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GI Special Studies

Gastroenterology

QuestionAnswer
Classic imaging modality for free air plain film (abd flat & upright)
CXR for: calcifications; foreign bodies; free air; obstruction
CXR with barium = fluoroscopy (for: transit times; mucosal abnormalities) (no longer for : CRC screening or reflux)
Risks of GI endoscopy perf, bleed, infxn, cardio 2/2 sedation
Comparative efficacy of screens for CRC Colonoscopy > flex sig > FOBT
Flex sig: useful for pts with: inflammatory diarrhea who need view of distal colon only
Study of choice for CRC screening Colonoscopy (also good to eval anemia, bleeding, IBD)l req ext bowel prep & liquid diet 24 hrs
ERCP: used to dx panc dz; now used more for tx; inject dye into bile/panc ducts; pt NPO 6-8 hrs
Has dx and tx uses EGD; ERCP; EUS? (has interventional use)
Study of choice to dx panc ca EUS (if not avail: CT) (may also do MRI/ERCP)
Study of choice: staging of rectal, esophageal and gastric tumors and identification of pancreatic tumors: EUS (also used for aspirational bx)
Gold std to visualize small bowel VCE
VCE CI avoid in patients with GI distress, fistulas, pregnancy or swallowing disorders
Role of trans-abd US often TOC in liver, biliary dz; TOC in pediatric appendicitis
CT/MRI CT: primary GI malig (liver, panc); MRI: liver lesions
Virtual colonoscopy req bowel prep, rectal tube; low sens/spec; MRI cannot detect lesion <5 mm
Liver bx: usu percutaneous; 1.5 cm x 2 mm (6-8 portal triads) gold std to eval liver inflam +/- fibrosis; usu O/P
Liver bx: complications bleed; brief RUQ pain; pneumothorax
Ischemic bowel on imaging X-ray: dilated loops with edema (thumbprinting). Angiography. CT may show aortic dissection, bowel distention/edema, arterial calcifications
Risks of GI endoscopy Perforation, bleed, infection, cardiac complications due to sedation
Comparative efficacy of screens for CRC Colonoscopy > flexible sigmoidoscopy > FOBT
Flexible sigmoidoscopy: useful for patients with: inflammatory diarrhea who need view of distal colon only
Study of choice for CRC screening Colonoscopy (also good to evaluate anemia, bleeding, IBD)
ERCP is used to diagnose: Pancreatic disease
Gold standard to evaluate liver inflammation +/- fibrosis: Liver biopsy
Liver biopsy approach is usually: percutaneous; 1.5 cm x 2 mm (6-8 portal triads)
Liver bx: complications bleed; brief RUQ pain; pneumothorax
Therapeutic use of ERCP inject dye into bile/pancreatic ducts (pt must be NPO)
Colon cancer: gold standard of dx eval: colonoscopy
H pylori diagnostic testing serology; bx w/histo; bx w/urease test; urease breath test; stool antigen; PPI, Abx, or bismuth gives false neg (except serology or bx w/histo)
PUD diagnostic testing EGD & bx; HP test
What % of PUD cases become malignant? 4%
Esophageal cancer workup tests CXR (mediastinal widening, lung or bony mets); barium esophagram (polypoid, infiltrative, or ulcerative lesion); EGD w/ bx (gold standard); Chest CT/EUS for staging
Colonoscopy with ileal intubation & bx (to Dx IBD): should see: chronic colitis/enteritis
IBD dx/ eval: endoscopy, histology, radiography; colonoscopy; small bowel follow-through, enteroclysis (+/- CT), MR enterography
Gold std for celiac testing mucosal bx (even if pos serologies); pathognomonic: villous atrophy; lymphocytic infiltration of lamina propria; crypt hyperplasia; inc intraepithelial lymphocytes
Pathognomic for celiac dz: Villous atrophy on mucosal bx
PUD TOC EGD + biopsy
Flexible Sigmoidoscopy examines: left colon; some bowel prep needed; can performed w/o sedation in Dr’s office; 5-year interval between exams
Patients w/ adenomas found on flex sig should: Have a colonoscopy
Created by: Abarnard
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