LEARNING OBJECTIVE

After this activity, the participant will be able to identify and differentiate the various radiographic imaging modalities that can be used to supplement endoscopic evaluation for the diagnosis and treatment of gastrointestinal (GI) bleeding.

QUESTION 1

An 80-year-old woman with a history of atrial fibrillation on apixaban, coronary artery disease, hypertension, hyperlipidemia, and recent colonoscopy revealing pan-colonic diverticulosis presents to the hospital with multiple episodes of hematochezia over the past 4 hours. Her vitals in the emergency department are blood pressure 80/62, heart rate 120, oxygen saturation 96% on room air, and temperature of 98.2°F. She is currently being resuscitated with blood products and she is being transferred to the intensive care unit. What is the next best step in localizing her bleed?

Computed tomography (CT) abdomen/pelvis without contrast CT angiography 99m Technetium-labeled red blood cell (RBC) scintigraphy Abdominal ultrasound QUESTION 2

A 40-year-old man with a history of obscure GI bleeding is found to have active contrast extravasation from the gastroduodenal artery on CT angiography. He is now being moved to the interventional radiology suite for embolization. What is the technical success of catheter angiography?

25% 50% 85% 95% QUESTION 3

A 56-year-old woman with a history of fibrostenosing Crohn’s disease of the small intestine with previous small intestinal resections in the past continues to have obscure GI bleeding. You have concerns that she may have a small bowel mass that is causing the bleeding based on an in-office intestinal ultrasound. A video capsule endoscopy is unable to be performed on her due to her increased risk of capsule retention. What is the next best imaging modality before endoscopic evaluation?

Meckel’s scan CT enterography CT angiography 99m Technetium-labeled RBC scintigraphy