GI Bleed/Endoscopy Lecture Powerpoint Flashcards
Enteroscopy
Viewing of the small intestine with an endoscope inserted down the esophagus
Choledocho- meaning
Common bile duct
Indications for Esophageogastroduodenoscopy (EGD) (5)
- unexplained anemia
- GERD
- abdominal pain
- dysphasia
- barret’s esophagus
EGD prep (3)
- NPO after midnight
- no anticoagulation
- optional sedation (propofol)
EGD complications (2)
- bleeding
- perforation
Black eschar lesions at the GE junction indicates
Gastritis, often 2nd to NSAID use
ERCP (Endoscopic retrograde choleopancreatography) indications (2)
- obstructed common bile duct (choledocholithiasis, pancreatic neoplasm, bile duct neoplasm)
- diagnostic and therapeutic
Endoscopic ultrasound indications (4)
- UGI neoplasm (esophagus, stomach, liver, pancreas, duodenum)
- lymph node biopsy and staging
- choledocholithiasis
- small missed cholelithiasis
Colonoscopy indications (5)
- anemia
- rectal bleeding without identifiable cause
- diverticulitis
- alternating diarrhea and constipation
- screening
Colonoscopy prep (5)
- mechanical bowel prep
- clear liquid diet
- NPO after midnight
- no anticoagulation
- optional sedation
Colonoscopy complications (3)
- bleeding
- perforation
- splenic injury
Types of colonic polyps (4)
- hyperplastic (benign)
- serrated (same as hyperplastic but higher risk of becoming cancer)
- inflammatory
- neoplastic (adenomatous)
Sessile polyp vs pedunculated
Sessile is flatter and covers more surface, pedunculated has a stalk protruding out from a base into a large head
Clinical manifestations of adenomatous polyps (4)
- mostly asymptomatic
- hematochezia
- occult blood loss
- diarrhea
How are adenomatous polyps typically detected? (3)
- sigmoidoscopy
- colonoscopy
- CT scan (virtual colonscopy)
What type of adenoma polyp is most likely to be cancerous?
Villous
Dividing area of upper and lower GI
Ligament of trietz
3 manifestations of GI bleed
- hematemesis
- melena (black dark tarry stool)
- hemotochezia (bright red blood)
Initial management of GI bleed (3)
- resuscitation (2 large bore IV, saline, type o neg packed RBC, same ratio of plasma and platelets)
- labs (beware that the H&H will be maintained in acute losses)
- NG tube
Common causes of upper GI bleed (4)
- gastric and duodenal ulcers (most common)
- varices
- mallorey weis tears
- neoplasms
Ulcer bleeding treatment options (3)
- PPI or H2 blockers
- endoscopic hemostasis via injection therapy of 1:10,000 epi
- coagulation via cauterization
- surgery (failed or recurrent cases)
Anterior wall of the duodenum exits to the ___, posterior wall exits to the ___
free abdomen (perforation), pancreas (gastroduodenal artery bleeding, highest risk of rebleeding)
Gastric/duodenal ulcer that has a clean base treatment options (2)
- nothing endoscopically
- PPI treatment
Varices treatment options (4)
- resuscitation
- balloon tamponade
- endoscopic therapy
- surgical therapy
4 categories of surgical varices therapy
- esophageal transection (stapling off varices)
- nonselective shunting (redirect portal vein flow and put into vena cava - high rates of encephalopathy)
- selective shunting (adjunctive tube redirecting some flow into vena cava, easy at clotting)
- orthotopic liver transplantation
Transjugular Intrahepatic portosystemic shunt (TIPSS)
Lower rates of encehpalopathy and only 50% thrombosis rate at 2 years, making it a great option for patients who will receive a transplant within 2 years, involves putting catheter into internal jugular vein into right atrium and down to vena cava, connect a shunt between the portal and hepatic veins positively effecting varices treatment without changing the vasculature
Erosive gastritis treatment options (3)
- self limiting
- NSAIDS
- ASA
Mallory weiss tear is most often a rip in the ___ mucosa
gastric
Mallory weiss tear pattern of bleeding
-Vomit initially then see bleeding with vomiting
Is diverticular bleeding painful?
No, most often painless and self resolving but can lead to hypovolemic shock, can be difficult to localize
Meckel’s diverticulum
An outpouching or bulge in lower part of small intestine (2 feet of the ileocecal valve) often congenital and leftover part of umbilical cord, can see heterotrophic mucosa within the diverticulum, most of the time these are asymptomatic
Meckel’s scan
A radionucleotide imaging study that can detect the presence of different types of mucosa that will proceed to illuminate where they should be located (for example gastric mucossa in te stomach) and where it shouldn’t be (on the diverticulum
Therapy options for lower GI bleed (4)
- colonoscopy
- surgery (removal of part of colon localizing bleeding)
- barium enema
- angiographic embolization (close off vessels to prevent bleeding)
