1
Q
Nasogastric Intubation
A
Passage of a tube through the nares, esophagus and into the stomach
2
Q
Nasogastric Intubation Indications (4)
A
- Evacuate blood
- Decompress
- Remove toxic substances
- Provide enteral feedings
3
Q
Nasogastric Intubation Contraindications (5)
A
- Facial trauma
- Basilar skull fracture
- Bilateral nasal obstruction
- Recent nasal, pharyngeal, esophageal or gastric surgery
- Bleeding diathesis
4
Q
Nasogastric Intubation Complications (5)
A
- Bleeding
- Aspiration
- Tracheal intubation
- Erosion of naris (Long term)
- Pharyngeal/nasal perforation
5
Q
Nasogastric Intubation Required equipment (5)
A
- Nasogastric tube
- Lubricant
- Cup of water with a straw
- Tape
- Large syringe
6
Q
The Levin tube
A
a one-lumen nasogastric tube. The Levin tube is usually made of PVC with several drainage holes near the gastric end of the tube. There are graduated markings on the lumen so that you can see how far you have inserted the tube into the patient.
7
Q
The Salem-Sump tube
A
a two-lumen tube. It has a drainage lumen and a smaller secondary tube that is open to the atmosphere. The second lumen allows for continuous suction and prevents gastric mucosa from being aspirated into the tube.
8
Q
Esophagogastroduodenoscopy (EGD)
A
- a procedure during which a small flexible endoscope is introduced through the mouth (or with smaller caliber endoscopes, through the nose) and advanced through the pharynx, esophagus, stomach, and duodenum. EGD is used for both diagnostic procedures and therapeutic procedures.
- Other instruments can be passed through the endoscope to perform additional procedures (bx or tumor removal)
9
Q
EGD Indications
A
- Diagnostic evaluation for signs or symptoms suggestive of upper GI disease, e.g. dyspepsia, dysphagia, noncardiac chest pain, recurrent emesis
- Surveillance for upper GI cancer in high-risk settings, e.g. Barrett’s esophagus, polyposis syndromes
- Biopsy for known or suggested upper GI disease, e.g. malabsorption syndromes, neoplasms, infections
- Therapeutic intervention e.g. retrieval of foreign bodies, control of hemorrhage, dilatation or stenting of stricture, excision of neoplasms, gastrostomy tube placement
10
Q
EGD Absolute contraindications
(3)
A
- Known or suspected perforation
- Medically unstable patients
- Obstruction
11
Q
EGD Relative contraindications
(4)
A
- Anticoagulation
- Pharyngeal diverticulum
- Recent head or neck surgery
- Esophageal stricture
12
Q
EGD Complications (6)
A
1 - Cardiopulmonary problems Cardiopulmonary events make up 50% of all major complications; such events are usually caused by the medications used for conscious sedation. 2 - Bleeding 3 - Infection 4 - Perforation 5 - Vocal chord injury 6 - Pharyngeal irritation
13
Q
The following increase the risk of esophagitis: (7)
A
1 - Alcohol use
2 - Cigarette smoking
3 - Surgery or radiation to the chest (for example, treatment for lung cancer)
4 - Taking certain medications, i.e. tetracycline, doxycycline, vitamin C and aspirin
5 - Prolonged vomiting
6 - Persons with weakened immune systems due to HIV and certain medications (such as corticosteroids)
7 - Fungi or viruses
14
Q
Barrett’s Esophagitis cause and tissue change?
A
- Esophageal adaption from chronic acid reflux
- Columnar epithelium replaces the squamous epithelium of the esophagus
15
Q
Barrett’s Esophagitis is a ______. Malignant transformation is highest in _______.
A
Premalignant condition……Caucasian men greater than 50 with more than 5 years of symptoms
16
Q
Esophageal Cancer Type correlated with location.
A
- Squamous cell - proximal and mid esophagus,
2. adenocarcinoma - distal esophagus
17
Q
Esophageal Cancer has a 20-30 times higher rate of occurrence in _____.
A
China
18
Q
Esophageal Cancer Risk Factors (4)
A
- Smoking
- Ethanol use
- High fat/low protein diet
- GERD/Barrett’s esophagitis
19
Q
Most common sites for Esophageal Cancer Metastasis? (7)
A
- lungs,
- pleura,
- liver,
- stomach,
- peritoneum,
- kidneys
- adrenal gland.
20
Q
Common cause of Gastric Ulcers?
A
Usually caused by disruption of the gastric mucosal barrier from:
- Helicobacter pylori infection
- NSAIDS/aspirin
21
Q
Common locations of gastric ulcers and order of frequency?
