Access Older Quiz Archive

View All VideoGIE Image Quizzes

An ooze diffuse

  • An ooze diffuse Figure 1

Question

A 67-year-old patient presents with melena and shortness of breath culminating over the last few weeks. Laboratory test results show a hemoglobin level of 7 mg/dl from a baseline of 13 mg/dl and a blood urea nitrogen/creatinine ratio >40. CT scan results reveal a fundal mass with hyper-enhancing locules consistent with a GI stromal tumor. Upper endoscopy finds a 5-cm ulcerated submucosal mass diffusely bleeding in the gastric fundus. To control this bleed, hemostatic powder therapy is chosen, and the injection catheter is modified to prevent clogging of the system during deployment (Figure). After successful hemostasis, the patient undergoes definitive therapy with surgical resection. Which of the following is true regarding upper GI bleeding?

The Horibe gAstRointestinal BleedING scoRe (HARBINGER) is a simple score to predict the presence of high-risk endoscopic stigmata in patients with upper GI bleeding. The Rockall and AIMS65 scores were developed to predict composite outcomes (the need for a blood transfusion or intervention to control bleeding, rebleeding, or death) in the context of upper GI bleeding. Hemostatic spray is a versatile modality of therapy in slow and torrential GI bleeding. Recurrent bleeding is rare after index successful hemostasis of malignancy—induced GI bleeding.
View picture quiz
View all
View All VideoGIE Image Quizzes

More Picture Quizzes

Hard to swallow

A 74-year-old woman undergoes an upper endoscopy because of symptoms of dysphagia and weight loss. A giant fibrovascular polyp is seen filling the esophageal lumen and estimated to be 17 cm. During EGD, forceful retching and vomiting result in disgorgement of the polyp from the mouth (Figure). Given the inability to reduce this lesion without the risk of airway obstruction, the decision is made to proceed with emergent endoscopic submucosal dissection after nasotracheal intubation. Which of the following is true about giant fibrovascular polyps?
View picture quiz

The GIST of it

During screening colonoscopy, a 45-year-old man is found to have a rectal submucosal lesion. EUS reveals a 2.5-cm hypoechoic lesion emanating from the adventitial layer with an intact muscularis propria. EUS-guided core biopsy shows a GI stromal tumor (GIST), and the patient is referred for endoscopic adventitial dissection (Figure). Which of the following is true regarding GISTs?
View picture quiz

The underwater leather bottle

A 70-year-old man presents with weight loss, anorexia, and nausea. A CT scan shows a significantly thickened gastric wall. Upper endoscopy and mucosal biopsies are performed from hyperemic, “angry-looking” areas, but malignancy is not discerned. A repeat endoscopy is performed, and the lumen is submerged in water. A specialized stiff cold snare is used to obtain sampling underwater. Histopathologic evaluation also is performed (Figure). Which of the following is true about this condition?
View picture quiz

Pesky pearls

A 73-year-old man presents with right upper quadrant pain 19 months after cholecystectomy. A CT scan shows perihepatic fluid collection extending to the gallbladder fossa suspicious for biloma. Percutaneous drainage is performed, and evidence of dropped gallstones is found during placement. After multidisciplinary discussion, cholangioscopy is completed through the percutaneous tract with removal of the dropped gallstones. Which of the following is true?
View picture quiz

Deeper dive

A 72-year-old man with underlying disease of right-sided tongue cancer undergoes EGD for a gastric subepithelial lesion in the gastric fundus. Biopsies are nondiagnostic. EUS shows a nearly 2-cm heterogeneous hypoechoic tumor originating from the muscularis propria layer. What is the best next step in management?
View picture quiz