When should pre-procedure antibiotics be given for EGD?
patient specific:
- patients with ANC < 500
- advanced hematologic malignancies
- cirrhotics with ascites or GIB
- those with vascular grafts placed in the last 6 months
procedure specific:
- PEG
- vatical bleeding control
- ERCP for biliary drainage
- EUS and FNA of pancreatic cyst
When visualizing the ampulla of Vater on endoscopy, in what position are the biliary and pancreatic ducts?
- biliary: 11 o’clock
- pancreatic: 1 o’clock
How do acid and base esophageal ingestion injuries differ?
- acid are more superficial due to coagulative necrosis
- alkali are deeper due to liquefactive necrosis
What regions of the esophagus are at higher likelihood for perforation?
- UES
- aortic arch
- LES
What foreign bodies require emergent EGD? Urgent?
- emergent: button batteries or anything sharp in the esophagus
- urgent: non-sharp objects in the esophagus, magnets, sharp objects in the stomach/duodenum, objects > 5cm in the stomach/duodenum
What foreign bodies are at high risk to not pass through the pylorus?
anything more than 2cm
Describe five measures of high-quality colonoscopy.
- cecum intubated > 90% of the time
- withdrawal time > 6 minutes
- perforation < 1 in 500
- post-polypectomy bleeding < 1%
- post-polypectomy bleeding managed non-operatively > 90%
What is post-polypectomy syndrome due to?
a full thickness thermal injury to the colon causes inflammation and peritoneal irritation without perforation
How is post-polypectomy syndrome treated?
treat with serial exams, bowel rest, IVF, and antibiotics
After quantitative BAL, what is considered the threshold for treating pneumonia?
> 100,000 CFU/mL
Why should you observe patients who aspirate a peanut?
they breakdown and release peanut oil which is a strong irritant and has the potential to cause an intense pneumonitis
Bipolar energy can be used to ligate vessels of what size?
up to 7mm in diameter
If the anesthesiologist notices a sudden rise and then drop in EtCO2 during laparoscopy, what has occurred? What is the treatment?
a CO2 embolus, treat with trendelenburg, left lateral decubitus positioning, and aspiration via CVC
