Gastrointestinal


Anoscopy

Rapid Review

  • Background
    • Use of anoscope to visually inspect the anus, anal canal, and internal sphincter, primarily for the purpose of identifying rectal bleeding. 
  • Indications
    • Evaluation of anorectal symptoms (bleeding, pain, discharge, protrusions, foreign bodies)
  • Contraindications
    • Imperforate anus, active bleeding. Relative contraindications included severe anal pain or recent surgery.
  • Complications:
    • Perineal skin/mucosa injury, infection, shearing of hemorrhoidal tissue.

Pearls

Video Credit: Lommekirurgi


Balloon Tamponade for Gastrointestinal Bleeding

Rapid Review

  • Background
    • Placement over an orogastric tube with balloon tamponade capabilities designed for the management of esophageal or gastric bleeding. Specifically devices include the sengstaken-blakemore tube, minnesota tube, and linton-nachlas tube
  • Indications
    • Unstable patient with massive upper GI bleed
  • Contraindications
    • Recent esophageal or gastric surgery
  • Complications
    • Esophageal rupture, mucosal ulceration, aspiration

Pearls

Video Credit: EM:RAP


Esophageal Foreign Body Removal

Rapid Review

Pearls

Deep Dive

Video Credit: Esophageal Foreign Body Removal


Gastric Lavage

Rapid Review

Pearls

Deep Dive

Video Credit: Gastric Lavage


Gastrostomy Tube Replacement

Rapid Review

Pearls

Deep Dive

Video Credit: Gloucestershire Hospital


Nasogastric Tube Placement

Rapid Review

  • Background
    • Placement of a tube via the nasogastric route to provide access to the stomach for therapeutic or diagnostic purposes. 
  • Indications
    • Gastric decompression, administration of medication, administration of radiographic contrast, bowel irrigation
  • Contraindications
    • Recent nasal surgery, severe facial trauma
  • Complications
    • Pulmonary placement, epistaxis, gagging/vomiting

Pearls

Video Credit: Geeky Medics


Paracentesis

Rapid Review

  • Background
    • Insertion of a needle/catheter into the peritoneal cavity to drain ascitic fluid for diagnostic or therapeutic purposes.
  • Indications
    • Acute onset of ascites, suspected bacterial peritonitis
  • Contraindications
    • Acute abdomen requiring surgery, severe thrombocytopenia, active bleeding
  • Complications
    • Hemorrhage, bladder/bowel perforation, vessel laceration, infection, ascites fluid leak

Pearls

Video Credit: EM:RAP


Rectal Foreign Body Extraction

Rapid Review

  • Background
    • Process of removing rectal foreign bodies. Common objects include bottles, vibrators, vegetables, fruit, or balls. May also be caused by drug packing/stuffing
  • Indications
    • Bedside removal indicated if object is less than 10 cm proximal to anal verge or palpable on digital rectal exam
  • Contraindications
    • Perforation, peritonitis
  • Complications
    • Local tissue trauma, tearing of rectal mucosa

Pearls

Video Credit: procedurettes


Whole Bowel Irrigation

Rapid Review

Pearls

Deep Dive

Video Credit: CritIC


Brandon Simpson, PA-C
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