Endoscopy and biopsy Flashcards

1
Q

Upper GI endoscopy: diagnostic indications

A
Haematemesis/melaena
Dysphagia
Dyspepsia (>55yrs old + alarm symptoms or treatment refractory)
Duodenal biopsy
Persistent vomiting
Iron deficiency (cancer)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Upper GI endoscopy: therapeutic indications

A
Treatment of bleeding lesions
Variceal banding and sclerotherapy
Argon plasma coagulation for suspected vascular abnormality
Stent insertion, laser therapy
Stricture dilatation, polyp resection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Upper GI endoscopy: pre-procedure

A

Stop PPIs 2wks pre-op if possible (pathology masking).
Nil by mouth for 6h before.
Don’t drive for 24h if sedation is used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Upper GI endoscopy: procedure

A

Sedation optional, e.g. midazolam 1-5mg slowly IV (to remain conscious; if deeper sedation is needed, propofol via an anaesthetist (narrow therapeutic range)); nasal prong O2 (e.g. 2L/min; monitor respirations and oximetry).
The pharynx may be sprayed with local anaesthetic before the endoscope is passed.
Continuous suction must be available to prevent aspiration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Upper GI endoscopy: complications

A

Sore throat
Amnesia from sedation
Perforation (<0.1%)
Bleeding (if on aspirin, clopidogrel, warfarin, or DOACs, these need stopping only if therapeutic procedure).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Upper GI endoscopy: duodenal biopsy

A

The gold standard test for coeliac disease.

Also useful in unusual causes of malabsorption, e.g. giardiasis, lymphoma, Whipple’s disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Sigmoidoscopy

A

Views the rectum and distal colon (to ~splenic flexure).
Flexible sigmoidoscopy has largely displaced rigid sigmoidoscopy for diagnosis of distal colonic pathology, but ~25% of cancers are still out of reach. It can be used therapeutically, e.g. for decompression of sigmoid volvulus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sigmoidoscopy: preparation

A

Phosphate enema PR.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Sigmoidoscopy: procedure

A

Learn from an expert.
Do PR exam first.
Do biopsies- macroscopic appearances may be normal, e.g. IBD, amyloidosis, microscopic colitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Colonoscopy: diagnostic indications

A
Rectal bleeding- when settled, if acute
Iron deficiency anaemia (bleeding cancer)
Persistent diarrhoea
Positive faecal occult blood test
Assessment or suspicion of IBD
Colon cancer surveillance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Colonoscopy: therapeutic indications

A
Haemostasis (e.g. by clipping vessel)
Bleeding angiodysplasia lesion (argon beamer photocoagulation)
Colonic stent deployment (cancer)
Volvulus decompression (flexi sig)
Pseudo-obstruction
Polypectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Colonoscopy: preparation

A

Stop iron 1wk prior

Discuss with local endoscopy unit bowel preparation and diet required.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Colonoscopy: procedure

A

Do PR first.

Sedation and analgesia are given before colonoscope is passed and guided around the colon.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Colonoscopy: complications

A
Abdominal discomfort
Incomplete examination
Haemorrhage after biopsy or polypectomy
Perforation (<0.1%)
Post-procedure: no alcohol, and no operating machinery for 24h.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Video capsule endoscopy (VCE)

A

To evaluate obscure GI bleeding and to detect small bowel pathology.
Use small bowel imaging (e.g. contrast) or latency capsule test ahead of VCE if patient has abdominal pain or symptoms suggesting small bowel obstruction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Video capsule endoscopy: preparation

A

Clear fluids only the evening before then nil by mouth from morning until 4h after capsule swallowed.

17
Q

Video capsule endoscopy: procedure

A

Capsule is swallowed- this transmits video wirelessly to capture device worn by patient. Normal activity can take place for the day.

18
Q

Video capsule endoscopy: complications

A
Capsule retention in 1% (endoscopic or surgical removal is needed)- avoid MRI for 2wks after unless AXR confirms capsule has cleared.
Obstruction.
Incomplete exam (e.g. slow transit, achalasia).
19
Q

Video capsule endoscopy: problems

A

No therapeutic options
Poor localisation of lesions
May miss more subtle lesions

20
Q

Liver biopsy: route

A

Percutaneous if INR in range else trans jugular with FFP

21
Q

Liver biopsy: indications

A

Raised LFTs of unknown aetiology.
Assessment of fibrosis in chronic liver disease (this indication being replaced by ultrasound based elastography).
Suspected cirrhosis.
Suspected hepatic lesions/cancer.

22
Q

Liver biopsy: pre-op

A

Nil by mouth for 8h.

Are INR <1.5 and platelets >50x10^9/L? Give analgesia.

23
Q

Liver biopsy: procedure

A

Sedation may be given.
Do under US/CT guidance.
The liver borders are percussed and where there is dullness in the mid-axillary line in expiration, lidocaine 2% is infiltrated own to the liver capsule.
Breathing is rehearsed and a needle biopsy is taken with the breath held in expiration.
Afterwards lie on the right side for 2h, then in bed for 4h.
Check pulse and BP every 15 mins for 1h, every 30 mins for 2h, then hourly until discharge 4h post-biopsy.

24
Q

Liver biopsy: complications

A

Local pain
Pneumothorax
Bleeding (<0.5%)
Death (<0.1%)