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Year 3 Gastrointestinal > Gastrointestinal procedures > Flashcards

Gastrointestinal procedures Flashcards

1
Q

How is colonoscopy performed? (x3)

A

Do PR first. Sedation. Analgesia given before colonoscopy.

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2
Q

What are the diagnostic indications for colonoscopy? (x6)

A
  • 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
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3
Q

What are the therapeutic indications for colonoscopy? (x6)

A
  • 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)
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4
Q

What are the complications of colonoscopy? (x3)

A

Abdominal discomfort, haemorrhage after biopsy, perforation.

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5
Q

What are the diagnostic indications for upper GI endoscopy? (x6)

A
  • 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)
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6
Q

What are the therapeutic indications for upper GI endoscopy? (x7)

A
  • Treatment of bleeding lesions
  • Variceal banding
  • Sclerotherapy
  • Argon plasma coagulation for suspected vascular abnormality
  • Stent insertion
  • Stricture dilatation
  • Polyp resection
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7
Q

How do you prepare for upper GI endoscopy?

A

Nil by mouth 6h before

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8
Q

How is upper GI endoscopy performed? (x4)

A

Sedation optional (but remain conscious), nasal prong O2, pharynx may be sprayed with local anaesthetic, continuous suction must be available to prevent aspiration.

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9
Q

What are the complications of upper GI endoscopy? (x4)

A

Sore throat, amnesia from sedation, perforation, bleeding (should therefore stop anticoagulants before a therapeutic endoscopy)

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10
Q

What is a sigmoidoscopy?

A

Views rectum and distal colon to the splenic flexure.

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11
Q

What is a rigid sigmoidoscopy?

A

.

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12
Q

What is a flexible sigmoidoscopy?

A

Has largely replaced rigid sigmoidoscopy.

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13
Q

How do patients prepare for sigmoidoscopy?

A

Phosphate enema PR.

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14
Q

How do patients prepare for video capsule endoscopy?

A

(Or VSE.) Clear fluids only the evening before then nil by mouth from morning.

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15
Q

What are the indications for VSE?

A

VCE: for obscure GI bleeding and SI pathology.

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16
Q

What are the complications of VSE? (x2)

A

Capsule retention – requires endoscopic or surgical removal. Obstruction.

17
Q

What does enteral feeding refer to?

A

Intake of food via the GI tract i.e., through mouth or through tube directly into stomach or intestines.

18
Q

What does parenteral feeding refer to?

A

Feeding intravenously with a nutritional formula that contains glucose, salts, amino acids, lipids and vitamins.

19
Q

What are the types parenteral nutrition? (x2 and x2)

A

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).

20
Q

What are the indications for parenteral nutrition? (x8)

A
  • 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
21
Q

What are the complications of parenteral nutrition? (x7)

A

Infection, blood clots, fatty liver/liver failure, cholecystitis, gut atrophy, hypersensitivity and metabolic complications.

22
Q

Why is fatty liver a complication of parenteral nutrition?

A

In long-term parenteral nutrition from linoleic acid use as a source of calories.

23
Q

Why is cholecystitis a complication of parenteral nutrition?

A

From disuse of the GI tract which may result in bile stasis.

24
Q

What metabolic complications are there in relation to parenteral nutrition? (x2)

A

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.

25
Q

What is a nasogastric tube?

A

Tube passed into stomach via the nose.

26
Q

What are the indications for nasogastric tube? (x3)

A
  • 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
27
Q

How is function of a nasogastric tube related to its function?

A

Large are good for drainage, and small for feeding.

28
Q

How do you confirm position of an NG tube? (x2)

A
  • 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.
29
Q

What are the complications of an NG tube? (x6)

A

Pain, loss of electrolytes, oesophagitis, tracheal/duodenal intubation, necrosis (retro- or nasopharyngeal), stomach perforation.

30
Q

What is another name for open abdominal surgery?

A

Laparotomy

31
Q

What are the advantages of laparoscopic surgery over laparotomy? (x5)

A
  • 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
32
Q

What are the disadvantages of laparoscopic surgery compared with laparotomy? (x3)

A
  • Requires pneumoperitoneum
  • Less dexterity and depth perception
  • Surgical time is longer
33
Q

What are the complications of laparoscopic abdominal surgery? (x4)

A
  • 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

Year 3 Gastrointestinal (29 decks)

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