Endoscope

Question 1

What are the parts of an endoscope?

Answer 1

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

Question 2

What is a gastroscope used for?

Answer 2

Viewing the stomach

Question 3

What is a colonoscope used for?

Answer 3

Viewing the colon

Question 4

What is an endobronchial retrograde cholandio- pancreatography ERCP scope used for?

Answer 4

Examining the billary tree and pancreatic ducts

Question 5

What is an enteroscope used for?

Answer 5

Viewing the small bowel

Question 6

What is endoscopic ultrasound?

Answer 6

Using an endoscop to look at different parts of the body beyong the gut using a miniature ultrasound probe

Question 7

Capsule cameras: what are they used for and what it the concern?

Answer 7

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.

Question 8

What are endoscopic ultrasounds often used for?

Answer 8

Staging oesophageal cancers

Question 9

Broadly, what are endoscopes used for?

Answer 9

Diagnosis
Therapeutics (both emergency and elective)
Screening
Surveilance

Question 10

Much of the diagnosis can be made by visulalising the surfaces of the GI tract. What common diseases can be seen?

Answer 10

Oesophagitis, gastritis
Ulceration
Coeliac disease
Crohn's disease
Ulcerative colitis 
Sclerosing cholangitis 
Benign tumours 
Malignant tumours

Question 11

What vascular abnormalities can be seen using an endoscope

Answer 11

Varices
Ecstatic blood vessels
Angiodysplasia

Question 12

What are varices?

Answer 12

extremely dilated sub-mucosal veins

Question 13

What are estatic blood vessels?

Answer 13

Blood vessels are normally covered by mucosa and do not bleed. These are new vessels that are not covered and can bleed

Question 14

What is angiodysplasia?

Answer 14

small vascular malformation of the gut. It is a common cause of otherwise unexplained gastrointestinal bleeding and anemia.

Question 15

What are Mallory Weiss tears?

Answer 15

tear in the mucous membrane, or inner lining, where the esophagus meets the stomach.

Question 16

What are diverticulae?

Answer 16

Pouches in the wall of the colon. Usually because we do not eat enough fruit and vegetables. Asymptomatic

Question 17

What other miscellaneous conditions can be diagnosed using an endoscope?

Answer 17

Gall stones
Worms- thred worms most commonly in the UK
Foreign bodies eg bezoars (balls of hair, razor blades, food bolus

Question 18

What are the advantages of using endoscopes?

Answer 18

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

Question 19

What is the pre malignant stage of colon cancer?

Answer 19

Adenomatous polyp

Question 20

What is the premalignant stage of some oesophageal cancers?

Answer 20

Barretts oesophagus

Question 21

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?

Answer 21

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

Question 22

Endoscopes can be used to obtain tissue samples. What are these?

Answer 22

Biopsy and histology
Brushings and cytology
Rarely aspirates and biopsies for microbiology

Question 23

What therapeutics can be carried ou using endoscopes?

Answer 23

Stemming GI bleeding
Nerve blocks to reduce pain
Resection of early cancer
Stenting to maintain patency

Question 24

What is haematemisis?

Answer 24

Vomiting clotted blood (usually due to a GI bleed above the duodenum)

Question 25

What is Melaena?

Answer 25

the production of dark sticky faeces containing partly digested blood, as a result of internal bleeding or the swallowing of blood.

Question 26

Is variceal bleeding a medical emergency?

Answer 26

Yes

=> ABC resuscitate

Question 27

How can variceal bleeding be treated?

Answer 27

1) Injection of fibrinogen
2) Banding
3) Histocryl glue

Question 28

What is a sclerosant?

Answer 28

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.

Question 29

How is arterial bleeding treated using an endoscope?

Answer 29

Injection therapy (adrenaline will lead to vasoconstriction)
Heater probe (coagulation)
Clips to ligate the bleeding

Question 30

How is angiodysplasia treated?

Answer 30

Argon plasma coagulation

Recent work with radiofrequency ablation

Question 31

When are stents used with endoscopy?

Answer 31

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

Question 32

What are the complications of stenting?

Answer 32

Foreign body sensation 
Reflux
Fever
Sepsis
Fistula formation
Bleeding 
Perforation
Migration 
Tumour overgrowth

Question 33

Where in the GI tract can you stent?

Answer 33

Oesophagus, Common bile duct

Colon

Question 34

How can you dilate the GI tract with an endoscope?

Answer 34

Using a balloon or bouginage

Question 35

A polypectomy is a method of tumour removal. What does it involve?

Answer 35

Removal of a polyp

Question 36

Endoscopic mucosal removal is a method of tumour removal. WHat does it involve

Answer 36

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

Question 37

How are gall stones removed?

Answer 37

ERCP
Endoscopic retrograde cholangio- pancreatography.
Sphincterotomy, balloon and trawl, lithotripsy

Question 38

What is lithotripsy?

Answer 38

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.

Question 39

What is a sphincterotomy?

Answer 39

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.

Question 40

How are endoscopes used in nutrition?

Answer 40

PEG insertionPEJ
insertion
Naso-jejunal tube insertion

Question 41

How is a PEG tube inserted using a endoscope?

Answer 41

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

Question 42

What is screening?

Answer 42

Investigating assymptomatic individuals for a disease. Done in bowel cancer and breast cancer

Question 43

What is surveillance?

Answer 43

Investigating and following up those with a predisposing factor/disease and ealry detection of complications eg polyps, barretts oesophagus, ulcerative colitis

Question 44

What does preparation for endoscopey involve?

Answer 44

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)

Question 45

What are the complications of endoscopy?

Answer 45

Rare:
Respiratory arrest
Aspiration 
Cardiac arrest
Slightly more common:
Bleeding
Perforation 
Infection