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Acute lower gastrointestinal bleeding — ESEGH MCQ

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HardGI BleedingAcute lower gastrointestinal bleedingESEGH

A 76-year-old woman presents with large-volume fresh rectal bleeding and syncope. She takes apixaban for atrial fibrillation. Blood pressure is 82/46 mmHg after initial fluids and haemoglobin is 78 g/L. Rectal examination confirms fresh blood. What is the most appropriate investigation?

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Correct answer: E — CT angiography after immediate resuscitation

Haemodynamically unstable lower GI bleeding requires resuscitation and CT angiography to localise active bleeding and guide embolisation or surgery. Routine outpatient colonoscopy is unsafe in shock. Capsule endoscopy is not first-line in unstable brisk bleeding. The teaching point is that physiology determines the first investigation in lower GI haemorrhage.

Reference: BSG Lower GI Bleeding Guideline