Gastrointestinal bleeding — formative SAQs

SAQ 1 — The toddler with painless bright rectal bleeding (10 marks, 15 minutes)

A previously well 18-month-old boy is brought in after passing a large amount of bright red blood per rectum with no pain. He is alert and haemodynamically stable, his abdomen is soft and non-tender, and the perianal examination is normal. [3]

a) Explain why the combination of painless bright bleeding in a well toddler raises a specific diagnosis, and state the rule-of-twos that describes it. (3 marks) [4]

b) Name the investigation of choice, what it detects, and an alternative imaging modality if that investigation is negative. (4 marks) [4] [3]

c) Outline the definitive treatment and the principles of resuscitation if the child becomes haemodynamically unstable. (3 marks) [2] [4]

SAQ 2 — The infant with colicky pain and bloody stool (10 marks, 15 minutes)

A 9-month-old infant has episodic drawing-up of the legs with crying, vomiting, and has now passed a stool containing blood and mucus. On examination he is irritable, and a sausage-shaped mass is palpable in the right upper quadrant. [6]

a) State the most likely diagnosis and explain why currant-jelly stool is a late rather than an early sign. (3 marks) [6] [3]

b) Outline your immediate assessment and the first-line imaging test and its key sign. (4 marks) [6] [2]

c) Describe the first-line definitive treatment, and state when you would abandon it for surgery. (3 marks) [6] [2]