Week 13 Handout EGD Flashcards
What are common indications for EGD?
Persistent and recurrent dyspepsia, persistent nausea or vomiting, dysphagia, chest pain with negative cardiac evaluation, iron-deficiency anemia, suspected small bowel malabsorption, malignancy, stomach or esophageal ulcer, control of bleeding, ligation or sclerosis of varices, dilation of strictures, percutaneous gastrostomy, polypectomy, removal of foreign body.
What are common indications for Colonoscopy?
Routine screening, gastrointestinal bleeding and occult bleeding, evaluation of an abnormality on barium enema, polypectomy, unexplained iron deficiency anemia, significant diarrhea, chronic inflammatory bowel disease, malignancy, dilation of stenotic lesions, foreign body removal.
What are patient-specific considerations for older adults undergoing EGD or colonoscopy?
Common comorbidities include CAD, HTN, DM. Risks include hypotension, hypoglycemia, cardiac instability. Medications to consider are beta blockers, insulin, antiplatelets. Cardiac and blood pressure management during sedation is crucial.
What are patient-specific considerations for middle-aged adults undergoing EGD or colonoscopy?
They often present with dyspepsia, GERD, or IBD. Risks include aspiration (GERD) and bleeding/inflammation (IBD).
What are patient-specific considerations for pediatrics undergoing EGD or colonoscopy?
Indications include GERD, foreign body, FTT, developmental delay. Usually require general anesthesia due to cooperation issues. Other challenges include shared airway and high anxiety.
What are procedural considerations for EGD?
Bite block use is essential to protect teeth and prevent damage to the endoscope during insertion.
What are procedural considerations for neck and facial protection during colonoscopy?
Avoid extreme neck rotation, especially in prone or lateral positions. Carefully pad and protect eyes, lips, and teeth to prevent pressure injuries.
What is the typical duration of EGD and colonoscopy procedures?
Typically brief (10–30 minutes). Requires complete immobility for patient safety and procedural success—adequate sedation or anesthesia is critical.
What are pregnancy considerations for EGD and colonoscopy?
Elective procedures should be postponed during pregnancy. Emergency EGD or colonoscopy can be performed safely with appropriate medications and monitoring, in consultation with obstetrics.
What should be evaluated in a preanesthetic assessment for EGD or colonoscopy?
Evaluate for reflux, hepatic dysfunction, bleeding risk. Review NPO status, coexisting conditions, current medications, and airway.
What are sedation and anesthesia options for EGD?
TIVA, light to deep sedation (Propofol ± opioid), local lidocaine to suppress gag reflex, antisialagogue may reduce secretions.
What is the positioning for EGD and colonoscopy?
EGD: Left lateral decubitus (sometimes supine). Colonoscopy: Left lateral or prone. Caution: prone positioning limits airway access.
What are airway management considerations during EGD and colonoscopy?
Shared airway increases aspiration risk. EGD often has no airway device; colonoscopy may require airway device for deeper sedation.
What are intraoperative management considerations for fluids?
NPO + bowel prep increases hypovolemia risk. Replace with LR or NS; monitor for signs of hypovolemia, orthostasis.
What monitoring is required during EGD and colonoscopy?
ASA standard monitors. Watch for signs of perforation (↑ HR, pain, ↓ BP).
What are postoperative considerations after EGD or colonoscopy?
Ensure return of airway reflexes before discharge. Monitor for laryngospasm, aspiration, nausea/vomiting, hypotension, sedation, bleeding, or perforation.
Which premedication helps suppress the gag reflex during EGD?
A. Fentanyl
B. Glycopyrrolate
C. Lidocaine gargle
D. Midazolam
Correct Answer: C. Lidocaine gargle
Rationale: Gargled viscous lidocaine is often used before EGD to reduce pharyngeal sensitivity and suppress the gag reflex, facilitating endoscope insertion
Why are patients at risk for bradycardia during colonoscopy?
A. Blood loss
B. Electrolyte imbalance
C. Vagal stimulation from scope manipulation
D. Overhydration
Correct Answer: C. Vagal stimulation from scope manipulation
Rationale: Colon distention during insertion or manipulation of the endoscope can stimulate the vagus nerve, leading to bradycardia or hypotension. (
What is a common complication specific to the bowel prep process for colonoscopy?
A. Hyperkalemia
B. Urticaria
C. Diarrhea and dehydration
D. Hypertension
Correct Answer: C. Diarrhea and dehydration
Rationale: Oral bowel prep solutions often cause cramping, diarrhea, and volume depletion, requiring IV fluid rehydration on arrival. (
In which of the following situations would general anesthesia with an ETT most likely be required for EGD or colonoscopy?
A. Routine adult colonoscopy
B. Pediatric EGD with poor cooperation
C. Outpatient EGD in healthy adult
D. Colonoscopy in a patient with GERD
Correct Answer: B. Pediatric EGD with poor cooperation
Rationale: Children often require general anesthesia with a secured airway due to limited cooperation, shared airway concerns, and positioning (E
Why is glycopyrrolate sometimes used prior to an EGD?
A. To lower blood pressure
B. To reduce salivary secretions
C. To treat bradycardia
D. To induce retrograde amnesia
Correct Answer: B. To reduce salivary secretions
Rationale: Glycopyrrolate is an antisialagogue used to reduce secretions that may interfere with visualization or increase aspiration risk during upper endoscopy.
Which of the following is the most accurate statement regarding anesthesia considerations for colonoscopy compared to EGD?
A. EGD typically requires deeper sedation than colonoscopy due to increased procedural discomfort.
B. Both EGD and colonoscopy are performed under general anesthesia with endotracheal intubation.
C. Colonoscopy usually requires deeper sedation than EGD and carries a higher risk of vagal stimulation.
D. Colonoscopy uses a bite block to protect the teeth and airway, while EGD does not.
Correct Answer: C
Rationale: Colonoscopy typically requires deeper sedation than EGD and carries risks such as vagal stimulation and perforation. EGD often uses light to moderate sedation and involves a shared airway, which increases the risk of aspiration but not necessarily the depth of sedation required. (Elisha et al., 2023. p. 1331-13
