GI Emergency Procedures & Response 2 — Questions and Answers
Question 1: A patient presents with sudden severe abdominal pain, rigid abdomen, and absent bowel sounds. Which condition should be suspected first?
- Acute appendicitis
- Perforated peptic ulcer (Correct answer)
- Irritable bowel syndrome
- Gastroenteritis
Correct answer: Perforated peptic ulcer
A rigid (board-like) abdomen with absent bowel sounds and sudden severe pain are classic signs of peritonitis from a perforated peptic ulcer.
Question 2: Which intervention is the highest priority for a patient presenting with hematemesis and hemodynamic instability?
- Schedule urgent endoscopy
- Administer IV proton pump inhibitor
- Establish large-bore IV access and initiate fluid resuscitation (Correct answer)
- Obtain CBC and coagulation studies
Correct answer: Establish large-bore IV access and initiate fluid resuscitation
Hemodynamic stabilization via IV access and fluid resuscitation takes precedence before any diagnostic or pharmacologic intervention in an unstable patient.
Question 3: A patient with known cirrhosis develops confusion and asterixis after a GI bleed. What is the most likely complication?
- Wernicke encephalopathy
- Hepatic encephalopathy (Correct answer)
- Hyponatremic encephalopathy
- Subdural hematoma
Correct answer: Hepatic encephalopathy
GI bleeding increases nitrogenous load in the gut, triggering hepatic encephalopathy in cirrhotic patients due to impaired ammonia metabolism.
Question 4: What is the recommended first-line pharmacologic treatment to reduce rebleeding risk in variceal hemorrhage before endoscopy?
- High-dose aspirin
- Octreotide (somatostatin analogue) (Correct answer)
- Oral lactulose
- IV metronidazole
Correct answer: Octreotide (somatostatin analogue)
Octreotide reduces splanchnic blood flow and portal pressure, decreasing variceal bleeding and is given as soon as variceal hemorrhage is suspected.
Question 5: During endoscopy for acute lower GI bleeding, the source cannot be found. What is the next best diagnostic step?
- Barium enema
- CT angiography of the abdomen and pelvis (Correct answer)
- Repeat colonoscopy in 24 hours
- Abdominal X-ray
Correct answer: CT angiography of the abdomen and pelvis
CT angiography can identify the bleeding source if it is active (≥0.3–0.5 mL/min) and guide subsequent embolization.
Question 6: A patient with acute mesenteric ischemia requires emergent surgery. Which intraoperative finding best determines bowel viability?
- Color of the serosa under white light
- Doppler flow signals and fluorescein dye perfusion (Correct answer)
- Presence of peristalsis on palpation alone
- Mucosal biopsy frozen section
Correct answer: Doppler flow signals and fluorescein dye perfusion
Doppler signals combined with intraoperative fluorescein dye under Wood's lamp provide the most reliable real-time assessment of bowel perfusion.
Question 7: In a patient with toxic megacolon, which finding is an absolute indication for emergency surgery?
- Colon diameter of 6 cm on X-ray
- Failure to improve after 48–72 hours of medical therapy
- Fever above 38.5°C
- Colonic perforation with pneumoperitoneum (Correct answer)
Correct answer: Colonic perforation with pneumoperitoneum
Free perforation with pneumoperitoneum is an absolute surgical emergency in toxic megacolon due to life-threatening peritonitis.
GI Emergency Procedures & Response 2
A patient presents with sudden severe abdominal pain, rigid abdomen, and absent bowel sounds.
Which condition should be suspected first?