GI Emergency Procedures & Response 3 — Questions and Answers
Question 1: A patient arrives with suspected foreign body ingestion and drooling but no respiratory distress. What is the most appropriate next step?
- Emergent tracheotomy
- Chest and neck X-ray to locate the object (Correct answer)
- Immediate blind finger sweep
- Encourage the patient to vomit
Correct answer: Chest and neck X-ray to locate the object
Plain radiographs of the neck and chest help locate radiopaque foreign bodies and guide management before any intervention.
Question 2: Which sign on plain abdominal X-ray is most characteristic of small bowel obstruction?
- Free air under the diaphragm
- Dilated loops of small bowel with air-fluid levels in a stepladder pattern (Correct answer)
- Thumbprinting of the colon wall
- Pneumobilia
Correct answer: Dilated loops of small bowel with air-fluid levels in a stepladder pattern
Dilated small bowel loops with air-fluid levels arranged in a stepladder pattern on upright X-ray are the hallmark of small bowel obstruction.
Question 3: A patient develops sudden severe epigastric pain radiating to the back with elevated lipase. Initial management should include:
- Immediate ERCP
- NPO status, IV fluids, and pain control (Correct answer)
- Oral pancreatic enzyme supplementation
- High-fat diet to stimulate pancreatic drainage
Correct answer: NPO status, IV fluids, and pain control
Acute pancreatitis initial management focuses on bowel rest (NPO), aggressive IV fluid resuscitation, and adequate analgesia.
Question 4: Which scoring system is used to predict severity and mortality risk in acute pancreatitis within the first 48 hours?
- Child-Pugh score
- Ranson's criteria (Correct answer)
- MELD score
- Glasgow Coma Scale
Correct answer: Ranson's criteria
Ranson's criteria assess 5 admission variables and 6 additional variables at 48 hours to stratify acute pancreatitis severity.
Question 5: A patient with sigmoid volvulus undergoes initial sigmoidoscopic detorsion successfully. What is the recommended next step to prevent recurrence?
- Long-term laxative therapy
- Elective sigmoid resection (Correct answer)
- Colonoscopic surveillance every 6 months
- High-fiber diet alone
Correct answer: Elective sigmoid resection
Elective sigmoid colectomy is recommended after successful detorsion because sigmoid volvulus has a very high recurrence rate (up to 90%) without surgical resection.
Question 6: During resuscitation of a patient with acute GI bleeding, at what hemoglobin threshold is red blood cell transfusion generally recommended in a hemodynamically stable patient?
- Below 10 g/dL
- Below 7 g/dL (Correct answer)
- Below 9 g/dL
- Below 11 g/dL
Correct answer: Below 7 g/dL
A restrictive transfusion strategy with a threshold of Hgb <7 g/dL is recommended for most stable GI bleeding patients and has been shown to improve outcomes.
Question 7: A cirrhotic patient with suspected spontaneous bacterial peritonitis (SBP) should receive empiric antibiotics within how many hours of diagnosis?
- Within 12 hours
- Within 6 hours (Correct answer)
- Within 1 hour
- Within 24 hours
Correct answer: Within 6 hours
Empiric IV cefotaxime or a third-generation cephalosporin should be started within 6 hours of SBP diagnosis to reduce mortality.
GI Emergency Procedures & Response 3
A patient arrives with suspected foreign body ingestion and drooling but no respiratory distress.
What is the most appropriate next step?