Gastrointestinal procedures Flashcards
How is colonoscopy performed? (x3)
Do PR first. Sedation. Analgesia given before colonoscopy.
What are the diagnostic indications for colonoscopy? (x6)
- Rectal bleeding – when settled, if acute.
- Iron deficiency anaemia – explore for GI bleed from cancer
- Persistent diarrhoea
- Positive faecal occult blood test
- Assessment or suspicious of IBD
- Colon cancer surveillance
What are the therapeutic indications for colonoscopy? (x6)
- Haemostasis e.g., by clipping vessel
- Bleeding angiodysplasia lesion (argon beamer photocoagulation)
- Colonic stent deployment in cancer
- Volvulus decompression (using a flexi sig)
- Pseudo-obstruction
- Polypectomy (remove polyps)
What are the complications of colonoscopy? (x3)
Abdominal discomfort, haemorrhage after biopsy, perforation.
What are the diagnostic indications for upper GI endoscopy? (x6)
- Haematemesis/melaena
- Dysphagia
- Dyspepsia (over 55 y/o and alarm symptoms or treatment refractory)
- Duodenal biopsy as gold standard test for coeliac disease. Also useful for unusual cases of malabsorption such as giardiasis, lymphoma and Whipple’s disease
- Persistent vomiting
- Iron deficiency (cancer)
What are the therapeutic indications for upper GI endoscopy? (x7)
- Treatment of bleeding lesions
- Variceal banding
- Sclerotherapy
- Argon plasma coagulation for suspected vascular abnormality
- Stent insertion
- Stricture dilatation
- Polyp resection
How do you prepare for upper GI endoscopy?
Nil by mouth 6h before
How is upper GI endoscopy performed? (x4)
Sedation optional (but remain conscious), nasal prong O2, pharynx may be sprayed with local anaesthetic, continuous suction must be available to prevent aspiration.
What are the complications of upper GI endoscopy? (x4)
Sore throat, amnesia from sedation, perforation, bleeding (should therefore stop anticoagulants before a therapeutic endoscopy)
What is a sigmoidoscopy?
Views rectum and distal colon to the splenic flexure.
What is a rigid sigmoidoscopy?
.
What is a flexible sigmoidoscopy?
Has largely replaced rigid sigmoidoscopy.
How do patients prepare for sigmoidoscopy?
Phosphate enema PR.
How do patients prepare for video capsule endoscopy?
(Or VSE.) Clear fluids only the evening before then nil by mouth from morning.
What are the indications for VSE?
VCE: for obscure GI bleeding and SI pathology.
What are the complications of VSE? (x2)
Capsule retention – requires endoscopic or surgical removal. Obstruction.
What does enteral feeding refer to?
Intake of food via the GI tract i.e., through mouth or through tube directly into stomach or intestines.
What does parenteral feeding refer to?
Feeding intravenously with a nutritional formula that contains glucose, salts, amino acids, lipids and vitamins.
What are the types parenteral nutrition? (x2 and x2)
Total parenteral nutrition (TPN; no nutrition obtained by other routes) and partial parenteral nutrition (PPN; when nutrition is also partially enteric). Peripheral parenteral nutrition (PPN; when administered through vein access in a limb by a peripherally inserted central catheter (PICC or PIC line)); or through central vein called central vein nutrition (CVN; through a central venous catheter into IJV, subclavian, axillary or femoral).
What are the indications for parenteral nutrition? (x8)
- Short bowel syndrome
- Small bowel obstruction
- Active GI bleed
- Pseudo-obstruction with complete intolerance to food
- Bowel rest required
- Severe IBD
- In geriatric population where there is poor nutrition intake
- In cancer where there is high risk of malnutrition and cachexia
What are the complications of parenteral nutrition? (x7)
Infection, blood clots, fatty liver/liver failure, cholecystitis, gut atrophy, hypersensitivity and metabolic complications.
Why is fatty liver a complication of parenteral nutrition?
In long-term parenteral nutrition from linoleic acid use as a source of calories.
Why is cholecystitis a complication of parenteral nutrition?
From disuse of the GI tract which may result in bile stasis.
What metabolic complications are there in relation to parenteral nutrition? (x2)
Hyperglycaemia common at the start but combatted by adding insulin to formula. Refeeding syndrome may also occur when enteral nutrition restarted, characterised by hypokalaemia, hypophosphatemia and hypomagnesaemia.
What is a nasogastric tube?
Tube passed into stomach via the nose.
What are the indications for nasogastric tube? (x3)
- To decompress the stomach/gastrointestinal tract especially when there is obstruction e.g., gastric outflow obstruction, ileus, intestinal obstruction
- Gastric lavage (aka stomach pumping or gastric irrigation)
- To administer feed/drugs, especially in critical ill patients or those with dysphagia e.g., MND following cerebrovascular event
How is function of a nasogastric tube related to its function?
Large are good for drainage, and small for feeding.
How do you confirm position of an NG tube? (x2)
- Use pH paper to test you are in stomach by aspirating gastric contents. pH must be below or equal to 5.5.
- If pH is over 5.5 and tube is needed for drug or feed, then position must be checked radiologically.
What are the complications of an NG tube? (x6)
Pain, loss of electrolytes, oesophagitis, tracheal/duodenal intubation, necrosis (retro- or nasopharyngeal), stomach perforation.
What is another name for open abdominal surgery?
Laparotomy
What are the advantages of laparoscopic surgery over laparotomy? (x5)
- Reduced haemorrhaging and need for blood transfusion
- Less pain
- Use of regional anaesthesia as oppose to general leading to fewer complications and quicker recovery
- Hospital stay is shorter
- Reduced infection risk
What are the disadvantages of laparoscopic surgery compared with laparotomy? (x3)
- Requires pneumoperitoneum
- Less dexterity and depth perception
- Surgical time is longer
What are the complications of laparoscopic abdominal surgery? (x4)
- Pneumoperitoneum
- Injuries to abdominal wall from trocar injuries (which are inserted blindly into abdominal cavity to facilitate laparoscopic surgery) including haematoma, umbilical hernias, perforation
- Intra-abdominal adhesion formation which can lead to obstruction
- Cardiopulmonary effects of systemic carbon dioxide absorption
