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FES Flashcards

1
Q

How many fiber optic fiber bundles are there?

Their functions?

How thick are they?

A

2.

One to deliver the light and one to transmit the image from the organ back to the viewer

8-10 micrometer

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2
Q

What is one disadvantage of the flexible fiber optic endoscope?

A

Fragility of the fibers. When an individual fiber breaks, you get dark spots

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3
Q

Fiber optics are now only used for what kind of scopes?

A

Scopes that require small diameter like bronch or choledoschoscope. No longer used in standard GI scopes

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4
Q

How is modern video endoscopy different from the fiber optic scopes?

A

Light is delivered via fiber optic.

But the viewing fiber optic is replaced with a charge-coupled device (CCD) chip based camera at the tip of the endoscope

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5
Q

What are the two possible sources of light

A

Xenon Arc

Halogen filled tungsten filament lamp

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6
Q

How wide are the instrument channels?

A

2-4.2mm

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7
Q

The umbilical cable contains connectors for what things?

A

Air insufflation, suction, water irrigation

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8
Q

Why not use saline for water bottle connecting to the scope?

A

May crystallize in the channel. Use sterile water

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9
Q

What is the advantage of disinfecting the scope with gluteraldehyde as opposed to ethylene oxide?

A

Ethylene oxide needs overnight cycle. Gluteraldehyde doesn’t.

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10
Q

What is the most common complication during colonoscopy?

A

Hypoxia (5.6%)
Hypotension (1.2%)
Bradycardia (0.8%)
Arrhythmia (0.1%)

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11
Q

What % of post-colonoscopy perforation needs an operation?

A

~50%

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12
Q

What is the incidence of post-colonoscopy perforation?

A

0.07%

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13
Q

What is the mortality rate of colonoscopy?

A

0.007%

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14
Q

What are the most common upper scope complications?

A

Hypoxia (up to 70%)

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15
Q

What is the incidence of perforation after upper endoscopy?

What is the mortality rate of upper endoscopy?

A

0.03% incidence

Mortality: 0.001%

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16
Q

Isoosmotic vs. hyperosmotic prep

Which one is better tolerated and more likely to be taken completely?

Which one is safe to use for pts who have electrolyte imbalance, liver disease, CHF, or renal failure?

A

Hyperosmotic more likely to be taken completely because it requires ingestion of only a small amount.

Isoosmotic prep is safe for liver disease, renal disease, etc

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17
Q

What is a potential side effect of sodium phosphate prep?

A

Nephrocalcinosis

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18
Q

Is magnesium citrate isoosmotic or hyperosmotic?

It also releases what hormone?

A

Hyperosmotic

Causes CCK release. Also promotes intestinal motility

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19
Q

Sodium phosphate prep might cause what electrolyte abnormality?

A

Hyperphos

Hypokalemia

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20
Q

What is the incidence of bacterial endocarditis during upper GI and colonoscopy?

A

4.4%

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21
Q

Which endoscopic procedure is associated with the highest risk of bacteremia?

A

Esophageal stricture dilation & sclerotherapy for esophageal varices

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22
Q

Risk of major pulmonary embolism in pts with mechanical heart valves in the absence of anticoagulation is what?

What is it with anticoagulation?

What about pts with AFib with no valvular disease without AC?

A

4 per 100 person-years without AC

2.2 with AC

5-7% for AFib alone

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23
Q

What are the 4 stages of sedation?

A

Mild, moderate, deep, general

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24
Q

What are the 2 most effective methods of identifying hypoventilation?

A

Side channel end tidal CO2

Transcutaneous CO2

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25
Q

What is MOAA?

The scale goes from what to what?

A

Modified observers assessment of awareness

0: doesn’t respond to noxious stimulation
1: doesn’t respond to mild stimulus
2: responds only to mild stimulus
3: responds only to loud voice
4: lethargic response to voice
5: fully responds

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26
Q

What’s the usual starting dose of versed?

A

0.5 - 2 mg IV or 0.05 to 0.1 mg/kg given as a bolus

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27
Q

What’s the onset of action of versed?

Allow how many minutes after giving a dose before dosing the next one?

A

3-5 minutes

Wait at least 2 min before redosing

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28
Q

Does flumazenil decrease time to discharge?

A

Usually not. Only when pt was given 0.09mg/kg of versed

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29
Q

Starting dose of flumazenil. How to titrate

A

Start with 1mg IV and titrate by 0.2mg to effect

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30
Q

How to dose fentanyl.

What’s the half life?

A

On avg 50-100 ug

Half life: 2-4hrs

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31
Q

What’s the usual starting dose of narcan?

A

0.4mg IV, repeating as necessary up to 2mg.

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32
Q

What is the reversal agent for propofol?

A

There is none

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33
Q

Propofolnis contraindicated in patients with what,m

A

Hypersensitivity to eggs or soybeans

34
Q

Does distraction during colonoscopy decrease the need for sedatives?

A

When auditory and visual distractions are used together, yes

35
Q

What is the role of nitrous oxide with colonoscopy?

