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GI/Hepatic > Colonoscopy/Bowel Prep > Flashcards

Colonoscopy/Bowel Prep Flashcards

1
Q

What are the two invasive colorectal cancer screening tests?

A

colonoscopy and flexible sigmoidoscopy (FSIG)

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2
Q

What is the difference between an FSIG and a colonoscopy?

A

The FSIG only focuses on the lower rectum and sigmoid colon whereas the colonoscopy examines the entire colon

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3
Q

What are the noninvasive tests?

A

CT colonography (CTC) and double contrast barium enema (DCBE)

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4
Q

Which tests can prevent colorectal cancer by detecting polyps AND detect cancerous tumors?

A

Colonoscopy, flexible sigmoidoscopy, CT colonography, and double contrast barium enema

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5
Q

Which tests can only detect cancerous tumors and not polyps?

A

gFOBT (guaiac-based fecal occult blood test)
FIT (fecal immunochemical test)
FIT-DNA test (Cologuard)

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6
Q

How often should the gFOBT, FIT, and FIT-DNA test be performed?

A

Annually

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7
Q

If one of the take-home tests produces a positive result, what is the next step?

A

A follow up colonoscopy

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8
Q

What should patients be counseled on when using the gFOBT test?

A

Not to ingest any interfering substances that can cause a false positive or negative result 72 hours before and through the test

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9
Q

Which substances can cause a false positive result on the gFOBT test?

A
  1. Red meat
  2. ASA (> 325 mg/day) and NSAIDs
  3. Corticosteroids
  4. Anticoagulants
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10
Q

Which two substances will NOT cause a false positive gFOBT test result?

A

Iron supplements and acetaminophen

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11
Q

Which substances will cause a false negative gFOBT test result?

A
  1. Ascorbic acid (vitamin C) > 250 mg/day

2. Excessive amounts of vitamin C enriched food

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12
Q

What test is preferred over the gFOBT and why?

A

the FIT test because it has better accuracy and doesn’t have the dietary or medication restrictions

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13
Q

Which take home test is labeled as accurate as a colonoscopy?

A

FIT test

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14
Q

What can affect the results of the FIT test by causing hemoglobin degradation?

A

High temperatures

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15
Q

What is the difference between a FIT and FIT-DNA test?

A

The FIT-DNA test has additional DNA testing

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16
Q

How accurate is the FIT-DNA test compared to the FIT test?

A

It is more effective at detecting cancer but has a higher rate of false positives

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17
Q

What guidelines does the CDC use for screening measures?

A

The US Multi-Society Task Force on Colorectal Cancer Guidelines

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18
Q

When does the CDC say patients should start being screened for cancer?

A

From age 50-75 years old

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19
Q

What factor determine screening for ages 76-85?

A
  1. consult with MD to determine risk benefit
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20
Q

When should someone age 76-85 definitely be screened?

A

If they have no history of colorectal cancer screening, are healthy enough to undergo treatment if diagnosed, and lack comorbid conditions that would limit life expectancy

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21
Q

When does screening start for a high risk person?

A

40 years old or 10 years younger than the affected relative (whichever comes first)

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22
Q

When does screening start for familial adenomatous polyps?

A

10-20 years old

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23
Q

When should screening start in IBD?

A

8-15 years post diagnosis depending on severity

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24
Q

How often are colonoscopies recommended?

A

Every 10 years

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25
Q

How often is CT colonography and flexible sigmoidoscopy recommended?

A

Every 5 years

26
Q

How often is flexible sigmoidoscopy plus FIT recommended?

A

Flexible sigmoidoscopy every 10 years with FIT annually

27
Q

What are the three types of bowel prep classes?

A

Osmotic, PEG, and stimulant

28
Q

What is the MOA of osmotic bowel preps?

A

It’s a hyperosmotic solution that draws water into the lumen which stimulates bowel movements and peristalsis

29
Q

How effective are osmotic bowel preps?

A

equally efficacious when compared to PEG and stimulant preps

30
Q

What are the adverse events associated with osmotic preps?

A
  1. electrolyte abnormalities
  2. decreased systolic pressure
  3. acute renal failure
  4. intestinal erosions
  5. acidosis
  6. N/V/cramping/GI fullness
31
Q

When do you use caution with osmotic preps?

