Endoscopy

Question 1

When should pre-procedure antibiotics be given for EGD?

Answer 1

patient specific:
- patients with ANC < 500
- advanced hematologic malignancies
- cirrhotics with ascites or GIB
- those with vascular grafts placed in the last 6 months

procedure specific:
- PEG
- vatical bleeding control
- ERCP for biliary drainage
- EUS and FNA of pancreatic cyst

Question 2

When visualizing the ampulla of Vater on endoscopy, in what position are the biliary and pancreatic ducts?

Answer 2

• biliary: 11 o’clock
• pancreatic: 1 o’clock

Question 3

How do acid and base esophageal ingestion injuries differ?

Answer 3

• acid are more superficial due to coagulative necrosis
• alkali are deeper due to liquefactive necrosis

Question 4

What regions of the esophagus are at higher likelihood for perforation?

Answer 4

• UES
• aortic arch
• LES

Question 5

What foreign bodies require emergent EGD? Urgent?

Answer 5

• emergent: button batteries or anything sharp in the esophagus
• urgent: non-sharp objects in the esophagus, magnets, sharp objects in the stomach/duodenum, objects > 5cm in the stomach/duodenum

Question 6

What foreign bodies are at high risk to not pass through the pylorus?

Answer 6

anything more than 2cm

Question 7

Describe five measures of high-quality colonoscopy.

Answer 7

• cecum intubated > 90% of the time
• withdrawal time > 6 minutes
• perforation < 1 in 500
• post-polypectomy bleeding < 1%
• post-polypectomy bleeding managed non-operatively > 90%

Question 8

What is post-polypectomy syndrome due to?

Answer 8

a full thickness thermal injury to the colon causes inflammation and peritoneal irritation without perforation

Question 9

How is post-polypectomy syndrome treated?

Answer 9

treat with serial exams, bowel rest, IVF, and antibiotics

Question 10

After quantitative BAL, what is considered the threshold for treating pneumonia?

Answer 10

> 100,000 CFU/mL

Question 11

Why should you observe patients who aspirate a peanut?

Answer 11

they breakdown and release peanut oil which is a strong irritant and has the potential to cause an intense pneumonitis

Question 12

Bipolar energy can be used to ligate vessels of what size?

Answer 12

up to 7mm in diameter

Question 13

If the anesthesiologist notices a sudden rise and then drop in EtCO2 during laparoscopy, what has occurred? What is the treatment?

Answer 13

a CO2 embolus, treat with trendelenburg, left lateral decubitus positioning, and aspiration via CVC