GI Imaging

Question 1

Upper GI Endoscopy:

What can you see with a normal endoscopy?

What can be done during this for diagnostic purposes?

What can be done to see the distal duodenum and proximal jejunum?

Answer 1

Allows visualisation of oesophagus, stomach and proximal duodenum

Biopsy

Push enteroscopy with longer scope

Question 2

Upper GI Endoscopy:

Indications - 4

Answer 2

Acute upper GI blessing

Suspected upper GI malignancy

Any persistent upper GI symptoms which don’t respond to treatment

Coeliac diagnosis

Question 3

Upper GI Endoscopy:

What would increase your suspicion of an upper GI malignancy?

Answer 3

Iron deficiency 
Anaemia 
Dysphagia 
Dyspepsia with onset age >55 yrs 
Weight loss 
Epigastric mass

Question 4

Upper GI Endoscopy:

What should be stopped for procedures with high bleeding risk?

Does any thing need to stopped for biopsy?

What about NSAID’s and aspirin?

Answer 4

Anticoagulants
Antiplatelets

No

Can be continued

Question 5

Upper GI Endoscopy:

How many weeks before the procedure should a PPI be stopped?

How long should the patient fast before procedure?

What about fluids?

How can discomfort be reduced as much as possible? - 2

Answer 5

2 wks

6 hrs

stop 2 hrs before

Topical throat anaesthesia +/- IV sedation

Question 6

Upper GI Endoscopy:

Complications - 3

Answer 6

Perforation
Bleeding
Respiratory depression from sedation

Question 7

Lower GI endoscopy:

What therapeutic procedures can be done?

Answer 7

Polypectomy - polyps - precancerous

Stenting - for blockage

Decompression - twisting of bowel

Question 8

Lower GI endoscopy:

2 types and where they reach

Answer 8

Sigmoidoscopy - splenic flexure - detects 75% of colorectal cancers

Colonoscopy - terminal ileum

Question 9

Lower GI endoscopy:

Indications - 3

Answer 9

Suspected colorectal cancer
Suspected IBD
Bowel obstruction

Question 10

Lower GI endoscopy:

What would suggest there is colorectal cancer present?

What test can be done to detect blood in stool?

Answer 10

PR bleeding
Altered bowel habit in elderly
Iron deficiency anaemia
Lesion seen on imaging

Positive FOB - Positive faecal occult blood test

Question 11

Lower GI endoscopy:

In what situation should it not be done?

Answer 11

Perforation present

Increased risk of perforation due to diverticulitis

Question 12

Lower GI endoscopy:

What type of diet should patient be on from day before procedure?

How many hours before should you fast from food?

What about fluids?

What else must be done to enable a clear view?

Answer 12

Low residue diet

6 hrs

2 hrs

Clear bowel of faeces - usually using enema

Question 13

Lower GI endoscopy:

What should be stopped for procedures with high bleeding risk?

Does any thing need to stopped for biopsy?

What about NSAID’s and aspirin?

Answer 13

Anticoagulants
Antiplatelets

No

Can be continued

Question 14

Lower GI endoscopy:

What drug can be given to sedate them?

What else needs to be given?

Answer 14

Midazolam

Analgesia

Question 15

What 2 situations are AXR indicated?

Answer 15

Bowel obstruction

Foreign body