A

Pts have more pain, tolerates the procedure less well, less satisfiee

36
Q

Preceded vs. Fentanyl/versed?

A

Less effective compared to fentanyl/versed

37
Q

What is the diameter of a small caliber scope?

Can this scope biopsy things?

A

3-6mm

Yes

38
Q

What is the maximum amount of sprayed lidocaine you can use?

A

200mg

39
Q

What are some negative effects associated with small caliber endoscopy?

Contraindication to SCE?

A

Vagal stimulation -> hypotension, hypoxia. Epistaxis

Coagulopathy, prior trauma to nasopharynx

40
Q

What’s the half life of naloxone vs. fentanyl?

A

Naloxone: 1 - 1.5 hrs
Fentanyl: 2 - 4 hrs

41
Q

Upper endoscopy surveillance:

Familial polyposis

Barrett’s esophagus

Esophageal varices

Esophageal/gastric ulcers

Pernicious anemia

A

Familial polyposis: 1-2 years

Barrett’s:
Low risk: every 2 yrs
High risk: 6mo-1yr

Esophageal varices: every 6-8 weeks

Esophageal/gastric ulcers: every 6 weeks until healed

Pernicious anemia: single endoscopy, no followup

42
Q

Correct or positioning for upper endoscopy.

When would you do right side down?

A

Left side down, head slightly elevated

Right side down: acute UGI bleed. When left side down the blood collects in the fundus. Right side down will empty the blood

43
Q

Upon reaching the sharp turn of the superior angle of the duodenum what should you do with the scope?

A

Dial up and right

Twist the shaft clockwise

44
Q

Does bite block help or hurt airway?

A

It acts as a reverse jaw thrust. Higher risk of airway obstruction

45
Q

HNPCC accounts for what % of colon cancers?

HNPCC develops cancer how many years earlier than the general public

What is the screening guideline for HNPCC?

A

6%

20 years

Begin at age 20-25 or 10 years earlier than the youngest agree of CRCA. Repeat every 1-2 years

46
Q

Colonoscopy should be done how soon after colon resection:

1) if the pt had a pre-op colonoscopy?
2) if the pt didn’t have a pre-op colonoscopy?

A

(+) pre-op scope: 1-2 years post-op

(-) pre-op scope: 3 months post-op

47
Q

For colonoscopy, the endoscopist stands on the patient’s (left/right)

Length of normal colonoscope

Length of a flexible signoidoscope

A

The patient’s right

Colonoscope: 130-160cm

Flex sig: 70cm

48
Q

What can you do if the angle of the flexure is too acute?

A

Turn the pt on their back or to the right side

49
Q

What is the incidence of polyps among ppl undergoing screening endoscopy?

What’s the size cutoff for small vs. large polyp?

A

~ 30%

1cm

50
Q

(T/F) lipomas found during colonoscopy should be biopsied

What sign is associated with lipomas

A

False

Pillow sign (soft and spongy indentation when palpating using biopsy forceps)

51
Q

What is the reported complication rate for

Diagnostic colonoscopy?

Polypectomy?

What is the mortality of colonoscopy?

A

Dx colonoscope: 1:1500

Polypectomy: 1:100

1/10,000

52
Q

What are the causes of early endoscopic bleeding vs. late bleeding

A

Early: scope trauma, inadequate control of a bleeding source

Late: 1-2 weeks after hot biopsy or snare polypectomy

53
Q

ERCP in cardiopulmonary instability or shock

In pregnant pt

Coagulopathic pts

A

Shock: may be of benefit if cholangitis

Pregnant: temporizing measure until completion of pregnancy

Coagulopathic: stent without sohincterotomy

54
Q

What is brush biopsy’s cancer detection rate?

Needle aspiration?

A

Brush: 20-60%

Needle aspiration: 6-30%

55
Q

Endoscopic sphincterotomy. Apply gentle pressure with the cutting wire towards (what clock) position. Continue the sphincterotomy until (what) portion of the bike duct is cut. Blended current with cutting and coagulation settings of (what) J are commonly used. Balloon dilation is associated with (higher/lower) rates of ERCP pancreatitis

A

11’oclock position

Intramural portion of the bile duct cut

15-20J

Dilation: higher rates of pancreatitis

56
Q

How long do plastic CBD stents stay open?

What do you need to do when that time is almost up? Because why?

How long can pancreatic stents stay in? Why?

How long can nasobiliary tubes stay?

What is SEMS? better or worse patency rate? When are they used generally?

A

3-6 months.

You gotta remove or exchange the stent. bc if stents are clogged then they can get cholangitis

Pancreatic stents can stay in for ~3 weeks. If left longer, can cause ductal damage

Nasobiliary tubes are long plastic catheters similar to my tubes. Traversing the papilla into the biliary tree. Can be left in for several days. Does not require endoscopy for removal

Self Expanding Metal Stents. Longer patency rate. Usually used for malignant obstructions. No further intervention may be needed for the patient’s lifetime

57
Q

When should ppl stop Coumadin or antiplatelets before ERCP?

