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Gastroenterology > GI study > Flashcards

GI study Flashcards

1
Q

EGD (Esophagogastroduodenoscopy)

A

-Flexible endoscope via the mouth into the esophagus, stomach, duodenum
-Best method for examining the upper gastrointestinal mucosa
-Permits directed biopsy and endoscopic therapy
-Intravenous conscious sedation vs general
anesthesia
-DX AND THERPAUTIC

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2
Q

indications for upper gastrointestinal endoscopy (chart from PP)

A

-upper abdominal symptoms that fulfill:
-are unresponsive to empiric therapy (omeprazole, Nexium etc.)
-associated with alarm symptoms
-new onset of symptoms in pt greater than 50 years of age
-dysphagia
-odynophagia- painful swallowing
-persistent or recurrent esophageal reflux despite therapy
-persistent vomiting of unknown cause
-active or recent upper GI bleeding
-presumed chronic blood loss and iron deficiency anemia if any of the following present- there is clinical suspicion of upper GI source, colonoscopy is neg
-lesion seen on upper GI
-acute caustic ingestion
-anemic
-eval for celiac disease

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3
Q

therapeutic EGD

A

-bleeding GI tract lesions
-variceal banding
-removal of FB
-removal of polypoid lesions*
-dilation of stenotic lesions

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4
Q

screenings EGD

A

-gastric cancer
-barretts esophagus
-polyposis
-esophageal varices

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5
Q

Contraindications to EGD

A

-Inability of the patient to cooperate despite adequate attempts at sedation/anesthesia
Inability to obtain informed consent
Presence of a known or suspected perforation
-Routine biopsies- pinch bx

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6
Q

schatzki ring

A

-fibrous tissue ring closes off esophagus
-narrows the esophagus
-asymptomatic often
-can cause intermittent dysphagia
-tissue is soft, thin, flexible but on occasion it can cause a blockage
-may have to go dilate it

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7
Q

erosive esophagitis

A

-acid splashes back into bottom of esophagus from stomach
-causes burn
-can look normal -> bx will show
-nonerosive reflux
-ones that present poorly on image are graded

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8
Q

barrett’s esophagus

A

-tongue of abnormal tissue
-reflux if so persistent (decades)
-normal tissue is replaced with intestinal type tissue
-thickens
-columnar intestinal type tissue is at risk to become cancer
-dysplasia
-C(circumference)-M(longest tongue)

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9
Q

barrett’s esophagus + cancer

A

-adenocarcinoma

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10
Q

gastric ulcer

A

-duodenual ulcer- almost always benign
-gastric ulcers- higher chance of cancer
-always bx
-scope until they heal

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11
Q

bezoar

A

-indigestable foods
-not moving
-cellulose
-forms a mass ins stomach
-bloating
-full quickly
-nausea
-gastric motility disorder, anatomical
-vegetable’s, hair,
-tear it apart with a scope, tap
-coca cola
-chemicals to make it more soluble
-extreme- surgery

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12
Q

erosive gastritis

A
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13
Q

duodenal ulcer

A

-almost always going to heal
-unlikely cancer
-multiple of them raise questions
-NSAIDs
-elers danlos

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14
Q

colonoscopy

A

-Flexible colonoscope via anal canal into the rectum and colon
-Cecum is reached in >95% of cases
-Terminal ileum can often be examined
-“Gold standard” for diagnosis of colonic mucosal disease
-Greater sensitivity than barium enema or CT for colitis, polyps, cancer
-IV conscious sedation vs general anesthesia

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15
Q

indications for colonscopy

A

-abnormal imaging
-lower gi bleeding
-iron deficiency anemia
-lower gi symptoms (chronic diarrhea)

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16
Q

screening colonoscopy

A

-colon polyp
-colon cancer
-inflammatory bowel disease

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17
Q

therapy colonscopy

A

-polypectomy
-localization of lesions
-foreign body removal
-decompression of sigmoid volvulus
-decompression of colonic pseudo obstruction
-balloon dilation of stricutures
-palliative treatment of bleeding or stenosed neoplasms
-placement of percutaneous endoscopy cesostomy tube

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18
Q

colonscopy contraindications

A

-pregnancy
-bowel perforation
-fulminant colitis
-acute diverticulitis
-peritonitis
-cardiopulmonary instability

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19
Q

pedunculated colon polyp

A

-stalk is not the cancerous part
-lasso around the stalk to remove
-large artery in the stalk -> cauterize
-make sure no rebleed

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20
Q

sessile polyp

A

-flat
-no stalk
-same color as intestines
-easy to miss
-important of clean prep
-high malignant potential
-snare -> bunch it up -> cut

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21
Q

colonic adenocarcinoma

A

-cancer
-cecum- not going to obstruct -> its going to bleed first
-sigmoid- thinner and more narrow
-left side tumor- blocks and obstructs

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22
Q

pseudomembraneous colitis

A

-caused by c. diff mostly
-pus
-encapsulates the normal tissue like a pseudomembrane