A
angular incisura > lesser curvature > antrum.
22
Q
Gastric Ulcer Risk Factors (6)
A
- H. pylori
- Salty and smoked foods
- Chronic gastritis
- Smoking
- Diet low in fruits and vegetables
- Blood type A
23
Q
Gastric cancers are primary _____.
A
adenocarcinoma
Once 2nd most common cancer in U.S., now 14th
24
Q
Common sites of gastric CA in western countries vs Asia
A
West - proximal lesser curvature, cardia, and GE junction
Asia - distal locations
25
Flexible sigmoidoscopy procedure
- is a procedure where the rectum and the lower (sigmoid) colon is examined under direct visualization.
- The flexible sigmoidoscope is a flexible tube 60 cm long and about 1.25 cm in diameter. It is inserted through the anus and advanced slowly into the rectum and sigmoid colon.
26
Sigmoidoscopy Indications (7)
1. Colorectal cancer screening
2. Preoperative evaluation prior to anorectal surgery
3. Surveillance of previously diagnosed (treated or untreated) malignancy (or polyp with high-grade dysplasia) in the rectum or sigmoid colon
4. Local treatment of ailments such as radiation proctitis
* 5. Removal of rectal foreign bodies
6. To perform therapeutic procedures such as endoluminal stent placement for strictures, balloon dilation, or decompression with placement of a decompression tube
7. Hematochezia requiring hemostasis
27
Sigmoidoscopy Absolute contraindications (5)
1. Bowel perforation
2. Acute diverticulitis
3. Active peritonitis
4. Fulminant colitis
5. Cardiopulmonary instability
28
Sigmoidoscopy Relative contraindications (3)
1. Lack of informed consent (except in emergencies)
2. Lack of patient cooperation
3. Lack of good bowel preparation
29
Sigmoidoscopy Complications (4(
1. Pain
2. Bleeding
3. Perforation
4. Infection
30
The advantage of colonoscopy over flexible sigmoidoscopy is ......
the ability to find and remove polyps in the parts of colon that are beyond the reach of the flexible sigmoidoscope.
31
Colonoscopy Indications (7)
1. Colorectal cancer screening in average-risk adults
2. Evaluation and removal of polyps
3. Current or previous bowel resection for colon cancer
4. Family history of cancer
5. Management of inflammatory bowel disease
6. Identification of acute bleeding sites
7. Decompression of colon
32
Colonoscopy Absolute contraindications
1. Fulminant colitis
2. Known or suspected perforation
3. During early post-colectomy time period
33
Colonoscopy Relative contraindications (5)
1. History of radiation therapy for abdominal or pelvic cancer
2. History of abdominal or pelvic malignancy
3. Extensive adhesions from prior abdominal surgery
4. Bleeding dyscrasias
5. Anticoagulant therapy
34
Colonoscopy Complications (7)
1. Bleeding
2. Perforation
3. Respiratory depression
4. Cardiac arrythmias or ischemia
5. Transient bacteremia
6. Nausea/vomiting
7. Ileus
35
Colonoscopy/Sigmoidoscopy Preparation
- proper results require the rectum and lower colon to be completely cleared of stool via the use of enemas
- under special circumstances (sig diarrhea) the preparations may be waived
36
Colon shapes?
Transverse colon - triangular
| Ascending and descending - circular
37
Pedunculated polyps characteristics
mushroom-like tissue growths that are attached to the surface of the mucous membrane by a long, thin stalk, or peduncle.(usually benign)
38
The development of pedunctulated polyps can be due to ......
inherited or non inherited causes.
39
Sessile Polyp characteristic and malignancy?
- sit right on the surface of the mucous membrane and do not have a stalk.
- flat.
- Generally have more malignant potential.
40
Colon cancer: Surface of the caner is generally ______.
irregular and ulcerated
41
Colon cancer: malignant tumors are _____ and if left untreated _____.
partially or completely circumferential .....obstruct the lumen
42
Ulcerative Colitis signs and symptoms?
- Patients generally have more pain, cramping and rectal bleeding
- Diarrhea and fever are common
43
Ulcerative Colitis colonoscopy findings?
ulceration, bleeding, continuous involvement and pseudopolyps
44
Ulcerative Colitis: Mucosa is _____ than Crohn’s
more friable and bleeds more easily
45
Ulcerative Colitis: Risk of colon cancer rises _____
each decade after diagnosis
46
Crohn’s Disease signs and symptoms?
