Diagnostics in GI

Question 1

Esophagogastroduodenoscopy

Answer 1

Known as an Upper Endoscopy or EGD, this test allows for visualization of the esophagus, stomach, and duodenum

Question 2

Indications for an EGD

Answer 2

○ Diagnostic evaluation for upper GI symptoms
(dyspepsia, dysphagia, etc)
○ Surveillance of known pathology
○ Biopsy for suspected pathology
○ Therapeutic intervention (control hemorrhage,
foreign body retrieval, Esophageal dilation)
Esophagogastroduodenoscopy - Medscape - ○ Transesophageal Echocardiogram (TEE)

Question 3

Contraindications for EGD

Answer 3

○ If Pt has a possible perforation
○ Medically unstable patient
○ On Anticoagulation (relative contraindication)

Question 4

Colonoscopy

Answer 4

Also called “lower endoscopy,” allows visualization of the entire
large intestine and rectum

Question 5

Indications of a colonoscopy

Answer 5

○ Screening and diagnosis of colorectal cancer
○ Surveillance after colon cancer resection
○ Diagnosis of Inflammatory Bowel Disease
○ Identification and treatment of colonic bleeding

Question 6

Pregnancy is considered a relative contraindication for _____ and may increase the risk of spontaneous abortion

Answer 6

Colonoscopy

Question 7

Flexible Sigmoidoscopy

Answer 7

Another endoscopic procedure where an endoscope is inserted into
the colon for both diagnostic and therapeutic reasons
○ Considered inferior to colonoscopy - It only reaches approximately 60cm into the colon.

Question 8

Video Capsule Endoscopy

Answer 8

VCE is a newer and powerful diagnostic tool that is
especially useful in evaluating the small intestine
(where colonoscopy can’t reach)

Question 9

Indications for VCE

Answer 9

○ Evaluation of suspected small bowel bleeding*
○ Diagnosis and surveillance of Crohn Disease*
○ Evaluating for small bowel tumors, polyps, neoplasms
○ Assessment of Celiac Disease
○ Evaluation of unexplained abdominal pain or symptoms

Question 10

Relative Contraindications for VCE include

Answer 10

○ Esophageal Stricture or Swallowing disorders
○ Known or suspected Small Bowel Obstruction
○ Gastroparesis (Caution in uncontrolled DM)

Question 11

The most significant complication of VCE

Answer 11

capsule retention in the bowel
with the need for surgical retrieval

Question 12

_____ is used as a radiographic contrast agent in the digestive system

Answer 12

Barium Sulfate

Question 13

Barium is used for the following GI studies

Answer 13

○ Barium Swallow Study (Oropharynx, larynx, and esophagus)
○ Barium Enema (Large intestine)
○ Barium Follow Through (Stomach and small intestine, mostly)

Question 14

Common indications for Barium Swallow (Esophagram)

Answer 14

■ Achalasia
■ Esophageal Neoplasm
■ Esophageal diverticula
■ Esophageal stenosis or obstruction

Question 15

Barium Enema indications

Answer 15

■ Colorectal cancer
■ Diverticular disease
■ Inflammatory Bowel Disease

Question 16

Weakness of the Abdominal X-ray study includes

Answer 16

○ Low diagnostic yield
○ Contraindicated in pregnancy
○ A fairly non-specific test

Question 17

T/F A normal abdominal XR will reveal a gastric air bubble

Answer 17

T

Question 18

White lines that go the full
circumference around a portion of the
intestine are called circular folds or
_____.

Answer 18

“Valvulae Conniventes”

Question 19

Small bowel obstruction may reveal ____

Answer 19

dilated loops of bowel (with prominent valvulae conniventes) and little to
no air in the large intestine

Question 20

Large Bowel Obstructions will present with______

Answer 20

large, dilated colon due to bowel gas, which often extends to the small intestine as well.

Question 21

Best initial test for a patient with possible cholecystitis or cholelithiasis

Answer 21

“Gallbladder US”

Question 22

Dx test of choice in children and pregnant Pts with RLQ pain

Answer 22

“Appendix US

Question 23

Ultrasound “FAST” Exam

Answer 23

important tool for examining
trauma patients .
○ “Focused Assessment with
Sonography for Trauma”

Question 24

Abdominal CT Scan Indications

Answer 24

○ Evaluation of abdominal or pelvic mass
○ Suspected neoplasm
○ Staging of metastatic malignancy
○ Splenomegaly
○ Intra-abdominal/pelvic abscess
○ Abdominal/Pelvic Trauma
& More

Question 25

CT is the initial imaging of choice for patients with ______

Answer 25

LLQ and RLQ mass or pain in adults(IE, expected appendicitis)

Question 26

Leukocytes in the stool suggests ____

Answer 26

an inflammatory process, such as Shigellosis, Salmonellosis, Amebiasis (sometimes), and often IBD (Ulcerative Colitis).

Question 27

Hemoccult

Answer 27

Fecal blood test that Uses a small sample of stool (usually acquired by digital rectal exam). ○ Sample is smeared on guaiac impregnated paper, which is then treated with Hydrogen Peroxide. ○ In the presence of blood, oxidation of the guaiac results in bluish discoloration. ○ Can be done in clinic

Question 28

Fecal Immunochemical Test

Answer 28

Pt brushes surface of stool with a long brush from a kit, wipes on a test card, and delivers the test card to the lab. ○ Using various antibodies, FIT detects the presence of the globin portion of hemoglobin. ○ FIT testing has been found to be more sensitive that FOBT

Question 29

Indication of FIT testing

Answer 29

○ Gastrointestinal bleeding ○ Screening for colon cancer

Question 30

T/F FIT is recently starting to replace Hemoccult

Answer 30

T

Question 31

FIT is more sensitive to the ____than Hemoccult, with accuracy rates near that of colonoscopy

Answer 31

presence of blood

Question 32

Diagnostic indications of Nasogastric intubation

Answer 32

○ Evaluation of upper GI bleeding ○ Aspiration of gastric fluid content ○ Administration of XR Contrast ○ ID of esophagus on a CXR

Question 33

Therapeutic indications for NG tube

Answer 33

○ Gastric decompression after Endotracheal intubation ○ Relief of symptoms and bowel rest during small bowel obstruction ○ Bowel irrigation ○ Administration of medications ○ Feeding

Question 34

Absolute contraindications of NG tube

Answer 34

○ Basilar skull fracture ○ Severe midface trauma ○ Recent nasal surgery

Question 35

Relative contraindications of NG tube

Answer 35

○ Anticoagulated or Hypocoagulable state ○ Esophageal varices

Question 36

How to reduce risk of epistaxis in NG tube placement?

Answer 36

Some providers will pre-treat the nasal passages with nasal sprays of Oxymetazoline or Phenylephrine (nasal decongestants that cause localized vascular constriction)

Question 37

As the tip reaches the posterior naso/oropharynx, instruct the patient to ____

Answer 37

take continual small sip of water through the straw

Question 38

Complications of NG tube insertion that can arise include

Answer 38

○ Sinusitis ○ Epistaxis ○ Sore Throat ○ Esophageal Perforation ○ Aspiration ○ Pneumothorax ○ Intracranial placement (rare, only with skull fracture)