A

Coumadin: 5 days + heparin/lovenox then stop heparin a day before

Antiplatelets: 10 days prior and not restart 5-7 days if sphincterotomy performed

58
Q

Pt positioning for ERCP

If doing through duodenum is difficult what can you do?

Endoscopy cart is placed on which side of the pt?

A

Prone position, head turned towards right shoulder

Left lateral decubitus then switch to prone once the endoscope passed the pylorus

Supine is much harder

Endoscopy cart on the right side of the pt

59
Q

Which part of upper scope is very painful for the pt and therefore you should try to complete as fast as possible?

In order to advance the scope across the pylorus and into the duodenum you must place the pylorus almost completely out of view along the (what)o’clock position

The major papilla is usually found in the medial aspect of the second portion of the duodenum. It will appear at the (what) o’clock position on the monitor?

A

Traversing the greater curvature because the excess looping is very painful

6 o’clock

1-2 o’clock position

60
Q

For selective pancreatic cannulation, direct the sphincterotomy towards the (what) o’clock position

For selective biliary cannulation, direct the sphincterotomy towards (what) o’clock position

A

Pancreatic: 1-3 o’clock

Biliary: 11-12 o’clock

61
Q

Incidence of post ERCP pancreatitis

A

3-5%

62
Q

What is post-ERCP pancreatitis defined as?

How to decrease pancreatitis

A

Increased abd pain

Serum AMYLASE x3 above normal

Requires hospitalization

Limit contrast injected into pancreatic duct

63
Q

ERCP is performed with a side viewing scope. When is a front viewing scope useful?

A

Duodenal stricture

64
Q

Concentration of epinephrine for submucosal injection

Two mechanism submucosal injection works

How much can you inject?

(T/F) submucosal injections have associations with both perforation and stricture

A

1:10,000

Create tamponade, vasospasm of the feeding vessels

0.5-1cc at a time up to 10cc

T

65
Q

Band ligation. What complications can be seen after band ligating esophageal varices?

Compared to sclerotherapy, band ligation has a (high/lower) complication rate.

What is the main disadvantage of band ligation?

A

Ulcers and stricture

Lower complication rate compared to sclerotherapy.

Main disadvantage: band ligating device cap can impair visualization

66
Q

When are endoscopic clips useful? After what failed?

Endoscopic clips have (higher/lower) success rate compared to other hemostatic techniques

A

After thermal energy failed or too dangerous

Lower success rate due to difficulty with application

67
Q

Monopolar vs. Bipolar cautery

Which one has higher risk of full thickness enteric injury?

Vessels up to what diameter are typically well controlled with cautery?

A

Monopolar has higher risk for full thickness enteric injury

Vessels up to 2mm

68
Q

How is argon plasma coagulation different from electric cautery?

A

Ionized argon gas. Does not adhere to the probe. So the clot is not likely to be displaced on probe withdrawal. Also doesn’t have the tamponade effect. Used when deeper thermal injury leading to perforation is a high concern

69
Q

Sessile polypectomy.

Why use hypertonic saline or hyaluronic acid?

A

Slows the redistribution/absorption of the injectate.

Inject at the proximal end of the colon and at the distal end of the foregut. This causes the lesion to be raised toward the endoscopist’s vision

70
Q

For lesions > (what size) piecemeal excision can be used.

Piecemeal polypectomy is not a good idea in which portion of the bowel? Why?

A

> 2-2.5cm

Not good in cecum because wall is thin and may perforate

71
Q

Most significant experience with mucosal resection has been in the management of what lesion?

A

Early gastric cancer

72
Q

What diameter channel is needed to use large biopsy forceps?

A

3.5mm

73
Q

What does lugol solution and methylene blue stain?

A

Lugol (1-2%) - stains glycogen containing normal esophageal squamous mucosal cell

Methylene blue (0.5-1%) - taken up by intestinal absorptive epithelium

Useful for identifying areas of intestinal metaplasia and focal carcinoma

74
Q

What is the depth of coagulation of argon plasma coagulation?

A

2mm

75
Q

Absolute contraindication for PEG or PEJ?

Removal of tubes within how many hours still require surgical closure?

A

Poorly controlled or massive ascites -> leak of ascietes or infection of ascites

96hrs

76
Q

What are the three forms of bougies?

Stricture in general shouldn’t be dilated more than how many times?

For esophageal dilation, what bougie size usually relieve symptoms?

A

Blunt tipped (Hurst)

Tapered-tip (Maloney)

Wire-guided (Savary)

Three successive french sizes

40Fr is usually enough for esophagus

77
Q

Balloon dilation for achalasia has perforate rate of what %?

A

2-3%

78
Q

Plastic stents have (higher/lower) perforation rate than self Expanding stents

A

Lower with self Expanding stents

79
Q

Rigid scope vs. flex scope for esophageal foreign body

A

Rigid: can use more rigid, large instruments

Flex is often successful, less prone to perforation.

80
Q

Why is tattooing not very feasible for gastric lesions?

A

Thickness of the gastric muscular layer and the rapid diffusion of eyes within the gastric wall

FES (1 decks)

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