GI study Flashcards
EGD (Esophagogastroduodenoscopy)
-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
indications for upper gastrointestinal endoscopy (chart from PP)
-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
therapeutic EGD
-bleeding GI tract lesions
-variceal banding
-removal of FB
-removal of polypoid lesions*
-dilation of stenotic lesions
screenings EGD
-gastric cancer
-barretts esophagus
-polyposis
-esophageal varices
Contraindications to EGD
-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
schatzki ring
-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
erosive esophagitis
-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
barrett’s esophagus
-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)
barrett’s esophagus + cancer
-adenocarcinoma
gastric ulcer
-duodenual ulcer- almost always benign
-gastric ulcers- higher chance of cancer
-always bx
-scope until they heal
bezoar
-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
erosive gastritis
duodenal ulcer
-almost always going to heal
-unlikely cancer
-multiple of them raise questions
-NSAIDs
-elers danlos
colonoscopy
-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
indications for colonscopy
-abnormal imaging
-lower gi bleeding
-iron deficiency anemia
-lower gi symptoms (chronic diarrhea)
screening colonoscopy
-colon polyp
-colon cancer
-inflammatory bowel disease
therapy colonscopy
-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
colonscopy contraindications
-pregnancy
-bowel perforation
-fulminant colitis
-acute diverticulitis
-peritonitis
-cardiopulmonary instability
pedunculated colon polyp
-stalk is not the cancerous part
-lasso around the stalk to remove
-large artery in the stalk -> cauterize
-make sure no rebleed
sessile polyp
-flat
-no stalk
-same color as intestines
-easy to miss
-important of clean prep
-high malignant potential
-snare -> bunch it up -> cut
colonic adenocarcinoma
-cancer
-cecum- not going to obstruct -> its going to bleed first
-sigmoid- thinner and more narrow
-left side tumor- blocks and obstructs
pseudomembraneous colitis
-caused by c. diff mostly
-pus
-encapsulates the normal tissue like a pseudomembrane
blood color
-sigmoid- bright red
-cecum- purple
-SI- dark
ischemic colitis
-blood supply to colon is impaired
-heart attack of the colon
-pain is out of relation (very high) to abdominal exam (normal)