CGRN Upper Endoscopy Procedures 2 — Questions and Answers
Question 1: During EGD, a Forrest Ia bleeding ulcer is identified. What does this classification indicate?
- Clean-based ulcer
- Active spurting arterial hemorrhage (Correct answer)
- Visible vessel without active bleeding
- Adherent clot on ulcer base
Correct answer: Active spurting arterial hemorrhage
Forrest Ia indicates active spurting hemorrhage, carrying the highest rebleeding risk.
Forrest Ia = spurting hemorrhage (90% rebleed risk without treatment). Requires immediate combination therapy: epinephrine injection plus thermal or mechanical hemostasis. Post-procedure: high-dose IV PPI (80 mg bolus + 8 mg/hr for 72 hr).
Question 2: What is the recommended surveillance interval for non-dysplastic Barrett's esophagus?
- Every 6 months
- Every 1 year
- Every 3-5 years (Correct answer)
- No surveillance needed
Correct answer: Every 3-5 years
Non-dysplastic Barrett's requires surveillance EGD every 3-5 years with systematic biopsies.
Surveillance intervals by dysplasia: non-dysplastic = 3-5 years; indefinite for dysplasia = repeat in 6 months on optimized PPI; LGD = 6-12 months or consider endoscopic eradication; HGD = endoscopic eradication therapy. Follow Seattle biopsy protocol.
Question 3: Which esophageal foreign body is considered a medical emergency requiring immediate removal?
- Coin in the stomach for <24 hours
- Button battery lodged in the esophagus (Correct answer)
- Blunt object in the stomach for <48 hours
- Food bolus in the stomach
Correct answer: Button battery lodged in the esophagus
A button battery in the esophagus causes rapid electrochemical burns and must be removed immediately.
Button batteries generate electrical current causing rapid caustic burns. Significant mucosal injury within 2 hours; life-threatening complications (perforation, aortoesophageal fistula) within 8-12 hours. Remove within 2 hours; do not delay for NPO status.
Question 4: What is the primary purpose of chromoendoscopy during upper endoscopy?
- Improve general visualization
- Enhance detection and characterization of mucosal lesions by highlighting surface patterns (Correct answer)
- Treat mucosal lesions
- Measure esophageal pH
Correct answer: Enhance detection and characterization of mucosal lesions by highlighting surface patterns
Chromoendoscopy uses dye agents to enhance visualization of mucosal surface patterns for better lesion detection.
Three dye categories: absorptive/vital (methylene blue, Lugol's iodine), contrast (indigo carmine), and reactive (Congo red). Applications include Barrett's surveillance, early gastric cancer detection, and squamous neoplasia screening. Virtual chromoendoscopy (NBI, BLI) uses optical filters instead.
Question 5: A patient presents with coffee-ground emesis and hemoglobin of 7.2 g/dL. What is the Blatchford score used for?
- Predicting variceal size
- Stratifying upper GI bleeding risk pre-endoscopically (Correct answer)
- Determining sedation dose
- Classifying peptic ulcer type
Correct answer: Stratifying upper GI bleeding risk pre-endoscopically
The Glasgow-Blatchford Score predicts the need for intervention before endoscopy is performed.
GBS uses BUN, hemoglobin, systolic BP, heart rate, melena, syncope, hepatic disease, and heart failure. Score 0-1 may allow outpatient management. Higher scores indicate need for urgent endoscopy, transfusion, and ICU monitoring. Complemented by post-endoscopic Rockall score.
Question 6: What is the nurse's role during endoscopic esophageal dilation?
- Observing only
- Preparing equipment, monitoring for complications, managing sedation, and documenting dilator sizes (Correct answer)
- Operating the endoscope
- Performing dilation independently
Correct answer: Preparing equipment, monitoring for complications, managing sedation, and documenting dilator sizes
The nurse prepares dilators, monitors for perforation and bleeding, manages sedation, and documents procedure details.
Pre-procedure: verify consent includes dilation risks, prepare dilator sizes, confirm fluoroscopy if needed. During: pass dilators sequentially, monitor for perforation signs, track sizes used (rule of three). Post: monitor for delayed complications, document all sizes used, educate on warning signs.
CGRN Upper Endoscopy Procedures 2
During EGD, a Forrest Ia bleeding ulcer is identified.
What does this classification indicate?