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23
Q

blood color

A

-sigmoid- bright red
-cecum- purple
-SI- dark

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24
Q

ischemic colitis

A

-blood supply to colon is impaired
-heart attack of the colon
-pain is out of relation (very high) to abdominal exam (normal)

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25
watershed area
-splenic flexure -marginal artery occlusion
26
ulcerative colitis
-major disease of bowel -cant see the normal internal vasculature -lumpy -diffuse inflammation -always involves the rectum -pus on the walls -can just be the rectum going all the way up to splenic flexure -pancolitis -not in the small bowel -limited to inner lining
27
crohn's Ds
-anemia -diarrhea -ulcerative colitits diff dx -ulcerations -transmural disease -fistulas -not limited to inner lining -whole bowel wall involved
28
colon vascular esctasias
-iron deficiency cause -anemia -laser it -bleeding
29
diverticulosis / litis
-pocket that occur -MC on the antimesenteric side, sigmoid colon -infection and bleeding -arterial bleed -> big -fluids -microscopic perforation of a pocket
30
flexible sigmoidoscopy
-Similar to colonoscopy -Visualizes anus through sigmoid colon -Primarily used for evaluation of diarrhea, rectal bleeding, and as part of colon cancer screening with other modalities -quick peak if ulcerative colitis check in
31
small bowel endoscopy: capsule endoscopy
-Swallow disposable capsule that contains chip camera -Color still images transmitted wirelessly to external receiver -Visualization: jejunal and ileal mucosa beyond the reach of a conventional endoscope -It remains purely a diagnostic procedure -just small intestine not for large -pictures / movie
32
indications capsule endoscopy
-Evaluation of obscure gastrointestinal bleeding -Suspicion of small bowel tumors, celiac disease, polyposis syndromes, early Crohn’s
33
contraindications to capsule endoscopy
-Implanted electromagnetic devices -Severe intestinal motility disorders -Zenker’s diverticulum -Swallowing disorders -Small bowel diverticulosis -Pregnancy -Severe Crohn’s enteritis -Small intestinal strictures -Obstruction
34
double balloon enteroscopy (DBE)
-Pan-enteric examination of the small bowel -Performed via mouth or rectum -Complimentary to capsule
35
double balloon enteroscopy (DBE) contraindications
-Pregnancy -Serious cardiac or respiratory disease -Multiple small bowel adhesions -Anti-coagulants cannot be discontinued
36
ambulatory 24 hour pH monitoring
-Test measures reflux of acid from the stomach into the esophagus -Gold standard for the diagnosis of GERD -Catheter is placed 5 cm above the upper border of the lower esophageal sphincter and is kept in place for 48 hours -DO NOT NEED TO DO THIS FOR EVERY GERD PT -> just for ones that arnt responding to treatment
37
ambulatory 24 hr pH monitoring
-indications- unresponsive to therapy ****** -contraindications- pacemakers, implantable defibrillators, neurostimulators, bleeding diatheses, varices, strictures, obstructions
38
gastric emptying study
-tag foods and see how long it takes to pass it -indications- evaluations of dumping syndrome, vagotomy, gastric outlet obstruction, effects of meds, and other causes of gastroparesis -contraindications- pregnancy -chronic cannabis use
39
barium esophagram
-if pt cant swallow down food -pt drinks or swallows barium or a tablet and x rays or video are taken -can evaluate swallowing, peristalsis, and lesions -Haiatal hernia , rings, strictures, Ca, ulcers, abnormal peristalsis, reflux -diagnostic
40
barium esophagram
-indications- dysphagia, odynophagia, esophageal reflux, non cardiac chest pain -findings- motility disorders, esophagitis, strictures, varices, neoplasm, obstruction, diverticulum, webs, rings -contraindications- pregnancy and perforation
41
upper GI series
-Barium is swallowed and xray images are taken of the esophagus, stomach and duodenum -Used to evaluate abdominal pain (ulcers, inflammation), structural disorders, motility disorders, weight loss, heme + stool, dysphagia, odynophagia -Not used much anymore -not stable enough for endoscopy
42
small bowel series
-barium to look at small bowel - x-ray -indications -> Not used much anymore -Location of site of intermittent partial small bowel obstruction -Evaluation of extent of Crohns disease or small bowel disease in patient with normal endoscopy and colonic evaluations -Evaluation of metastatic disease to the small bowel -contraindications- Complete bowel obstruction, Perforation, Pregnancy
43
double contrast barium enema (DCBE)
-REPLACED BY CT Colonography -Old Indications: -Evaluation of colonic mucosa for inflammatory bowel disease, polyps, neoplasm, incomplete colonoscopy -Contraindications: -Toxic megacolon -Immediately after full-thickness colonoscopic biopsy
44
plain film of abdomen
-Perforated ulcer or free air in the abdomen- Plain films may demonstrate as little as 1 to 2 mL of air -small bowel obstruction- Plain films have a sensitivity of 69 to 82 percent for revealing high-grade small bowel obstruction -Moderate or severe abdominal tenderness, suspicion of bowel obstruction, ingestion of foreign body or penetrating foreign bodies (gunshot wounds)
