Endoscope Flashcards
What are the parts of an endoscope?
Screen, Light source, air/water source,
Control head,
Flexible tip, Video camera, hollow channel allowing you to suck things up and insert tools down for biopsy
What is a gastroscope used for?
Viewing the stomach
What is a colonoscope used for?
Viewing the colon
What is an endobronchial retrograde cholandio- pancreatography ERCP scope used for?
Examining the billary tree and pancreatic ducts
What is an enteroscope used for?
Viewing the small bowel
What is endoscopic ultrasound?
Using an endoscop to look at different parts of the body beyong the gut using a miniature ultrasound probe
Capsule cameras: what are they used for and what it the concern?
Used for gaining images of the GI tract that are particularity hard to get to. Produces a 2-4 hour video.
Concerns: swallowing batteries- you need to make sure the capsule doesn’t get stuck or be digested as batteries will cause ulceration of the gut.
What are endoscopic ultrasounds often used for?
Staging oesophageal cancers
Broadly, what are endoscopes used for?
Diagnosis
Therapeutics (both emergency and elective)
Screening
Surveilance
Much of the diagnosis can be made by visulalising the surfaces of the GI tract. What common diseases can be seen?
Oesophagitis, gastritis Ulceration Coeliac disease Crohn's disease Ulcerative colitis Sclerosing cholangitis Benign tumours Malignant tumours
What vascular abnormalities can be seen using an endoscope
Varices
Ecstatic blood vessels
Angiodysplasia
What are varices?
extremely dilated sub-mucosal veins
What are estatic blood vessels?
Blood vessels are normally covered by mucosa and do not bleed. These are new vessels that are not covered and can bleed
What is angiodysplasia?
small vascular malformation of the gut. It is a common cause of otherwise unexplained gastrointestinal bleeding and anemia.
What are Mallory Weiss tears?
tear in the mucous membrane, or inner lining, where the esophagus meets the stomach.
What are diverticulae?
Pouches in the wall of the colon. Usually because we do not eat enough fruit and vegetables. Asymptomatic
What other miscellaneous conditions can be diagnosed using an endoscope?
Gall stones
Worms- thred worms most commonly in the UK
Foreign bodies eg bezoars (balls of hair, razor blades, food bolus
What are the advantages of using endoscopes?
Safe and easy to follow up.
Mostly day cases or short hospital stays
Can remove tissue in a minimally invasive way
Detects premalignant and sometimes assymptomatic conditions
Screening of assymptomatic individuals
What is the pre malignant stage of colon cancer?
Adenomatous polyp
What is the premalignant stage of some oesophageal cancers?
Barretts oesophagus
Dye staining the oesophagus can be done using iodine and indigo carmine but it is messy, time consuming and uncomfortable for the patient. What can be done instead?
Narrow band imaging where ble light is reflected off the surface and green light is reflected from deeper in the tissue.
Helps to exadurate the changes seen
Endoscopes can be used to obtain tissue samples. What are these?
Biopsy and histology
Brushings and cytology
Rarely aspirates and biopsies for microbiology
What therapeutics can be carried ou using endoscopes?
Stemming GI bleeding
Nerve blocks to reduce pain
Resection of early cancer
Stenting to maintain patency
What is haematemisis?
Vomiting clotted blood (usually due to a GI bleed above the duodenum)
What is Melaena?
the production of dark sticky faeces containing partly digested blood, as a result of internal bleeding or the swallowing of blood.
Is variceal bleeding a medical emergency?
Yes
=> ABC resuscitate
How can variceal bleeding be treated?
1) Injection of fibrinogen
2) Banding
3) Histocryl glue
What is a sclerosant?
An injectable irritant that is used in the treatment of varicose veins and that causes inflammation and subsequent fibrosis, thus obliterating the lumen of the vein.
How is arterial bleeding treated using an endoscope?
Injection therapy (adrenaline will lead to vasoconstriction) Heater probe (coagulation) Clips to ligate the bleeding
How is angiodysplasia treated?
Argon plasma coagulation
Recent work with radiofrequency ablation
When are stents used with endoscopy?
Usually reserved for malignancy due to complications.
Can be used to allow patients with advanced malignancy to eat.
Plastic stents are removable
Metal self expanding stents are permanent
What are the complications of stenting?
Foreign body sensation Reflux Fever Sepsis Fistula formation Bleeding Perforation Migration Tumour overgrowth
Where in the GI tract can you stent?
Oesophagus, Common bile duct
Colon
How can you dilate the GI tract with an endoscope?
Using a balloon or bouginage
A polypectomy is a method of tumour removal. What does it involve?
Removal of a polyp
Endoscopic mucosal removal is a method of tumour removal. WHat does it involve
procedure to remove early-stage cancer and precancerous growths from the lining of the digestive tract. Pealing off the mucosa by using a loop to convert it to a polyp and then cutting at the base of the loop
How are gall stones removed?
ERCP
Endoscopic retrograde cholangio- pancreatography.
Sphincterotomy, balloon and trawl, lithotripsy
What is lithotripsy?
a treatment, typically using ultrasound shock waves, by which a kidney/gall stone or other calculus is broken into small particles that can be passed out by the body.
What is a sphincterotomy?
An operation to cut the muscle between the common bile duct and the pancreatic duct. The operation uses a catheter and a wire to remove gallstones.
How are endoscopes used in nutrition?
PEG insertionPEJ
insertion
Naso-jejunal tube insertion
How is a PEG tube inserted using a endoscope?
1) Gastroscopy
2) Identify insertion site from the inside
3) Transabdominal passage of wire
4) Pull wire out of mouth
5) Tie PEG tube to wire and pull into position
6) Fix in place and set up connectors
What is screening?
Investigating assymptomatic individuals for a disease. Done in bowel cancer and breast cancer
What is surveillance?
Investigating and following up those with a predisposing factor/disease and ealry detection of complications eg polyps, barretts oesophagus, ulcerative colitis
What does preparation for endoscopey involve?
1) Explanation and consent with patient
2) Fasting and bowel prep (taking a drug which makes you have diarrhoea for 24 hours to clear bowel)
3) Monitor bleeding diathesis (unusual susceptibility to bleed)
4) Infection prophylaxis (only in endocarditis, shunt, immunosupression)
What are the complications of endoscopy?
Rare: Respiratory arrest Aspiration Cardiac arrest Slightly more common: Bleeding Perforation Infection