A
  1. elderly
  2. hypovolemia
  3. bowel obstruction
  4. CHF
  5. kidney disease
  6. IBD (intestinal lesions)
  7. ACE/ARBs
  8. NSAIDs
  9. diuretics
32
Q

What are the advantages of osmotic preps?

A

better tolerability compared to PEG and stimulant preps

33
Q

What are the disadvantages of osmotic preps?

A
  1. increased risk of electrolyte abnormalities
  2. increased risk of renal failure
  3. more expensive than PEG or stimulant preps
34
Q

Who should osmotic preps be saved for?

A

patients less than 55 years old with a low risk of renal problems

35
Q

What are examples of osmotic preps?

A
  1. OsmoPrep (Na phosphate tablets)
  2. Suprep (Na, Potassium, and Magnesium Sulfate)
  3. Prepopik (Na picosulfate, Mg oxide, and anhydrous citric acid)
36
Q

What is the black box warning on OsmoPrep?

A

acute phosphate nephropathy

37
Q

What drink can be given with OsmoPrep?

A

gatorade because it helps decrease fluid and electrolyte shift which increases tolerability

38
Q

What population of patients can Suprep be considered for?

A

patients without kidney or heart failure

39
Q

What is the MOA of PEG bowel preps?

A

larger-volume, iso-osmotic, non-absorbable electrolyte solution that cleanses the intestinal lumen through cathartic effect from the ingestion of large fluid volumes

40
Q

What are the adverse effects of PEG solutions?

A

GI side effects, decreased systolic blood pressure, hyponatremia, Mallory-Weiss tear, SIADH

41
Q

What is the biggest advantage of PEG preps?

A

There is no significant water of electrolyte shifts like osmotic preps

42
Q

What is the biggest disadvantage of PEF preps?

A

They are a large volume of liquids and most patients fail to finish the prep. It is the least tolerable.

43
Q

When is PEG prep preferred?

A

In patients with risk of complications from electrolyte shifts, renal failure, CHF, advanced liver disease with ascites, or IBD

44
Q

What is the MOA of the stimulant bowel preps?

A

hyperosmotic action increases intraluminal fluid volume and enhances gut motility

45
Q

What are the adverse drug reactions of stimulant preps?

A

hypermagnesemia, dehydration, dizziness, weakness, nausea, and vomiting

46
Q

When do you use caution with stimulant bowl preps?

A

elderly, GI obstruction, patients on low-sodium diet, and renal failure

47
Q

What are the disadvantages of stimulant preps?

A

electrolyte abnormalities, significant renal elimination, limited evidence, and requires combination with other cathartics to be effective

48
Q

What are examples of PEG preps?

A

GoLytely, Colyte, Nulytely, and TriLyte (4 L)
HalfLytely, MoviPrep, and Suclear (2 L)
Miralax (PEG without electrolytes)

49
Q

What is an example of a stimulant bowel prep?

A

Magnesium Citrate

50
Q

What are considered high bleed risk GI procedures?

A

polypectomy, PEG tube placement, tumor ablation

51
Q

What are considered low risk GI procedures?

A

EGD, colonoscopy, flexible sigmoidoscopy

52
Q

For a high risk GI procedure, when should you stop dabigatran?

A

2-3 days prior (CrCl > 50)

53
Q

For a high risk GI procedure, when should you stop apixiban or rivaroxaban?

A

1-2 days prior (CrCL > 60)

54
Q

For a high risk GI procedure, when should you stop edoxaban?

A

at least 1 day prior (CrCL ≥ 15)

55
Q

For a high risk GI procedure, when should you stop heparin?

A

6 hours prior to procedure and resume 2-6 hours after procedure

56
Q

For a high risk GI procedure, when should you stop LMWH?

A

24 hours prior to procedure and resume 48-72 hours after procedure

57
Q

For a high risk GI procedure, when should you stop warfarin?

A

5 days before procedure and resume 24 hours after

58
Q

For a high risk GI procedure, when should you stop clopidogrel?

A

At least 5-7 days prior to procedure

59
Q

For a high risk GI procedure, when should you stop ticagrelor?

A

at least 3-5 days prior to procedure

60
Q

What do you do with warfarin during an emergent/urgent GI procedure?

A

Hold it and give FFP or 4-factor prothrombin with vitamin K

61
Q

What do you do with DOACs during an emergent/urgent GI procedure?

A

Charcoal can be considered if last dose was taken 2-3 hours prior or give PCC or reversal agents

GI/Hepatic (4 decks)

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