- Symptoms can occur at any point along the gastrointestinal tract
- similar to ulcerative/colitis but with more cramping/diarrhea and less bleeding
- symptoms wax and wane
47
Chrohn's Disease colonoscopy findings?
inflammation, cobble-stone appearance and “skip” lesions
48
Chrohn's Disease Major characteristics (7)
1. Discontinuous involvement
2. Cobblestoning
3. Aphthous ulcers
4. Deep longitudinal serpiginous elcers
5. rectal sparing or segmenta; inflammation
6. Anal Lesions
7. Ileocecal valve stenotic and ulcerated
49
Ulcerative Colitis Major Characteristics (5)
1. Continuous Involvement
2. Erosions/microulcers
3. Loss of vascular pattern
4. Rectal Involvement
5. Illeocecal Valve Patulous and free of ulceration
50
Virtual Colonoscopy (VC)
- Medical imaging procedure which uses imaging and computers to produce two- and three-dimensional images of the colon from the rectum, all the way to the distal ileum.
- Performed via x-rays, CT, MRI
- used to dx colon/bowel disease (polyps, diverticulitis, and cancer)
51
Fecal Occult Blood Test (FOBT)
| Advantages (4)
1. No cleansing of the colon is necessary.
4. Samples can be collected at home.
3. The cost is low compared with other colorectal cancer screening tests.
4. FOBT does not cause bleeding or tearing/perforation of the lining of the colon.
52
Fecal Occult Blood Test (FOBT)
| Disadvantages (4)
1. This test fails to detect most polyps and some cancers.
2. False-positive results are common. (repeat tests needed)
3. Dietary restrictions and changes, such as avoiding meat, certain vegetables, vitamin C, iron supplements, and aspirin are often recommended for several days before a guaiac FOBT.
4. Additional procedures, such as colonoscopy, may be necessary if the test indicates an abnormality.
53
Sigmoidoscopy Advantages (4)
1. The test is usually quick, with few complications.
2. For most patients, discomfort is minimal.
3. In some cases, the doctor may be able to perform a biopsy and remove polyps during the test, if necessary.
4. Less extensive cleansing of the colon is necessary with this test than for a colonoscopy.
54
Sigmoidoscopy Disadvantages (3)
1. Only allows view the rectum and the lower part of the colon. Any polyps in the upper part of the colon will be missed.
2. Very small risk of bleeding or tearing/ perforation of the lining of the colon.
3. Additional procedures, such as colonoscopy, may be necessary if the test indicates an abnormality.
55
Colonoscopy Advantages (2)
1. Allows view of the rectum and the entire colon.
| 2. The doctor can perform a biopsy and remove polyps or other abnormal tissue during the test, if necessary.
56
Colonoscopy Disadvantages (4)
1. test may not detect all small polyps, nonpolypoid lesions, and cancers, but it is one of the most sensitive tests currently available.
2. Thorough cleansing of the colon is necessary before this test.
3. Some form of sedation is used in most cases.
4. Although uncommon, complications such as bleeding and/or tearing/perforation of the lining of the colon can occur.
57
Colonography Advantages (2)
1. test allows for the of view the rectum and the entire colon.
2. Test is not an invasive procedure, so there is little risk of bleeding or tearing/perforation of the lining of the colon.
58
Colonography Disadvantages (3)
1. test may not detect all small polyps, nonpolypoid lesions, and cancers.
2. Thorough cleansing of the colon is necessary before the test.
3. If a polyp or nonpolypoid lesion 6 to 9 millimeters in size or larger is detected, standard colonoscopy, usually immediately after the virtual procedure, will be recommended to remove the polyp or lesion or perform a biopsy.
59
Double Contrast Barium Enema (DCBE) Advantages (3)
1. This test usually allows the doctor to view the rectum and the entire colon.
2. Complications are rare.
3. No sedation is necessary
60
Double Contrast Barium Enema (DCBE) Disadvantages (5)
1. test may not detect some small polyps and cancers.
2. Thorough cleansing of the colon is necessary before the test.
3. False-positive results are possible.
4. The doctor cannot perform a biopsy or remove polyps during the test.
5. Additional procedures are necessary if the test indicates an abnormality.
61
Digital Rectal Exam (DRE) Advantages (3)
1. Often part of a routine physical examination.
2. No cleansing of the colon is necessary.
3. The test is usually quick and painless.
62
Digital Rectal Exam (DRE) Disadvantages
1. The test can detect abnormalities only in the lower part of the rectum.
2. Additional procedures are necessary if the test indicates an abnormality.
