs with caution. Always use at the end of a meal when the stomach is full.