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DU PA GI Sp Studies

Duke PA GI Special Studies

endoscopy is both __ diagnostic and therapeutic
risks of endoscopy perforation, bleeding, infection, cardiopulmonary complications secondary to sedation, death
upper endoscopy (gastroscope); allows visualization of esophagus, stomach and duodenum Esophagogastroduodenoscopy (EGD)
examines descending colon, sigmoid colon and rectum flexible sigmoidoscopy
visualization of entire colon colonoscopy
push endoscopy of small bowel enteroscopy
combines endoscopy and radiography to image pancreatic and biliary ducts endoscopic retrograde cholangiopancreatography (ERCP)
limited use now. More effective than FOBT less effective than colonoscopy Flexible sigmoidoscopy
diagnostic use of Esophagogastroduodenoscopy (EGD) dysphagia, odynophagia, refractory GERD, screening for Barret's, PUD, upper GI bleeding, malabsorption
therapeutic uses of Esophagogastroduodenoscopy (EGD) treatment of varices, dilation of strictures, rupture of webs, removal of polyps, stent placement
very useful for patients with inflammatory diarrhea who need view of distal colon only flexible signoidoscopy
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
study of choice for CRC (colorectal cancer) colonoscopy
first introduced in 1968 and widely used in diagnosing pancreatic disease. Because of better imaging it is now used mainly for therapy ERCP
ERCP Endoscopic retrograde cholangiopancreatography
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
EUS endoscopic ultrasound
VCE video capsule endoscopy
esophageal indications for VCE screening for varices, screening for GERD complications, esophagitis
small bowel indications for VCE tumors, obscure bleeding, survey in polyposis syndromes, refractory malabsorption syndromes,
has become gold standard visualizing small bowel VCE
avoid VCE in patients with __ GI distress, fistulas, pregnancy or swallowing disorders
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
virtual colonoscopy is unable to detect lesions <__ 5mm
what makes up the portal triad portal vein, hepatic artery, bile duct
considered gold standard for evaluation of liver inflammation and or fibrosis liver biopsy
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
contraindications for liver biopsy increase PT, thrombocytopenia, ascites, difficult body habitus, suspected hemangioma
The USTSPF recommends screening for colorectal cancer using __ beginning at age 50 and continuing until age 75. Grade A recommendation FOBT, sigmoidoscopy, or colonoscopy
The USTSPF recommends screening for colorectal cancer using FOBT, sigmoidoscopy, or colonoscopy beginning at age __ and continuing until age 75. 50
The USTSPF recommends against routine screening for colorectal cancer in patients __ years of age. Grade C recommendation 76-85
The USTSPF recommends against screening for colorectal cancer in adults older than __. Grade D recommendation 85
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
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)
FOBT can detect as little as __ml of blood lost per day 5
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
conditions that cause occult blood in the stool GI tumors, ulcers, IBD, hemorrhoids, swallowed blood (oral or nasopharyngeal bleed), arteriovenous malformations, diverticulosis, and hematobilia
__ can create non pathologic occult blood in the stool vigorous excercise
the ingestion of __ can cause false positive for FOBT red meat and pork(the other white meat), fish, turnips, horseradish
a positive result obtained on multiple specimens collected on successive days (four out of six specimens) warrants a __ thorough GI evaluation
drugs that may cause GI bleeding positives with colchicine, anticoagulants, aspirin, iron preparations, nonsteroidal antiarthritics, and steroids
drugs that may cause false negatives include vitamin C
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
besides being more sensitive and specific than an upper GI series EGD also can be used __ therapeutically
EGD is contraindicated in patients with __ b/c of risk of perforation esophageal diverticula
examination of the anus and rectum proctoscopy
sigmoidoscopy is diagnostically helpful b/c the lower GI tract is __ difficult to visualize with radiographs
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
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
this test is recommended for patients with a strong personal family history of colon cancer, polyps, or ulcerative colitis colonoscopy
the American Cancer Society has proposed a colonoscopy every __ years as an alternative to Hemoccult testing with periodic flexible sigmoidoscopy 10
colonoscopy is contraindicated in anyone with a recent (14-21 days) __ colon anastomosis
when prepping for colonoscopy it is recommended that the patient drink the entire gallon of glycol preparation within __ hours 4
__ should indicate immediate cessation of the preparation procedure for colonoscopy N/V
patients with __ should receive prophylactice antibiotics before the test valvular heart disease
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
therapeutically barium enema may be used to __ in children reduce non-strangulated ileocolic intussusception
bleeding from diverticula can cease after a __ Barium enema
ACBE air contrast barium enema or double contrast barium enema, used especially when small polyps are suspected
Barium enema is contraindicated in patients with __ megacolon
colorectal cancer affects __% of men and women 6
colorectal cancer is fatal in almost __% of cases yet is curable if detected early 50
the vast majority of colorectal cancers arise from __ that progress over many years to cancer benign adenomas
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
__ are the most important factors in achieving patient compliance with screening programs discussion and encouragement by primary care provider
to detect occult blood the __ has undergone the most extensive testing and has had the greatest clinical use guaiac-based test (Hemoccult II)
to do the guaiac FOBT two slides must be prepared from __ consecutive bowel movements 3
with guaiac FOBT to avoid false positives patients should abstain from aspirin, NSAIDS, red meat, poultry, fish, and turnips/horseradish for 72 hours
guaiac FOBT slides should be processed within __ days after preparation 7
__ has a higher sensitivity than Hemoccult II Hemoccult Sensa
patients with positive FOBT should __ undergo colonoscopy
if after a positive FOBT, and a colonoscopy with no identified polyps further screening for colorectal cancer __ can be deferred for 10 years
of those with positive FOBT 5-18% have colorectal cancer
__ are identified in 25-50% of patients with a positive FOBT adenomatous polyps
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
upon flexible sigmoidoscopy __ are identified in 10-20% of patients adenomatous polyps
upon flexible sigmoidoscopy __ are identified in 1% of patients colorectal cancers
using only flexible sigmoidoscopy means that __% of advanced colonic neoplasia located only in the proximal colon will be overlooked 30
__ is the preferred screening test in patients deemed to be at higher risk due to a positive family history of colorectal cancer colonoscopy
in asymptomatic individuals 50-75 years old undergoing screening colonoscopy the prevalence of __ is 6-11% advanced neoplasia
in asymptomatic individuals 50-75 years old undergoing screening colonoscopy the prevalence of __ is 1% cancer
the incidence of serious complications after colonoscopy (perforation, bleeding, cariopulmonary events) is __% 0.1
__ has been widely supplanted by colonoscopy and CT colonography, even though it is widely available, inexpensive and safe barium enema
Created by: bwyche