Duke PA GI Special Studies
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| endoscopy is both __ | diagnostic and therapeutic
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| risks of endoscopy | perforation, bleeding, infection, cardiopulmonary complications secondary to sedation, death
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| upper endoscopy (gastroscope); allows visualization of esophagus, stomach and duodenum | Esophagogastroduodenoscopy (EGD)
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| examines descending colon, sigmoid colon and rectum | flexible sigmoidoscopy
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| visualization of entire colon | colonoscopy
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| push endoscopy of small bowel | enteroscopy
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| combines endoscopy and radiography to image pancreatic and biliary ducts | endoscopic retrograde cholangiopancreatography (ERCP)
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| limited use now. More effective than FOBT less effective than colonoscopy | Flexible sigmoidoscopy
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| diagnostic use of Esophagogastroduodenoscopy (EGD) | dysphagia, odynophagia, refractory GERD, screening for Barret's, PUD, upper GI bleeding, malabsorption
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| therapeutic uses of Esophagogastroduodenoscopy (EGD) | treatment of varices, dilation of strictures, rupture of webs, removal of polyps, stent placement
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| very useful for patients with inflammatory diarrhea who need view of distal colon only | flexible signoidoscopy
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| requires extensive bowel prep and liquid diet for 24 hours prior to procedure. Sedation. indications are CRC screening, evaluation of anemia, bleeding, assessment of IBD | colonoscopy
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| study of choice for CRC (colorectal cancer) | colonoscopy
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| first introduced in 1968 and widely used in diagnosing pancreatic disease. Because of better imaging it is now used mainly for therapy | ERCP
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| ERCP | Endoscopic retrograde cholangiopancreatography
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| initially developed in the 1980s to improve limitations of pancreatic images with trans-abdominal traditional U/S.now regarded as study of choice for staging of rectal, esophageal and gastric tumors and identification of pancreatic tumors | endoscopic ultrasound
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| EUS | endoscopic ultrasound
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| VCE | video capsule endoscopy
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| esophageal indications for VCE | screening for varices, screening for GERD complications, esophagitis
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| small bowel indications for VCE | tumors, obscure bleeding, survey in polyposis syndromes, refractory malabsorption syndromes,
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| has become gold standard visualizing small bowel | VCE
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| avoid VCE in patients with __ | GI distress, fistulas, pregnancy or swallowing disorders
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| low specificity and sensitivity but this is constantly being improved with use of barium, oral and IV contrast, still requires bowel prep, rectal tube | virtual colonoscopy
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| virtual colonoscopy is unable to detect lesions <__ | 5mm
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| what makes up the portal triad | portal vein, hepatic artery, bile duct
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| considered gold standard for evaluation of liver inflammation and or fibrosis | liver biopsy
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| indications for liver biopsy | evaluation of abnormal LFT's, suspected neoplasm, confirmation of diagnosis/prognostication, evaluation of granulomatous disease, unexplained jaundice or suspected drug reaction, to manage post transplantation care
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| contraindications for liver biopsy | increase PT, thrombocytopenia, ascites, difficult body habitus, suspected hemangioma
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| The USTSPF recommends screening for colorectal cancer using __ beginning at age 50 and continuing until age 75. Grade A recommendation | FOBT, sigmoidoscopy, or colonoscopy
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| The USTSPF recommends screening for colorectal cancer using FOBT, sigmoidoscopy, or colonoscopy beginning at age __ and continuing until age 75. | 50
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| The USTSPF recommends against routine screening for colorectal cancer in patients __ years of age. Grade C recommendation | 76-85
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| The USTSPF recommends against screening for colorectal cancer in adults older than __. Grade D recommendation | 85
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| The USPSTF concludes that the evidence is insufficient to assess the benefits and harms of __ and fecal DNA testing as screening modalities for colorectal cancer. Grade I recommendation | computed tomographic colonography
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| this test is part of a routine physical, evaluation for ab pain, and is also a part of routine colorectal cancer screening of asymptomatic individuals older than age 50 | Fecal Occult Blood Test (FOBT)
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| FOBT can detect as little as __ml of blood lost per day | 5
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| what is the pathology of occult blood in the case of colon cancer | tumors of the intestine grow into the lumen and are subject to repeated trauma by the fecal stream. Eventually the friable tumor ulcerates and bleeding occurs
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| conditions that cause occult blood in the stool | GI tumors, ulcers, IBD, hemorrhoids, swallowed blood (oral or nasopharyngeal bleed), arteriovenous malformations, diverticulosis, and hematobilia
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| __ can create non pathologic occult blood in the stool | vigorous excercise
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| the ingestion of __ can cause false positive for FOBT | red meat and pork(the other white meat), fish, turnips, horseradish
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| a positive result obtained on multiple specimens collected on successive days (four out of six specimens) warrants a __ | thorough GI evaluation
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| drugs that may cause GI bleeding positives with | colchicine, anticoagulants, aspirin, iron preparations, nonsteroidal antiarthritics, and steroids
