What are the urgent/emergent indications for lower gastrointestinal endoscopy?
- Lower gastrointestinal bleeding
- Endoscopic decompression
These indications require immediate attention during the procedure.
What are the elective indications for lower gastrointestinal endoscopy?
- Screening
- Staging
- Surveillance
These procedures are planned rather than urgent.
What are the absolute contraindications for lower gastrointestinal endoscopy?
- Acute severe colitis
- Enteric perforation
- Patient refusal
These conditions prevent the procedure from being performed safely.
What are the relative contraindications for lower gastrointestinal endoscopy?
- Cardiopulmonary instability
- Coagulopathy
These conditions may complicate the procedure but do not outright prohibit it.
What is the first landmark visualized during lower gastrointestinal endoscopy?
Anal verge
The perianal area is also evaluated for benign and malignant conditions.
What is the dentate line in the context of lower gastrointestinal endoscopy?
Squamocolumnar junction at the anal verge
It is identified by a change in color and texture of the anal canal lining.
What are the rectal valves/folds also known as?
Rectal folds of Houston
These divide the rectum into three segments for lesion description.
What is the significance of the rectosigmoid junction during endoscopy?
Commonly affected by diverticula and diverticulitis
Vigilance is required for strictures or stenosis in this area.
What does the splenic flexure indicate during endoscopy?
Bluish-gray hue at the end of the descending colon
It transitions to the air-filled transverse colon.
What is the cecum identified by during endoscopy?
Blind-ending larger lumen with thickened taenia
The taenia coalesce at the caput.
What is the appendiceal orifice during endoscopy?
Small slit in a whirl of mucosal folds
It is an important landmark in the cecum.
What is essential to perform before a planned endoscopic procedure?
Thorough history and physical examination
This is crucial for procedural planning.
What are the common bowel preparations used before endoscopy?
- Polyethylene glycol
- Magnesium citrate
- Fleet enema (for sigmoidoscopy)
Bowel prep must be individualized based on patient conditions.
What is the risk of perforation for diagnostic procedures?
0.1%
This risk increases to up to 3% for therapeutic procedures.
What should be discussed with the patient regarding sedation?
- Risks of respiratory failure
- Cardiac complications
- Aspiration
Understanding these risks is crucial for informed consent.
What are the key steps in the endoscopic procedure?
- Positioning
- Equipment check
- Sedation
- Endoscope advancement
- Special techniques
Each step is vital for a successful procedure.
What is the purpose of transabdominal pressure during challenging colonoscopies?
Helps advance the endoscope and prevent looping
This can be done by applying pressure to the abdomen.
What are some anesthetic-related complications to be aware of?
- Cardiac problems
- Pulmonary problems
- Arrhythmias
- Vasovagal reactions
These complications can arise during sedation.
What are the surveillance guidelines for no polyps found after a colonoscopy?
Repeat colonoscopy in 10 years
This is part of the follow-up care for average-risk individuals.
What is the follow-up for one to two tubular adenomas found during colonoscopy?
Repeat colonoscopy in 7 to 10 years
This guideline helps manage future screening.
What is the follow-up for three to four tubular adenomas found during colonoscopy?
Repeat colonoscopy in 3 to 5 years
Increased frequency is necessary for monitoring.
What is the follow-up for five to ten adenomas found during colonoscopy?
Repeat colonoscopy in 3 years
This indicates a higher risk of colorectal cancer.
What is the follow-up for adenomas greater than 10 mm?
Repeat colonoscopy in 3 years
Larger adenomas have a higher risk of malignancy.
What is the follow-up for more than 10 tubular adenomas found during colonoscopy?
Screening in 1 year and consideration for genetic testing
This is crucial for patients with multiple adenomas.
