GI procedures King 12/5

Question 1

indications for NG tube

Answer 1

evacuate blood, decompress, remove toxic substances, provide enteral feedings

Question 2

contraindications NG tube

Answer 2

facial trauma, basilar skull fracture, b/l nasal obstruction
recent nasal pharyngeal esophageal or gastric surgery
bleeding diathesis

Question 3

complications NG tube

Answer 3

bleeding aspiration, tracheal intubation, erosion of naris

pharyngeal/nasal perforation

Question 4

difference of levin tube vs salem sump

Answer 4

levin is one lumen with graduated markings on side

salem sump is two lumen so there can be continuous suction without gastric mucosa from being aspirated into lumen

Question 5

What is EGD

Answer 5

endoscope through mouth into duodenum

diagnsotic and therapeutic

Question 6

Indications for EGD

Answer 6

Dx for upper GI disease,
surveillance for cancer
biopsy upper GI disease
therapeutic intervention (control hemorrhage, stenting of stricture, ablation of neoplasms)

Question 7

absolute contraindications to EGD

Answer 7

known or suspected perforation
medically unstable
obstruction

Question 8

relative contraindications to EGD

Answer 8

anticoagulation
pharyngeal diverticulum, recent head or neck surgery
esophageal stricture

Question 9

complications EGD

Answer 9

bleeding, infection, perforation, vocal cord injury, pharyngeal irritation
cardiopulmonary problems

Question 10

risks for esophagitis

Answer 10

alcohol, cigarette smoking, surgery or radiation to chest, medications, prolonged vomiting, weakened imune systems
fungi or virus

Question 11

what medications can cause esophagitis

Answer 11

tetracycline, doxycycline, vit C and aspirin

Question 12

probable outcome barrets esophagus

Answer 12

malignant transformation >50% with 5+ yrs Sx

Question 13

squamous cell carcinomona more common where in esophagus

adeno?

Answer 13

SCC in proximal

adeno in the distal

Question 14

risk factors with esophageal cancer

Answer 14

smoking, ethanol use, high fat. low protein diet, GERD/Barrett’s esophagitis

Question 15

most common sites metastasis in esophageal cancer

Answer 15

lungs, pleura, liver, stomach, peritoneum, kidneys and adrenal gland

Question 16

what are common causes of gastric ulcers

Answer 16

H pylori infection
NSAIDs/aspirin
angular incisura= most common site
then lesser curvature and the antrum

Question 17

risk factors gastric cancer

Answer 17

H pylori, salty and smoked foods
chronic gastritis
smoking, diet low in fruits and vegetables, blood type A

Question 18

what is a sigmoidoscopy

Answer 18

rectum and lower colon examined under direct visualization
60 cm long and 1.25 cm in diameter
inserted through anus

Question 19

indications sigmoidoscopy

Answer 19

• colorectal cancer screening
• preoperative evaluation
• surveillance of preiously diagnosed malignancy in rectum or sigmoid colon
• local Tx ailments like radiation proctitis
• removal foreign bodies
• therapeutic procedures
• hematochezia requiring hemostasis

Question 20

absolute contraindications sigmoidoscopy

Answer 20

bowel perforation
acute diverticulitis
active peritonitis
fulminant colitis
cardiopulm instability

Question 21

relative contraindications sigmoidoscopy

Answer 21

lack of informed consent
lack of patient cooperation
lack of good bowel preparation

Question 22

complications sigmoidoscop

Answer 22

pain
bleeding
perforation
infection

Question 23

why is a colonscopy better than sigmoidoscopy

Answer 23

remove polyps in parts of colon beyond sigmoid

other tests like biopsy can be preformed with colonoscope

Question 24

indications colonoscopy

Answer 24

• colorectal cancer screening in average risk adults
• evaluation and removal of polyps
• current or previous bowel resection for colon cancer
• +FMH cancer
• management of IBD
• identification acute bleeding sites
• decompression of colon

Question 25

absolute contraindications colonoscopy

Answer 25

fulminant colitis known or suspected perforation during early post-colectomy time period

Question 26

relative contraindications colonoscopy

Answer 26

- Hx radiation therapy for abdominal or pelvic cancer - Hx abdominal or pelvic malignancy - Extensive adhesions from prior abdominal surgery - bleeding dyscrasias - anticoagulatn therapy

Question 27

-complications colonoscopy

Answer 27

``` bleeding perforation respiratory depression cardiac arrythmias or ischemia transient bacteremia nausea/vomiting ileus ```

Question 28

what is a pedunculated polyp

Answer 28

mushroom like tissue growths long thin stalk or peduncule inherited or non inherited causes

Question 29

what is a sessile polyp

Answer 29

no stalk polyps are flat generally have more malignant potential

Question 30

colon cancer characteristics

Answer 30

partially or completely circumferential and if left unTx will obstruct the lumen

Question 31

UC Sx

Answer 31

pain, crmaping, rectal bleeding, diarrhea and fever

Question 32

UC on colonscopy

Answer 32

ulceration, bleeding, continuous involvement and pseudopolyps

Question 33

Sx crohns and characteristics

Answer 33

``` more cramping and diarrhea less bleeding (compared to UC) wax and wane cobblestone appearance skips areas of colon ```

Question 34

What is virtual colonoscopy

Answer 34

medical imaging producing 2-3 x dimensional images of colon from rectum to distal ileum used to Dx colon and bowel including polyps, diverticulosis and cancer

Question 35

How is virtual colonoscopy done

Answer 35

XR, CT or MRI

Question 36

Is occult blood test specific

Answer 36

no because resin reacts with iron

Question 37

Advantages of fecal occult blood test

Answer 37

no cleansing necessary samples can be collected at home low cost does not cause bleeding or tearing/perforation of the lining of the colon

Question 38

disadvantages of fecal occult blood test

Answer 38

fails to detech most polyps and some cancers false positive results are common dietary restrictions may need additional procedures if indicates abnormality

Question 39

what are the dietary restrictions needed for fecal occult blood test

Answer 39

avoiding meat, certain vegetables, vit C, Fe supplements and aspirin

Question 40

advantages of sigmoidoscopy

Answer 40

quick few complications discomfort is minimal doc may be able to perform biopsy and remove polyps during test less extensive cleansing of colon needed than colonoscopy

Question 41

disadvantages of sigmoidoscopy

Answer 41

allows doc to view only rectum and lower part of colon any polyps upper colon will be missed small risk bleeding, tearing, perforation may need additional procedures

Question 42

advantages colonscop

Answer 42

allows doc to see entire colon | can do other procedures if need be

Question 43

disadvantages colonoscopu

Answer 43

need thorough cleansing does not detect all small polyps, nonpolypoid lesions and cancers sedation needed can have bleeding complications

Question 44

advantages of colonography

Answer 44

doc can see entire colon | not invasive, little risk

Question 45

disadvantage colonography

Answer 45

may not detect all small polyps, nonpolypoid lesions and cancers thorough cleansing if polyp or nonpolypoid lesion found have to do biopsy

Question 46

advantages of double contrast barium enema

Answer 46

allows doc to see entire colon complications rare no sedation necessary

Question 47

disadvantages of double contrast barium enema

Answer 47

may not detech small polyps thorough cleansing is necessary can have false + doc cannot perform biopsy or remove polyps during test additional procedures necessary if test indicates abnormality

Question 48

advantages DRE

Answer 48

oftne part of PE no cleansing needed quick and painless

Question 49

disadvantages of DRE

Answer 49

only detects in lower part of rectum | additional procedures needed if abrnomality