45
zanker diverticulum
pharynx pushing against closed pharyngeal muscle -> pushes mucosa out -> forms pouch -result of motility disorder
46
-birds beak -motility disorder -not a true narrowing -hypertensive LES -LES is closed -esophagus is weak -> lacks peristalsis secondarily to the LES -tx- botox
47
abdominal US
-Uses sound waves to create images of organs -Differentiation of cystic versus solid lesions of the liver and kidneys -Detection of intra- and extrahepatic biliary ductal dilation, cholelithiasis, gallbladder wall thickness, pericholecystic fluid, peripancreatic fluid and pseudocyst, hydronephrosis, abdominal aortic aneurysm, appendicitis, ascites, primary and metastatic liver carcinoma
48
hepatobiliary iminiodiacetic acid (HIDA) scan
-Evaluate the function of the gallbladder and the bile ducts -Given with CCK to assess gallbladder emptying -> ejection fraction -Anatomic and functional information -Used with RUQ pain, nausea, vomiting
49
apple core lesion
-colon cancer -section that doesnt show up on barium image
50
acoustic shadowing
-gall stone is blocking sound waves -streaks in the US -polyps wouldnt show this
51
endoscopic US
-Ultrasound transducers incorporated into the tip of a flexible endoscope -Ultrasound images are obtained of the gut wall and adjacent organs, vessels, and lymph nodes -Very high resolution images are obtained -Provides the most accurate preoperative local staging of esophageal, pancreatic, and rectal malignancies
52
EUS is also highly sensitive for dx of
-Bile duct stones -Gallbladder disease -Submucosal gastrointestinal lesions -Chronic pancreatitis -Can bx exoluminal lesions -> pancreatic cysts via FNA
53
endoscopic retrograde cholangiopancreatogrpahy (ERCP)
-Endoscope is passed through the mouth to the duodenum -Ampulla of Vater is identified and cannulated with a thin plastic catheter -Radiographic contrast material is injected into the bile duct and pancreatic duct under fluoroscopic guidance -Sphincter of Oddi can be opened via endoscopic sphincterotomy -Stones retrieved from ducts -Biopsies obtained -Strictures dilated and stented -Therapeutic and diagnostic procedure especially for ductal strictures and CBD stones
54
CT scan of abdomen and pelvis
-With or without contrast agent -Oral contrast* (usually) agent before abdominal or pelvic scans helps delineate the bowel -IV contrast is used to obtain vascular and tissue enhancement -Most helpful in evaluating retroperitoneum (pancreas, kidney, nodes, aorta), liver, appendicitis, bowel disease (inflammation, diverticular disease, masses, hernias, obstruction
55
CT colonography
-Indications: -Evaluation for possible colonic polyps and masses -Incomplete colonoscopy -Not stable for colonoscopy-anesthesia -Contraindications: Pregnancy
56
CT colonography ADVantages
-No IV contrast needed or anesthesia -Has ability to evaluate extracolonic intraabdominal disease (AAA, renal cell cancer, kidney stones).
57
CT colonography Disadvantage
-Diagnostic not therapeutic -Still need prep -Retained fecal material limits study -If polyps or masses are found, patient will need to undergo colonoscopy or sigmoidoscopy for tissue diagnosis. -Can’t asses for AVM or treat them -$ not covered - need a failed attempt -full cat scan of everything -6mm or more
58
MRI of abdomen
-MRI provides better soft-tissue contrast than CT -not covered commonly -Detection of adrenal lesions, tumor staging, abdominal masses, examination of almost all intraabdominal organs and retroperitoneal structures, and differentiation of benign adenoma from metastasis -Aids CT in evaluation of liver lesions- Benign from malignant liver tumors
59
magnetic resonance cholangiopancreatography (MRCP)
-Evaluation of intra- and extra-hepatic biliary and pancreatic duct dilatation, and the cause of obstruction -Evaluates choledocholithiasis, retained gallstones, pancreatobiliary neoplasms, strictures, primary sclerosing cholangitis, and chronic pancreatitis -ERCP may be needed after -usually ordered with MRI of abdomen
60
CT/MR enterography***
-assess small bowel -this is commonly used -rule in or out crohns disease -Indications: -Assess for extent of IBD, postoperative adhesions, and small bowel tumors -Contraindications: -CT: Pregnancy -MR: cardiac pacemakers, intraocular metallic foreign bodies, intracranial aneurysm clips, cochlear implants, and some artificial heart valves
61
Imaging Crohns
-wall thickening and enhancement
62
CTE / MRE
CTE -Takes 10 seconds -More cost effective -Do not have to hold breath -No glucogon used -Iodine based IV contrast -Radiation exposure -Obesity and respiratory disease does not limit exam MRE** -Takes 30 minutes -Twice as expensive -Have to hold breath -Glucagon +/- nausea/vomiting -Non iodine based IV contrast -No radiation exposure -Obesity or respiratory problems can limit exam

Gastroenterology (20 decks)

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