Q 1:
A 12-year-old girl presents with an episode of “feeling faint” and melena. On physical
examination, you note a gallop rhythm and mild, nonspecific abdominal tenderness. Stool is
guaiac-positive. Laboratory analysis demonstrates anemia, with a hematocrit of 18% (0.18). You
administer fluid resuscitation and packed red blood cells, and the patient’s hemodynamic status
stabilizes.
Of the following, the next MOST appropriate diagnostic test is
A. angiography
B. barium contrast upper gastrointestinal tract radiography
C. Doppler ultrasonography of portal and esophageal veins
D. upper gastrointestinal endoscopy
E. video capsule study
Answer
D
Upper gastrointestinal endoscopy remains the initial diagnostic test of choice for most upper
gastrointestinal hemorrhages because it is not only highly sensitive for mucosal lesions such as
peptic ulcers and varices, but also allows the endoscopist to treat any bleeding lesions.
Upper gastrointestinal bleeding (bleeding proximal to the ligament of Treitz) may be either acute
(presenting with melena and hemodynamic instability) or chronic (presenting with anemia).
Common causes include gastric or duodenal ulcers, chronic gastritis, esophageal or gastric
varices, and reflux esophagitis. Vascular lesions such as arteriovenous malformations or
telangiectasias (as seen in hereditary hemorrhagic telangiectasia [Osler-Weber-Rendu
disease]) also can present with chronic gastrointestinal blood loss. Dieulafoy lesion is another
cause of upper gastrointestinal hemorrhage that presents with massive and recurrent bleeding
and is caused by an abnormally enlarged arteriole in the gastric cardia or duodenum that
periodically bleeds into the gastric lumen.
Answer
D
Upper gastrointestinal endoscopy remains the initial diagnostic test of choice for most upper
gastrointestinal hemorrhages because it is not only highly sensitive for mucosal lesions such as
peptic ulcers and varices, but also allows the endoscopist to treat any bleeding lesions.
Upper gastrointestinal bleeding (bleeding proximal to the ligament of Treitz) may be either acute
(presenting with melena and hemodynamic instability) or chronic (presenting with anemia).
Common causes include gastric or duodenal ulcers, chronic gastritis, esophageal or gastric
varices, and reflux esophagitis. Vascular lesions such as arteriovenous malformations or
telangiectasias (as seen in hereditary hemorrhagic telangiectasia [Osler-Weber-Rendu
disease]) also can present with chronic gastrointestinal blood loss. Dieulafoy lesion is another
cause of upper gastrointestinal hemorrhage that presents with massive and recurrent bleeding
and is caused by an abnormally enlarged arteriole in the gastric cardia or duodenum that
periodically bleeds into the gastric lumen.
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