GI Procedures Flashcards
EGD
- what is it
- Indications
- an upper GI tract endoscope exam
- endoscope: flexible tube with light and camera!
- EGD: upper GI tract only (doenst go into small bowel entirely)
Standard EGD: gets to the first/second part of teh duodenum
a “push EGD”: a longer one which can go to the ligament of treitz (a bit longer)
Indications
- evaluate symptoms (like if PUD and PPI isnt working)
- treatment of pathology (GI bleed)
- screening (barretts, varices)
- trouble swalloing, hematemisis, reflux, weight loss or vomiting can be reasons for EGD
Contraindications
- cnat do anesthesia
- hemodynamically unstable
- bleeding risk: cant stop anticoags.
- bowel obstruction
- aspiration risk
How to do EGD (prior to procdure do what)
- things that can be done thearepeduically
- complications
- no food/drink 8 hours prior
- hold anticoags. day of
- no Abx prophy. (unless GI bleed in cirhosis and severely neutropenic)
Thearepeudic Intervenstions with EGD
- biopsy/polyectomy
- percut. G tube placement (stomach)
- FB removal
- botox injection
- hemostasis
- ablation
- stent/dilated
Complications
- bleeding
- perforation
- infection
- cardiopulm. issues due to anesthesia
Colonoscopy
indications
contraindications
colonoscopy: a lower GI evaluation with the endoscope: starting at the rectum and going to the terminal ileum
Indications
- assess symptoms and etiology
- assess for reasons for changes in bowel habits
- assess and treat lower GI pathology
- screen for colorectal cancer!
- change in bowel habitis, hemoatochezia or rectal pain
Contraindications
- risk of perforation!!!: DO NOT DO IN acute diverticulitis (too inflammed) & fulminent colitis!!
- unable to tolerate anesthesia
- unstable
- diverticular bleed: DO NOT DO COLONOSCOPY if activ ebleed
if you cant do a colonoscopy: what are some alternatives
sigmoidoscopy: a shorter version
- visualized up to the splenic flexture
- can be done in office without sedation
Anoscopy: very short
- limited evaluation for anal warts, neoplasms, hemorrhoids (internal) and fissures
Colonoscopy Prep
- what must pt. do
therapeudic/treatments which can be done with colonoscopy
complications
Pre- colonopscy
- clear liquid diet day before (no red dye)
- golytely prep 4,000 mL
- alternative is lots of miralax
- want CLEAR stool to get clear picture
Interventions
- biopsy/polyecomty
- stent plancement
- FB removal
- hemostaiss
- dialtaion/decompression
- inject meds
Complications
- N/V
- aspiration
- bleeding
- perforamtion
- bloating/pain
- RARE!!!!
Colorectal Screening
- best imaging test
- alternative test & why you would use it
- when to screen
Colorectal cancer screening: the Colonoscopy is the best screening test
CT can be done: a “virtual” colonoscpy : still need bowel prep & insufflation
- if colonsocpy is contraindicated
- if there is an obstruction/tumor which the colonoscpy scope cannot pass
When to Screen
- recommended to screen starting at agee 45 if average risk
- screen sooner if increasd risk (family history, etc.)
(fecal occult blood testing for specifc markers can be done & is better than no testing at all!)
NG tube
- types
- indications
- contraindications
- placement key pearls
NG Tube: nasogastric tube which is inserted through the nares & passed down esophagus into the stomach
Types
- traditonal: stiffer tube, good for decompression, but uncomfy for pt. (easier for provider!)
- Dobhoff Tube: narrow, flexible, good for feeds/meds, easier on pt. difficult since its thin to place
Indications
- decompression of bowel obstruction or ileus
- administer food/meds
- gastric lavage (break up clots)
Contraindications
- complex anaomty of face, nasopharynx or esophagus
- high bleeding risk pt. (like varices)
- those who cannot be safely positioned upright to place
Placement Pearls
- measure (nose - earlobe, to sternum), and tape
- pt. drinks as you place
- always verify placement with radiographic evidence that its in the right spot!! : chest xray or abdomenal xray
(dobhoff tube needs double check: halfway place: get chest xray to ensure its not in mainstem bronchus & then conitue and follow with abdomenial xray)
want tip to be approx. 10cm past the GE junction into the stomach !!!! & want the tube facing toward the pts. right side: to follow normal flow of food
Areas of which the NG tube can be imporperly placed
complications of NG tube placement
- esophageal placement
- bronchial placement : R mianstem since its less angled can lead to PTX!!!
- coiled in upper airways
- coling in stomach
- intracranial
Complications
- epistaxis from upper airway trauma
- aspiration pneumonia, hemorrhage, empyema
- PTX
- GI tract perforatmion
- rarely: meningitis, neurological deficit
Abdomnial Paracentesis
- what is it
- indications
- contraindications
- complications
Paracentesis: US guided fluid removal procedure to remove fluid buildup from the peritoneal space
Indications
- diagnostic: evaluate new ascites & infection
- Therapeudic: symptomatic relief
- reasons for ascites: cirrhosis, cancer, heart failure, TB, dialysis, pancreatic disease
Contraindications
- those with increase bleed risk (coag disorder, low platelets, use of anticoags)
- those with overdistented bowel: risk of perforation
Prep Pt.
- does NOT need ot be NPO
- hold anticoag. therapeudic
- get new CBC, coags and (typing/screen)
- pt. supine, use US to place needle
Complications
- leaking fluid
- bleeding
- bowel perforation
- fluid shifts (affect BP as you take out fluid)
- infection
Fluid analysis of pericentesis
what are some key ones to find
what is the SAAG score and what does it indicate
- cell count & diff : infection!
- culutre : infection!
- gram stain
- proteins
- albumin!
- gluocse
- amylase
- triglycerides
- AFB (acid -fast for TB)
SAAG Score
- serum albumin gradient: determine if ascites is due to prtal hypertension or not
- (albumin in serum) - (albumin in ascites fluids)
- if SAAG > 1.1 indicates PORTAL HTN
Reasons for portal hypertension
- cirrhosis (90%) of the time
- portal vein thrombosis (influx to liver)
- intrahepatic issues (biliary cholangitis)
- sinusoidal (alcoholic and nonalcohli liver disease, hepatic injury)
- non-sinusoidal ( budd-chaiari– hepaive vein throbosis)
- posthepatic: constrictive pericarditis
SBP with a paracentesis
accounting for a tramatic tap
infection of the asciti fluid within an intra-abdominal source of infection
- a dx. is made if > 250 PMN + postive culutres
account for traumatic tap
- subtract 1 PMN for every 250 red cells in the count
