GI radiology

Question 1

When should you arrange an Endoscopy

Answer 1

After resuscitation
Within 4h of suspected variceal haemorrhage
Bleeding is still on going 24h after admission

Question 2

Name 3 functions of endoscopy

Answer 2

Id bleeding sites
Help estimate risk of rebleeding
Aid treatment: sclerotherapy, variceal banding, argon plasma coagulation

Question 3

When should you inform a surgeon about rebleeding

Answer 3

Haematemesis with melaena
Inc pulse rate
Dec CVP
Dec BP
Dec urine output

Question 4

What are the 3 indications for surgery in Upper GI bleeding

Answer 4

Severe bleeding or bleeding despite transfusing 6U if >60yo
Active or uncontrollable bleeding at endoscopy
Initial Rockall score >3 or final Rockall score >6

Question 5

Diagnostic Indications of Upper GI endoscopy

Answer 5

Hematemesis
New dyspepsia >55yo
Gastric biopsy
Duodenal biopsy
Persistent vomiting
Fe deficiency (ca, hiatus hernia)

Question 6

Therapeutic indications of Upper GI endoscopy

Answer 6

Rx of bleeding lesions
Variceal banding and sclerotherapy
Stricture dilatation
Stent insertion, laser therapy
Argon plasma coagulation for suspected vascular abnormality

Question 7

Specific complications of Upper GI endoscopy

Answer 7

Sore throat
Amnesia from sedation
Perforation
Cardioresp arrest
Bleeding (incl sphincterotomies)

Question 8

Indications for Duodenal biopsy

Answer 8

Gold standard for diagnosing coeliac disease
Malabsorption
Lymphoma
Whipple’s disease
Amyloid
Microscopic colitis

Question 9

Diagnostic Indications for sigmoidoscopy

Answer 9

Rigid and flexible in suspected ca, before barium enema

Flexible for best access

Question 10

Therapeutic indications for sigmoidoscopy

Answer 10

Decompression of sigmoid volvulus

Question 11

Diagnostic indications for colonoscopy

Answer 11

Rectal bleeding: when settled if acute
Fe-def anaemia (bleeding ca)
Peristent diarrhoea
Biopsy of lesion seen on barium enema
Assessment or suspicion of IBD
Colon ca surveillance

Question 12

Therapeutic indications for colonoscopy

Answer 12

Stents
Haemostasis
Bleeding angiodysplasia lesion
Volvulus untwisting
Pseudo-osbtruction
polypectomy

Question 13

Specific complications of colonoscopy

Answer 13

Abdo discomfort
Incomplete examination
Haemorrhage after biopsy or polypectomy
Perforation
Post op: no alcohol, op heavy machinery

Question 14

Indications for Video capsule endoscopy

Answer 14

Obscure GI bleeding
Detect small bowel Crohn’s
After (contrast) bowel imaging or patency
Oesophageal problems despite rapid transit

Question 15

Routes for liver biopsy

Answer 15

Percutaneous if INR is ok

Transjugular with FFP

Question 16

Indications for liver biopsy

Answer 16

Inc LFT
Chronic viral hepatitis
Alcoholic hepatitis
Autoimmune hepatitis
Suspected cirrhosis
Liver ca
Hepatic lesions
Pyrexia of unknown origin (PUO)

Question 17

Complications of liver biopsy

Answer 17

Local pain
Pneumothorax
Bleeding
death