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Gastroenterology & Nutrition > GI Endoscopy > Flashcards

GI Endoscopy Flashcards

1
Q

Diagnostic Indications of EGD

A
  1. Long standing GERD (5+ years)
  2. Dysphagia
  3. Anemia
  4. Epigastric abdominal pain
  5. Recurrent or chronic nausea/vomiting
  6. Follow-up on abnormal imaging
  7. Screening for esophageal varices and sprue
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2
Q

Therapeutic Indications for EGD

A
  1. GI bleeding: cauterize, inject epinephrine, place clips
  2. Esophageal variceal banding
  3. Esophageal or pyloric channel dilation
  4. Bx abnormal tissue
  5. Stent placement
  6. Small bowel capsule placement
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3
Q

EGD Preparation

A
  • NPO for 8 hours
  • Coumadin needs to be held, but not ASA or Plavix
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4
Q

GERD - Esophagitis Causes

A
  • Mechanisms of Reflux
    • Transient lower esophageal sphincter relaxation
    • Hypotensive LES
    • Diaphragmatic sphincter and hiatal hernia
  • Esophageal acid clearance
    • Impaired esophageal emptying
  • Tissue resistance
  • Delayed gastric emptying (not a cause, an exacerbating factor)
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5
Q

Esophagus - Schatzki’s Ring

A
  • Patients often present with dysphagia
  • Benign stricture in distal esophagus
  • No clear etiology
  • Associated with hiatal hernia, old age, GERD
  • Treatment includes slow careful mastication, dilation, PPI
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6
Q

Barrett’s Esophagus

A
  • Mucosal injury of esophagus from chronic exposure of refluxed acid and bile
  • Changes from normal squamous mucosa to a specialized intestinal metaplasia
  • Believed to be an intermediate step in the development of esophageal adenocarcinoma
  • 5-15% of patients with GERD will develop Barrett’s
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7
Q

Esophageal Cancer

A
  • Most common esophageal neoplasm is adenocarcinoma which is associated with GERD and Barrett’s esophagus. Typically at GE junction.
  • Squamous cell carcinoma is associated with tobacco and alcohol use. Typically in proximal esophagus.
  • Less common leiomyoma and lymphoma
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8
Q

Diseases that can be found with an EGD

A
  1. GERD - Esophagitis
  2. Esophagus - Schatzki’s Ring
  3. Esophageal Varices
  4. Barrett’s Esophagus
  5. Esophageal Cancer
  6. Gastritis & Duodenitis
  7. Ulcer Disease - Duodenal or Gastric
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9
Q

Flexible Sigmoidoscopy Benefits

A
  • Colon exam up to 60cm, to distal sigmoid and descending colon
  • Approximately 50% of cancerous tumors and adenomas can be identified
  • Used in combination with fecal occult blood tests for colorectal cancer screening
  • Typically no sedation given, patients can drive home
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10
Q

Flexible Sigmoidoscopy Indications

A
  1. Screening asymptomatic patients (in addition to FOBT/stool guiac)
  2. Evaluate diarrhea, proctitis, rectal pain, and abnormal imaging studies
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11
Q

Flexible Sigmoidoscopy Contraindications

A
  • Diverticulitis
  • Toxic Megacolon
  • Recent Bowel Surgery
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12
Q

Colonoscopy Diagnostic Indications

A
  1. Iron deficiency anemia
  2. GI bleeding
  3. Abdominal Pain (low yeild)
  4. Abnormal CT, BE, GGE
  5. Inflammatory Bowel Disease
  6. Colon cancer screening
  7. Diarrhea
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13
Q

Colonoscopy Therapeutic Indications

A
  1. Control of GI bleeding: cautery, injection, place clips
  2. Dilation of stricture
  3. Placement of stent
  4. Colonic decompression
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14
Q

Colonoscopy Prep

A
  1. Clear liquids 24 hours before prep
  2. Polyethylene glycol (Miralax) with gatorade or Osmoprep (tabs)
  3. NPO for 8 hours
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15
Q

Double Balloon Enteroscopy

A
  • Can be performed from above or below
  • Allows visualization and intervention of the small bowel not reachable by traditional EGD or colonoscopy
  • Disadvantage is that the procedure can exceed 3 hours
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16
Q

Small Bowel Video Capsule Indications

A
  1. Obscure GI bleeding
  2. Crohn’s disease
  3. Abnormal imaging
17
Q

Small Bowel Video Capsule Limitations

A
  1. Inability to obtain biopsy
  2. Difficulty in identifying the exact location of findings
  3. False positives
  4. Colon prep needed prior to study
  5. Lengthy viewing time required to analyze video
18
Q

Endoscopic Ultrasound Diagnostic Indications

A
  1. Esophageal cancer bx and staging
  2. Pancreatic cancer bx and staging
  3. Mediastinal mass/lymph node bx
  4. Evaluating chronic pancreatitis and pancreatic cysts
  5. Evaluating gallbladder, bile, and pancreatic ducts for stones
  6. Liver lesions
  7. Rectal and peri-rectal lesion evaluation
19
Q

Endoscopic Ultrasound Therapeutic Indications

A
  1. Drain pancreatic pseudocysts - cystogastrostomy/cystoduodenostomy
  2. Celiac plexus nerve block
20
Q

Endoscopic Retrograde Cholangiopancreatography (ERCP)

A
  • Endoscopic and radiologic exam of biliary system including common bile duct, intrahepatic and pancreatic ducts
  • Used for diagnostic and therapeutic purposes
  • Performed under conscious sedation, MAC anesthesia, or general anesthesia
21
Q

ERCP Endoscopic Purposes

A

Look at:

  • Duodenum
  • Major duodenal papilla
  • Ampulla of Vater
22
Q

ERCP Radiographic Purposes

A

Look at:

  • Bile ducts
  • Gallbladder
  • Pancreatic ducts
23
Q

ERCP Diagnostic Indications

A
  1. Obstructive jaundice
  2. Fistulae
  3. Tumors
  4. Elevated LFTs
  5. Abnormal imaging (MRCP)
  6. Pancreatitis: Idiopathic recurrent, Chronic, Pseudocysts
24
Q

ERCP Therapeutic Indications

A
  1. CBD stone removal (sphincterotomy)
  2. Stenting of malignant biliary obstruction
  3. SOD - sphincterotomy
  4. Papillary tumors - endoscopic resection/papillectomy
  5. Choledochocele - unroofing via needle knife
  6. Pancreatic divisum - minor papillotomy

Gastroenterology & Nutrition (6 decks)

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