Question | Answer |
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 |