Diagnostics in GI Flashcards
Esophagogastroduodenoscopy
Known as an Upper Endoscopy or EGD, this test allows for visualization of the esophagus, stomach, and duodenum
Indications for an EGD
○ Diagnostic evaluation for upper GI symptoms
(dyspepsia, dysphagia, etc)
○ Surveillance of known pathology
○ Biopsy for suspected pathology
○ Therapeutic intervention (control hemorrhage,
foreign body retrieval, Esophageal dilation)
Esophagogastroduodenoscopy - Medscape - ○ Transesophageal Echocardiogram (TEE)
Contraindications for EGD
○ If Pt has a possible perforation
○ Medically unstable patient
○ On Anticoagulation (relative contraindication)
Colonoscopy
Also called “lower endoscopy,” allows visualization of the entire
large intestine and rectum
Indications of a colonoscopy
○ Screening and diagnosis of colorectal cancer
○ Surveillance after colon cancer resection
○ Diagnosis of Inflammatory Bowel Disease
○ Identification and treatment of colonic bleeding
Pregnancy is considered a relative contraindication for _____ and may increase the risk of spontaneous abortion
Colonoscopy
Flexible Sigmoidoscopy
Another endoscopic procedure where an endoscope is inserted into
the colon for both diagnostic and therapeutic reasons
○ Considered inferior to colonoscopy - It only reaches approximately 60cm into the colon.
Video Capsule Endoscopy
VCE is a newer and powerful diagnostic tool that is
especially useful in evaluating the small intestine
(where colonoscopy can’t reach)
Indications for VCE
○ Evaluation of suspected small bowel bleeding*
○ Diagnosis and surveillance of Crohn Disease*
○ Evaluating for small bowel tumors, polyps, neoplasms
○ Assessment of Celiac Disease
○ Evaluation of unexplained abdominal pain or symptoms
Relative Contraindications for VCE include
○ Esophageal Stricture or Swallowing disorders
○ Known or suspected Small Bowel Obstruction
○ Gastroparesis (Caution in uncontrolled DM)
The most significant complication of VCE
capsule retention in the bowel
with the need for surgical retrieval
_____ is used as a radiographic contrast agent in the digestive system
Barium Sulfate
Barium is used for the following GI studies
○ Barium Swallow Study (Oropharynx, larynx, and esophagus)
○ Barium Enema (Large intestine)
○ Barium Follow Through (Stomach and small intestine, mostly)
Common indications for Barium Swallow (Esophagram)
■ Achalasia
■ Esophageal Neoplasm
■ Esophageal diverticula
■ Esophageal stenosis or obstruction
Barium Enema indications
■ Colorectal cancer
■ Diverticular disease
■ Inflammatory Bowel Disease
Weakness of the Abdominal X-ray study includes
○ Low diagnostic yield
○ Contraindicated in pregnancy
○ A fairly non-specific test
T/F A normal abdominal XR will reveal a gastric air bubble
T
White lines that go the full
circumference around a portion of the
intestine are called circular folds or
_____.
“Valvulae Conniventes”
Small bowel obstruction may reveal ____
dilated loops of bowel (with prominent valvulae conniventes) and little to
no air in the large intestine
Large Bowel Obstructions will present with______
large, dilated colon due to bowel gas, which often extends to the small intestine as well.
Best initial test for a patient with possible cholecystitis or cholelithiasis
“Gallbladder US”
Dx test of choice in children and pregnant Pts with RLQ pain
“Appendix US
Ultrasound “FAST” Exam
important tool for examining
trauma patients .
○ “Focused Assessment with
Sonography for Trauma”
Abdominal CT Scan Indications
○ Evaluation of abdominal or pelvic mass
○ Suspected neoplasm
○ Staging of metastatic malignancy
○ Splenomegaly
○ Intra-abdominal/pelvic abscess
○ Abdominal/Pelvic Trauma
& More
CT is the initial imaging of choice for patients with ______
LLQ and RLQ mass or pain in adults(IE, expected appendicitis)
Leukocytes in the stool suggests ____
an inflammatory process, such as Shigellosis,
Salmonellosis, Amebiasis (sometimes), and
often IBD (Ulcerative Colitis).
Hemoccult
Fecal blood test that Uses a small sample of stool (usually acquired by digital rectal exam).
○ Sample is smeared on guaiac impregnated
paper, which is then treated with Hydrogen
Peroxide.
○ In the presence of blood, oxidation of the
guaiac results in bluish discoloration.
○ Can be done in clinic
Fecal Immunochemical Test
Pt brushes surface
of stool with a long brush from a kit, wipes on a test card, and delivers the test card to the lab.
○ Using various antibodies, FIT detects the
presence of the globin portion of hemoglobin.
○ FIT testing has been found to be more sensitive that FOBT
Indication of FIT testing
○ Gastrointestinal bleeding
○ Screening for colon cancer
T/F FIT is recently starting to replace Hemoccult
T
FIT is more sensitive to the ____than Hemoccult, with accuracy rates near that of colonoscopy
presence of blood
Diagnostic indications of Nasogastric intubation
○ Evaluation of upper GI bleeding
○ Aspiration of gastric fluid content
○ Administration of XR Contrast
○ ID of esophagus on a CXR
Therapeutic indications for NG tube
○ Gastric decompression after
Endotracheal intubation
○ Relief of symptoms and bowel rest
during small bowel obstruction
○ Bowel irrigation
○ Administration of medications
○ Feeding
Absolute contraindications of NG tube
○ Basilar skull fracture
○ Severe midface trauma
○ Recent nasal surgery
Relative contraindications of NG tube
○ Anticoagulated or Hypocoagulable state
○ Esophageal varices
How to reduce risk of epistaxis in NG tube placement?
Some providers will pre-treat the nasal passages with nasal sprays of
Oxymetazoline or Phenylephrine (nasal decongestants that cause
localized vascular constriction)
As the tip reaches the posterior naso/oropharynx,
instruct the patient to ____
take continual small sip of water
through the straw
Complications of NG tube insertion that can arise include
○ Sinusitis
○ Epistaxis
○ Sore Throat
○ Esophageal Perforation
○ Aspiration
○ Pneumothorax
○ Intracranial placement (rare, only with skull fracture)
