GI procedures King 12/5 Flashcards
indications for NG tube
evacuate blood, decompress, remove toxic substances, provide enteral feedings
contraindications NG tube
facial trauma, basilar skull fracture, b/l nasal obstruction
recent nasal pharyngeal esophageal or gastric surgery
bleeding diathesis
complications NG tube
bleeding aspiration, tracheal intubation, erosion of naris
pharyngeal/nasal perforation
difference of levin tube vs salem sump
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
What is EGD
endoscope through mouth into duodenum
diagnsotic and therapeutic
Indications for EGD
Dx for upper GI disease,
surveillance for cancer
biopsy upper GI disease
therapeutic intervention (control hemorrhage, stenting of stricture, ablation of neoplasms)
absolute contraindications to EGD
known or suspected perforation
medically unstable
obstruction
relative contraindications to EGD
anticoagulation
pharyngeal diverticulum, recent head or neck surgery
esophageal stricture
complications EGD
bleeding, infection, perforation, vocal cord injury, pharyngeal irritation
cardiopulmonary problems
risks for esophagitis
alcohol, cigarette smoking, surgery or radiation to chest, medications, prolonged vomiting, weakened imune systems
fungi or virus
what medications can cause esophagitis
tetracycline, doxycycline, vit C and aspirin
probable outcome barrets esophagus
malignant transformation >50% with 5+ yrs Sx
squamous cell carcinomona more common where in esophagus
adeno?
SCC in proximal
adeno in the distal
risk factors with esophageal cancer
smoking, ethanol use, high fat. low protein diet, GERD/Barrett’s esophagitis
most common sites metastasis in esophageal cancer
lungs, pleura, liver, stomach, peritoneum, kidneys and adrenal gland
what are common causes of gastric ulcers
H pylori infection
NSAIDs/aspirin
angular incisura= most common site
then lesser curvature and the antrum
risk factors gastric cancer
H pylori, salty and smoked foods
chronic gastritis
smoking, diet low in fruits and vegetables, blood type A
what is a sigmoidoscopy
rectum and lower colon examined under direct visualization
60 cm long and 1.25 cm in diameter
inserted through anus
indications sigmoidoscopy
- 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
absolute contraindications sigmoidoscopy
bowel perforation acute diverticulitis active peritonitis fulminant colitis cardiopulm instability
relative contraindications sigmoidoscopy
lack of informed consent
lack of patient cooperation
lack of good bowel preparation
complications sigmoidoscop
pain
bleeding
perforation
infection
why is a colonscopy better than sigmoidoscopy
remove polyps in parts of colon beyond sigmoid
other tests like biopsy can be preformed with colonoscope
indications colonoscopy
- 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
absolute contraindications colonoscopy
fulminant colitis
known or suspected perforation
during early post-colectomy time period
relative contraindications colonoscopy
- Hx radiation therapy for abdominal or pelvic cancer
- Hx abdominal or pelvic malignancy
- Extensive adhesions from prior abdominal surgery
- bleeding dyscrasias
- anticoagulatn therapy
-complications colonoscopy
bleeding perforation respiratory depression cardiac arrythmias or ischemia transient bacteremia nausea/vomiting ileus
what is a pedunculated polyp
mushroom like tissue growths
long thin stalk or peduncule
inherited or non inherited causes
what is a sessile polyp
no stalk
polyps are flat
generally have more malignant potential
colon cancer characteristics
partially or completely circumferential and if left unTx will obstruct the lumen
UC Sx
pain, crmaping, rectal bleeding, diarrhea and fever
UC on colonscopy
ulceration, bleeding, continuous involvement and pseudopolyps
Sx crohns and characteristics
more cramping and diarrhea less bleeding (compared to UC) wax and wane cobblestone appearance skips areas of colon
What is virtual colonoscopy
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
How is virtual colonoscopy done
XR, CT or MRI
Is occult blood test specific
no because resin reacts with iron
Advantages of fecal occult blood test
no cleansing necessary
samples can be collected at home
low cost
does not cause bleeding or tearing/perforation of the lining of the colon
disadvantages of fecal occult blood test
fails to detech most polyps and some cancers
false positive results are common
dietary restrictions
may need additional procedures if indicates abnormality
what are the dietary restrictions needed for fecal occult blood test
avoiding meat, certain vegetables, vit C, Fe supplements and aspirin
advantages of sigmoidoscopy
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
disadvantages of sigmoidoscopy
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
advantages colonscop
allows doc to see entire colon
can do other procedures if need be
disadvantages colonoscopu
need thorough cleansing
does not detect all small polyps, nonpolypoid lesions and cancers
sedation needed
can have bleeding complications
advantages of colonography
doc can see entire colon
not invasive, little risk
disadvantage colonography
may not detect all small polyps, nonpolypoid lesions and cancers
thorough cleansing
if polyp or nonpolypoid lesion found have to do biopsy
advantages of double contrast barium enema
allows doc to see entire colon
complications rare
no sedation necessary
disadvantages of double contrast barium enema
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
advantages DRE
oftne part of PE
no cleansing needed
quick and painless
disadvantages of DRE
only detects in lower part of rectum
additional procedures needed if abrnomality
