GI Endoscopy Flashcards
1
Q
Diagnostic Indications of EGD
A
- Long standing GERD (5+ years)
- Dysphagia
- Anemia
- Epigastric abdominal pain
- Recurrent or chronic nausea/vomiting
- Follow-up on abnormal imaging
- Screening for esophageal varices and sprue
2
Q
Therapeutic Indications for EGD
A
- GI bleeding: cauterize, inject epinephrine, place clips
- Esophageal variceal banding
- Esophageal or pyloric channel dilation
- Bx abnormal tissue
- Stent placement
- Small bowel capsule placement
3
Q
EGD Preparation
A
- NPO for 8 hours
- Coumadin needs to be held, but not ASA or Plavix
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)
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
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
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
8
Q
Diseases that can be found with an EGD
A
- GERD - Esophagitis
- Esophagus - Schatzki’s Ring
- Esophageal Varices
- Barrett’s Esophagus
- Esophageal Cancer
- Gastritis & Duodenitis
- Ulcer Disease - Duodenal or Gastric
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
10
Q
Flexible Sigmoidoscopy Indications
A
- Screening asymptomatic patients (in addition to FOBT/stool guiac)
- Evaluate diarrhea, proctitis, rectal pain, and abnormal imaging studies
11
Q
Flexible Sigmoidoscopy Contraindications
A
- Diverticulitis
- Toxic Megacolon
- Recent Bowel Surgery
12
Q
Colonoscopy Diagnostic Indications
A
- Iron deficiency anemia
- GI bleeding
- Abdominal Pain (low yeild)
- Abnormal CT, BE, GGE
- Inflammatory Bowel Disease
- Colon cancer screening
- Diarrhea
13
Q
Colonoscopy Therapeutic Indications
A
- Control of GI bleeding: cautery, injection, place clips
- Dilation of stricture
- Placement of stent
- Colonic decompression
14
Q
Colonoscopy Prep
A
- Clear liquids 24 hours before prep
- Polyethylene glycol (Miralax) with gatorade or Osmoprep (tabs)
- NPO for 8 hours
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
16
Q
Small Bowel Video Capsule Indications
A
- Obscure GI bleeding
- Crohn’s disease
- Abnormal imaging
17
Q
Small Bowel Video Capsule Limitations
A
- Inability to obtain biopsy
- Difficulty in identifying the exact location of findings
- False positives
- Colon prep needed prior to study
- Lengthy viewing time required to analyze video
18
Q
Endoscopic Ultrasound Diagnostic Indications
A
- Esophageal cancer bx and staging
- Pancreatic cancer bx and staging
- Mediastinal mass/lymph node bx
- Evaluating chronic pancreatitis and pancreatic cysts
- Evaluating gallbladder, bile, and pancreatic ducts for stones
- Liver lesions
- Rectal and peri-rectal lesion evaluation
19
Q
Endoscopic Ultrasound Therapeutic Indications
A
- Drain pancreatic pseudocysts - cystogastrostomy/cystoduodenostomy
- 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
- Obstructive jaundice
- Fistulae
- Tumors
- Elevated LFTs
- Abnormal imaging (MRCP)
- Pancreatitis: Idiopathic recurrent, Chronic, Pseudocysts
24
Q
ERCP Therapeutic Indications
A
- CBD stone removal (sphincterotomy)
- Stenting of malignant biliary obstruction
- SOD - sphincterotomy
- Papillary tumors - endoscopic resection/papillectomy
- Choledochocele - unroofing via needle knife
- Pancreatic divisum - minor papillotomy
