day 1 - endoscopy Flashcards
what does OGD stand for
Oesophago-gastro duodenoscopy
what is an OGD
a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure (unless sedation or anesthesia has been used). However, a sore throat is common
indications for an OGD
Diagnostic:
eg -
Unexplained anemia (usually along with a colonoscopy)
Upper gastrointestinal bleeding as evidenced by hematemesis or melena
Heartburn and chronic acid reflux - this can lead to a precancerous lesion called Barrett’s esophagus
Persistent vomiting
Dysphagia - difficulty in swallowing
Surveillance:
Surveillance of Barrett’s esophagus
Surveillance of gastric ulcer or duodenal ulcer
Confirmation of diagnosis/biopsy:
Abnormal barium swallow or barium meal
Confirmation of celiac disease (via biopsy)
Therapeutic[edit]
Treatment (banding/sclerotherapy) of esophageal varices
Injection therapy (e.g. epinephrine in bleeding lesions)
Cutting off of larger pieces of tissue with a snare device (e.g. polyps, endoscopic mucosal resection)
Application of cautery to tissues
Removal of foreign bodies (e.g. food) that have been ingested
Tamponade of bleeding esophageal varices with a balloon
OGD complications
Perforation 1/10000
Bleeding
what is a colonoscopy
Colonoscopy or coloscopy[1] is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It can provide a visual diagnosis (e.g. ulceration, polyps) and grants the opportunity for biopsy or removal of suspected colorectal cancer lesions.
what is the difference between a colonoscopy and a sigmoidoscopy
Colonoscopy is similar to sigmoidoscopy—the difference being related to which parts of the colon each can examine. A colonoscopy allows an examination of the entire colon (1200–1500 mm in length). A sigmoidoscopy allows an examination of the distal portion (about 600 mm) of the colon, which may be sufficient because benefits to cancer survival of colonoscopy have been limited to the detection of lesions in the distal portion of the colon.
colonoscopy indications
gi Bleeding abdo Pain Change of bowel habit Acute diarrhoea Screening or ca.
Biopsy IBD Cancer Infections Remove polyp/cancer Stent Stop bleeding
colonoscopy complications
Perforation 1/1000 (siggy 1/10000)
Bleeding
Pain
what is ERCP
Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject radiographic contrast into the ducts in the biliary tree and pancreas so they can be seen on X-rays.
ERCP is used primarily to diagnose and treat conditions of the bile ducts and main pancreatic duct,[1] including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP can be performed for diagnostic and therapeutic reasons, although the development of safer and relatively non-invasive investigations such as magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound has meant that ERCP is now rarely performed without therapeutic intent.
ERCP indications
Obstructive jaundice Panc ca Gallstones Cholangiocarcinoma Benign causes \+/- Cholangitis Pancreatic disease
Remove stones Stent Bile duct Pancreas Biopsy or brushings
ERCP complications
Pancreatitis 3.5% (severe 10%)
Perforation
Bleeding
Cholangitis
describe the ERCP procedure
The patient is sedated or anaesthetized. Then a flexible camera (endoscope) is inserted through the mouth, down the esophagus, into the stomach, through the pylorus into the duodenum where the ampulla of Vater (the opening of the common bile duct and pancreatic duct) exists. The sphincter of Oddi is a muscular valve that controls the opening of the ampulla. The region can be directly visualized with the endoscopic camera while various procedures are performed. A plastic catheter or cannula is inserted through the ampulla, and radiocontrast is injected into the bile ducts and/or pancreatic duct. Fluoroscopy is used to look for blockages, or other lesions such as stones.
When needed, the opening of the ampulla can be enlarged (sphincterotomy) with an electrified wire (sphincterotome) and access into the bile duct obtained so that gallstones may be removed or other therapy performed.
Other procedures associated with ERCP include the trawling of the common bile duct with a basket or balloon to remove gallstones and the insertion of a plastic stent to assist the drainage of bile. Also, the pancreatic duct can be cannulated and stents be inserted. The pancreatic duct requires visualisation in cases of pancreatitis.
is sedation used in colonoscopy
in most cases
describe the procedure of OGD
The patient is kept NPO (Nil per os) or NBM (Nothing By Mouth) that is, told not to eat, for at least 4 hours before the procedure. Most patients tolerate the procedure with only topical anesthesia of the oropharynx using lidocaine spray. However, some patients may need sedation and the very anxious/agitated patient may even need a general anesthetic. Informed consent is obtained before the procedure. The main risks are bleeding and perforation. The risk is increased when a biopsy or other intervention is performed.
The patient lies on his/her left side with the head resting comfortably on a pillow. A mouth-guard is placed between the teeth to prevent the patient from biting on the endoscope. The endoscope is then passed over the tongue and into the oropharynx. This is the most uncomfortable stage for the patient. Quick and gentle manipulation under vision guides the endoscope into the esophagus. The endoscope is gradually advanced down the esophagus making note of any pathology. Excessive insufflation of the stomach is avoided at this stage. The endoscope is quickly passed through the stomach and through the pylorus to examine the first and second parts of the duodenum. Once this has been completed, the endoscope is withdrawn into the stomach and a more thorough examination is performed including a J-maneuver. This involves retroflexing the tip of the scope so it resembles a ‘J’ shape in order to examine the fundus and gastroesophageal junction. Any additional procedures are performed at this stage. The air in the stomach is aspirated before removing the endoscope. Still photographs can be made during the procedure and later shown to the patient to help explain any findings.
what is anaesthesia
a drug induced reversible loss of consciousness to allow surgery and invasive procedures. it has 3 parts - hypnosis, analgesia, and neuromuscular relaxation/paralysis.
