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59 Cards in this Set
- Front
- Back
why are stents not inserted if there is a stricture more distal in the GI tract |
because a stent higher up will not resolve digestion problems |
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what are indications for GI stents |
presence of malignancy relieve pressure from tumor outside esophagus presence of fistula between esophagus and trachea |
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why would an esophageal stent be needed for a patient with malignancy |
if there is malignancy, esophagus stent placement allows for palliative care or nutritional support before treatment |
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why would an esophageal stent be needed for a patient with a tumour outside their esophagus |
A stent could push a displaced esophagus back into place and the push the tumor away to clear passage way |
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why would it be necessary to place a stent in an area with a fistula |
stent allows blockage of fistula preventing possibility of possible aspiration |
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what are contraindication of stent insertion |
coagulopathy (blood clotting disorder) pt not well enough for procedure peritoneal seeding (Ca of abdo that has spread to the peritoneum as sm seedings obstruction of stomach or small bowel presence of high strictures close to vocal cords |
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what equipment in used in stent placement |
done in IR suite under fuoro with similar equipment to as other IR procedures |
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what are the most common stents in esophageal stenting |
self expanding stents |
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what are self expanding stents made of |
metallic with plastic (teflon) coating |
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what size are self expanding stents |
16-18F with expanded diameter of 16-24mm |
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why are self expanding stents ideal for esophageal stenting |
they are retrievable, have antireflux option where a one way valve reduces the likelyhood of reflux after the procedure |
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what are the two types of stents available |
covered uncovered |
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what are the benefits of using an uncovered stent |
decreased chance of migration or movement but increased chance of blockage from growing tumors that can invade walls of stents |
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what are the benefits of covered stents |
almost no chance of tumor invasion often first choice |
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what design element reduces the risk of migration |
a small partial covering on the inside of the stent |
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why would an esophageal stent be removed after a short period of time |
if a benign structure is present and only temporary dilation is required (6-8wks) when pt tolerance is questionable after surgery to improve pt nutrition postop if fistula is present and requires time to heal |
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what exam must be done before stent placement and why |
a modified swallow or other contrast exam of the upper GI tract to define length and severity of stricture |
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describe the procedure for esophageal stent placement |
pt in lateral pstn with conscious sedation catheter suitable for oral ingestion inserted down esophagus placement confirmed with contrast stiff guidewire passed through stricture into gastric antrum stent delivery device passed over wire and across stricture stent deployed by pulling back outer sheath under fluoro |
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what follow up is done for esophageal stent placement |
follow up contrast study may be performed to confirm placement and assess function |
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what is the postprocedural care for esophageal stents |
pt restarted on oral fluids and progress to a low residue diet (food without fiber) |
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what dietary advice is given to the patients |
take small bites chew well take plenty of fluid with meals consume fizzy drinks to allow air to escape stomach treat reflux with medication |
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what are the complications of esophageal stents |
haemorrhage chest pain migration of stent perforation death |
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where is a colonic stent placed |
in a stricture of the large bowel when the patient has been diagnosed with malignancy |
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stent may serve to be a....? |
prelude to delayed surgery preventative easure to avoid further blockage palliative measure for pts with inoperatable Ca due to mets and high risk of death from surgery |
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what are contraindications to a colonic stent |
perforation uncooperative patient right colic lesion |
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how is a right colic lesion best treated |
with ileocolonic anastomosis surgery |
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why is a stent not placed if there is a right colic lesion |
because the ascending colon can be tortuous and if an attempt is made there is a high risk of perforation and a chance the rad will not be able to move the guidewire or catheter all the way along the bowel to reach the lesion |
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what are complications of colonic stents |
perforation migration of stent reobstruction of colon |
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where are enteral feeding tube insertions commonly done |
in the IR suite |
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who are enteral feeding tube insertions done for |
pts who require long term enteral feeding and are unable to swallow due to pathology (neurological damage or tumors) |
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where can the enteral feeding tubes be inserted to |
in the stomach (gastrostomy) @ the stomach/jejunum (gastrojejunostomy) in the jejunum (jejunostomy) |
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what does the placement depend on |
existing history |
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why are Gtubes preferred when possible |
because the stomach will still be involved in digestion even though the tube is used for feeding |
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what are indications for G tube placement |
pt rneeds nutrition support after biliary surgery dysphagia due to CVA, Ca, dementia, or trauma small bowel disease short gut syndrome, Crohns anorexia gastric decompression: gastroparesis, ileus, obstruction caused by malignancy |
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what do patients not require with a G tube that they would for other feeding tubes |
a feeding pump |
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when are J tubes a good option |
for patients who are more likely to experience reflux, aspirate, or have delayed emptying of stomach |
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what are indications for Jtubes |
pt requires feeding after stomach or duodenal surgery |
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what are cons to J tubes |
need feeding pump known to clog more often than G tube needs to be flushed with water after feeding |
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under what circumstances are GJ tubes placed |
when patient is no longer able to tolerate G tube |
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how is a patient switched from a Gtube to a GJ tube |
existing feeding tube is passed further along GI tract at the junction of the stomach and small bowel |
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how are indications for GJ tube insertion categorized |
by relative or absolute |
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what is an absolute indication |
a definite indication where there is pathology involving the GI tract |
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what is a relative indication |
another area of the body is affected requiring intervention of the GI system |
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what are some examples of absolute indications |
previous total gastroectomy gastric carcinoma uncorrectable coagulopathy non functional GI tract |
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what are examples of relative indications |
ascites gastric varices peritoneal dialysis inability to insert G tube previous complex abdominal surgery |
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Where are J tubes inserted and why |
in the endoscopy department or OR because the jejunum is a very mobile structure and is difficult to localize with fluoro |
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what are the tech's responsibilities for tube placement |
have all of pts previous images available for rad to view set up sterile tray prepare sterile field operate fluoro equipment |
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what is on the sterile tray for tube insertion |
10mL 1% lidocaine 18G needle T fastener to adhere the catheter to the patient stiff wire (amplatz) dilator (6-12F) |
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how do catheters differ in tube placement |
in their shape that anchors onto the stomach eg pigtail, mushroom, or balloon |
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what will a patient requiring a J or NJ tube already have |
and NG tube |
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describe the procedure or tube placement |
pt needs IV access for pain medication pt given one dose of antibiotic before procedure to prevent infection rad checks pstn of liver with US rad insufflates stomach to place it below the rib cage, liver, and colon needle inserted midway between lesser and greater curvature of stomach catheter (G/GJ tube) inserted to desired location |
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how much air is used to insufflate the stomach |
250-400ccs |
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why is the needle inserted half way between the greater and lesser curvature of the stomach |
to avoid all major vessels |
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where is the end of a G tube placed |
toward the fundus of the stomach |
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where is the end of the GJ tube placed |
toward the duodenum allowing easy conversion to J tube |
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what is the post procedure for tube placement |
tube placed in gravity overnight |
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why is a tube placed in gravity |
to permit it to sit freely below the patient's stomach allowing residual gastric secretions to flow out of the body |
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what indicates that something may be wrong |
large amounts of residuals visible after several hours may indicate bowel motility or inappropriate position |
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when can tube feeding comence |
when there is no residuals present |