GI Bleed/Endoscopy Lecture Powerpoint

Question 1

Enteroscopy

Answer 1

Viewing of the small intestine with an endoscope inserted down the esophagus

Question 2

Choledocho- meaning

Answer 2

Common bile duct

Question 3

Indications for Esophageogastroduodenoscopy (EGD) (5)

Answer 3

• unexplained anemia
• GERD
• abdominal pain
• dysphasia
• barret’s esophagus

Question 4

EGD prep (3)

Answer 4

• NPO after midnight
• no anticoagulation
• optional sedation (propofol)

Question 5

EGD complications (2)

Answer 5

• bleeding

- perforation

Question 6

Black eschar lesions at the GE junction indicates

Answer 6

Gastritis, often 2nd to NSAID use

Question 7

ERCP (Endoscopic retrograde choleopancreatography) indications (2)

Answer 7

• obstructed common bile duct (choledocholithiasis, pancreatic neoplasm, bile duct neoplasm)
• diagnostic and therapeutic

Question 8

Endoscopic ultrasound indications (4)

Answer 8

• UGI neoplasm (esophagus, stomach, liver, pancreas, duodenum)
• lymph node biopsy and staging
• choledocholithiasis
• small missed cholelithiasis

Question 9

Colonoscopy indications (5)

Answer 9

• anemia
• rectal bleeding without identifiable cause
• diverticulitis
• alternating diarrhea and constipation
• screening

Question 10

Colonoscopy prep (5)

Answer 10

• mechanical bowel prep
• clear liquid diet
• NPO after midnight
• no anticoagulation
• optional sedation

Question 11

Colonoscopy complications (3)

Answer 11

• bleeding
• perforation
• splenic injury

Question 12

Types of colonic polyps (4)

Answer 12

• hyperplastic (benign)
• serrated (same as hyperplastic but higher risk of becoming cancer)
• inflammatory
• neoplastic (adenomatous)

Question 13

Sessile polyp vs pedunculated

Answer 13

Sessile is flatter and covers more surface, pedunculated has a stalk protruding out from a base into a large head

Question 14

Clinical manifestations of adenomatous polyps (4)

Answer 14

• mostly asymptomatic
• hematochezia
• occult blood loss
• diarrhea

Question 15

How are adenomatous polyps typically detected? (3)

Answer 15

• sigmoidoscopy
• colonoscopy
• CT scan (virtual colonscopy)

Question 16

What type of adenoma polyp is most likely to be cancerous?

Answer 16

Villous

Question 17

Dividing area of upper and lower GI

Answer 17

Ligament of trietz

Question 18

3 manifestations of GI bleed

Answer 18

• hematemesis
• melena (black dark tarry stool)
• hemotochezia (bright red blood)

Question 19

Initial management of GI bleed (3)

Answer 19

• resuscitation (2 large bore IV, saline, type o neg packed RBC, same ratio of plasma and platelets)
• labs (beware that the H&H will be maintained in acute losses)
• NG tube

Question 20

Common causes of upper GI bleed (4)

Answer 20

• gastric and duodenal ulcers (most common)
• varices
• mallorey weis tears
• neoplasms

Question 21

Ulcer bleeding treatment options (3)

Answer 21

• PPI or H2 blockers
• endoscopic hemostasis via injection therapy of 1:10,000 epi
• coagulation via cauterization
• surgery (failed or recurrent cases)

Question 22

Anterior wall of the duodenum exits to the ___, posterior wall exits to the ___

Answer 22

free abdomen (perforation), pancreas (gastroduodenal artery bleeding, highest risk of rebleeding)

Question 23

Gastric/duodenal ulcer that has a clean base treatment options (2)

Answer 23

• nothing endoscopically

- PPI treatment

Question 24

Varices treatment options (4)

Answer 24

• resuscitation
• balloon tamponade
• endoscopic therapy
• surgical therapy

Question 25

4 categories of surgical varices therapy

Answer 25

- esophageal transection (stapling off varices) - nonselective shunting (redirect portal vein flow and put into vena cava - high rates of encephalopathy) - selective shunting (adjunctive tube redirecting some flow into vena cava, easy at clotting) - orthotopic liver transplantation

Question 26

Transjugular Intrahepatic portosystemic shunt (TIPSS)

Answer 26

Lower rates of encehpalopathy and only 50% thrombosis rate at 2 years, making it a great option for patients who will receive a transplant within 2 years, involves putting catheter into internal jugular vein into right atrium and down to vena cava, connect a shunt between the portal and hepatic veins positively effecting varices treatment without changing the vasculature

Question 27

Erosive gastritis treatment options (3)

Answer 27

- self limiting - NSAIDS - ASA

Question 28

Mallory weiss tear is most often a rip in the ___ mucosa

Answer 28

gastric

Question 29

Mallory weiss tear pattern of bleeding

Answer 29

-Vomit initially then see bleeding with vomiting

Question 30

Is diverticular bleeding painful?

Answer 30

No, most often painless and self resolving but can lead to hypovolemic shock, can be difficult to localize

Question 31

Meckel's diverticulum

Answer 31

An outpouching or bulge in lower part of small intestine (2 feet of the ileocecal valve) often congenital and leftover part of umbilical cord, can see heterotrophic mucosa within the diverticulum, most of the time these are asymptomatic

Question 32

Meckel's scan

Answer 32

A radionucleotide imaging study that can detect the presence of different types of mucosa that will proceed to illuminate where they should be located (for example gastric mucossa in te stomach) and where it shouldn't be (on the diverticulum

Question 33

Therapy options for lower GI bleed (4)

Answer 33

- colonoscopy - surgery (removal of part of colon localizing bleeding) - barium enema - angiographic embolization (close off vessels to prevent bleeding)