Final_GI

Question 1

EGD - anesthesia

Answer 1

• LLD position
• RN conscious sedation vs. MAC anesthesia
• Natural airway vs. secured airway
• Diagnostic vs. Interventional
• Respiratory complications
• Patient Challenges: Co-morbidities, Body habitus, GER, Pulmonary, Cardiac issues
  -Pre-anesthetic eval is very important, planning = necessary
• Procedural Challenges: Access to airway, Location of anesthesia provider, Dimly lit room, Pressure on abdomen, Fast-paced
  ■ Fast asleep
  ■ Fast procedure
  ■ Fast awake and recovery

Question 2

ERCP - anesthesia

Answer 2

● Allows the proceduralist to examine the pancreatic + bowel ducts
● Can be used to treat: Bile stones or Pancreatic stones can be removed
● Prone or semi-prone
● Deep MAC vs. GA
● Natural airway vs. secured
airway

Question 3

colonoscopy - anesthesia

Answer 3

● Diagnostic or therapeutic ● RN conscious sedation vs.
MAC anesthesia
● Bowel prep
○ Risk of dehydration
○ “Split-dose bowel prep” is confusing to patients
● Procedure is generally well tolerated
● Often EGD done right before colonoscopy, or “upper + lower”
endoscopy

Question 4

esophageal diverticula

Answer 4

Out-pouchings of wall of esophagus
● Zenker’s diverticulum
● Retained food
● Large ones may cause:
Dysphagia from compression, Regurgitation, Risk of aspiration during DL

Question 5

Primary vs. Secondary hemostasis

Answer 5

Primary hemostasis is a procoagulation clot forming process associated with the initiation and formation of the platelet plug.
Secondary hemostasis also a procoagulation clot forming process and it is associated with the propagation of the clotting process via the intrinsic and extrinsic coagulation cascades.

Question 6

· What pathway is responsible for earliest process in coagulation cascade (intrinsic or extrinsic)?

Answer 6

Extrinsic Pathway

Question 7

· What factor complex is responsible for intrinsic Xase complex, why is this important in clotting?

Answer 7

Factor VIIIa-IXa complex is responsible for the intrinsic Xase complex.
This is important for clotting as the formation of this complex allows factor Xa generation to switch from a reaction catalyzed by the factor VIIa-tissue factor complex to one produced by the intrinsic Xase pathway. The intrinsic Xase complex is fifty times more efficient which is of enormous kinetic advantage.

Question 8

What electrolyte is critical in the coagulation cascade?

Answer 8

Calcium ions and Factor XIII (Fibrin Stabilizing Factor) act on fibrin monomers to make fibrin polymers and lead to the formation of a clot.