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| drugs that may cause false negatives include | vitamin C
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| EGD is used to evaluat patients with the following | dysphagia, wt loss, early satiety, upper abdominal pain, ulcer symptoms, dyspepsia, alcoholism and suspected varices, barium swallow suggestive of pathology
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| besides being more sensitive and specific than an upper GI series EGD also can be used __ | therapeutically
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| EGD is contraindicated in patients with __ b/c of risk of perforation | esophageal diverticula
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| examination of the anus and rectum | proctoscopy
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| sigmoidoscopy is diagnostically helpful b/c the lower GI tract is __ | difficult to visualize with radiographs
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| recommended for patients who have had a change in bowel habits or obvious or occult blood in the stool or who ahve abdominal pain. it is also used as a screening tool for those who have had colorectal cancer, inflammatory bowel disease or polyposis | colonoscopy
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| this test is recommended for patients who have had hemoccult positive stools, abnormal sigmoidoscopy, lower GI tract bleeding, or a change in bowel habits. This test is also recommended for those with a high risk of colon cancer | colonoscopy
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| this test is recommended for patients with a strong personal family history of colon cancer, polyps, or ulcerative colitis | colonoscopy
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| the American Cancer Society has proposed a colonoscopy every __ years as an alternative to Hemoccult testing with periodic flexible sigmoidoscopy | 10
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| colonoscopy is contraindicated in anyone with a recent (14-21 days) __ | colon anastomosis
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| when prepping for colonoscopy it is recommended that the patient drink the entire gallon of glycol preparation within __ hours | 4
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| __ should indicate immediate cessation of the preparation procedure for colonoscopy | N/V
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| patients with __ should receive prophylactice antibiotics before the test | valvular heart disease
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| Barium enema is indicated in patients with the following conditions. | ab pain, obvious or occult blood in the stools, IBD, suspected cancer (bowel or abdominal, suspected volvus or colon obstruction
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| therapeutically barium enema may be used to __ in children | reduce non-strangulated ileocolic intussusception
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| bleeding from diverticula can cease after a __ | Barium enema
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| ACBE | air contrast barium enema or double contrast barium enema, used especially when small polyps are suspected
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| Barium enema is contraindicated in patients with __ | megacolon
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| colorectal cancer affects __% of men and women | 6
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| colorectal cancer is fatal in almost __% of cases yet is curable if detected early | 50
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| the vast majority of colorectal cancers arise from __ that progress over many years to cancer | benign adenomas
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| despite growing awareness of the importance of screening on the part of medical professionals and the public less than __% of patients have undergone screening of any kind | 50
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| __ are the most important factors in achieving patient compliance with screening programs | discussion and encouragement by primary care provider
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| to detect occult blood the __ has undergone the most extensive testing and has had the greatest clinical use | guaiac-based test (Hemoccult II)
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| to do the guaiac FOBT two slides must be prepared from __ consecutive bowel movements | 3
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| with guaiac FOBT to avoid false positives patients should abstain from | aspirin, NSAIDS, red meat, poultry, fish, and turnips/horseradish for 72 hours
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| guaiac FOBT slides should be processed within __ days after preparation | 7
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| __ has a higher sensitivity than Hemoccult II | Hemoccult Sensa
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| patients with positive FOBT should __ | undergo colonoscopy
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| if after a positive FOBT, and a colonoscopy with no identified polyps further screening for colorectal cancer __ | can be deferred for 10 years
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| of those with positive FOBT 5-18% have | colorectal cancer
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| __ are identified in 25-50% of patients with a positive FOBT | adenomatous polyps
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| in several prospective studies __ has been demonstrated to reduce mortality from colorectal cancer by 30-40% among those who are compliant with regular testing | FOBT
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| upon flexible sigmoidoscopy __ are identified in 10-20% of patients | adenomatous polyps
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| upon flexible sigmoidoscopy __ are identified in 1% of patients | colorectal cancers
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| using only flexible sigmoidoscopy means that __% of advanced colonic neoplasia located only in the proximal colon will be overlooked | 30
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| __ is the preferred screening test in patients deemed to be at higher risk due to a positive family history of colorectal cancer | colonoscopy
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| in asymptomatic individuals 50-75 years old undergoing screening colonoscopy the prevalence of __ is 6-11% | advanced neoplasia
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| in asymptomatic individuals 50-75 years old undergoing screening colonoscopy the prevalence of __ is 1% | cancer
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| the incidence of serious complications after colonoscopy (perforation, bleeding, cariopulmonary events) is __% | 0.1
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| __ has been widely supplanted by colonoscopy and CT colonography, even though it is widely available, inexpensive and safe | barium enema
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