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]}