Hematochezia

[nurmd01]

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i was solving a question involving hematochezia and it was asking what endoscopic technique would be considered first. The answer was upper endoscopy.
I dont understand why this is, i would have assumed lower endoscopy as they are bright red feces so should be lower GI damage. In Melena (black feces) should be upper GI prob so upper endoscopy.
I dont understand what Im missing here

 

[Transposony]

It is based on the most common cause of GI bleed.
UGI bleed can present with hematochezia if the rate of bleed is high enough.

 

[seminoma]

i was solving a question involving hematochezia and it was asking what endoscopic technique would be considered first. The answer was upper endoscopy.
I dont understand why this is, i would have assumed lower endoscopy as they are bright red feces so should be lower GI damage. In Melena (black feces) should be upper GI prob so upper endoscopy.
I dont understand what Im missing here

Upper doesn't require bowel prep. As @Transposony pointed out, a rapid UGI can present with hematochezia so instead of sitting with your thumbs in your ass for the pt to be ready for a lower scope you do the upper.

FWIW these are the kinds of questions that made my particular step 1 form difficult. Things that are not in UFAP, but at the same time technically aren't "step 2" level clinical knowledge/management. We all know there's no feces in the upper GI tract, but (at least for me) it's not something that has any clinical relevance unless I think really hard about it. It's hard to step back and think about non-science stuff that might help answer the question for you.

 

[Transposony]

The hardest questions on the test for me are the one's where the answer is "normal" (i.e. heart sounds).
I am not a fan of looking for normal on the test.