Diverticular bleeding — MCCQE Part 1 MCQ

Correct answer: B — Resuscitate, hold/reverse anticoagulation when appropriate and arrange urgent lower-GI bleeding evaluation

Resuscitate, hold/reverse anticoagulation when appropriate and arrange urgent lower-GI bleeding evaluation is best because painless brisk bleeding in an older adult suggests diverticular haemorrhage. Wait for confirmatory testing before any stabilisation is suboptimal because resuscitation and time-critical treatment should not wait when instability is present; Discharge once symptoms temporarily improve is suboptimal because temporary improvement can precede deterioration; Give an adjunctive medication as the sole first-line treatment is suboptimal because adjuncts do not replace definitive stabilisation; Delay escalation until cardiac arrest or respiratory failure occurs is suboptimal because early escalation is central to emergency care. Haemodynamic status determines urgency more than stool colour alone.

Reference: Canadian Association of Gastroenterology lower GI bleeding guidance