Endoscope and the GI tract Flashcards
What are the parts of a basic endoscope
Screen, Light source, air/ water, control head and flexible tip
What are some specialised types of endoscope and what do they look at?
Gastroscope - Stomach
Colonoscope - Colon
Side viewing ERCP - Some of the organs that come off of the GI tract
Enteroscope - looking at the bit you cant see with the Gastroscope (Small bowel)
Capsule - pill cam
Endoscopic Ultrasound - lumen of the stomach - can scan the organs from inside out
How big are capsule?
1-2cm
What are the risks with capsule?
They contain a battery which must come out
Difficult to swallow
Relatively expensive
What are the drawbacks of the EUS Scopes
Very expensive
What do patients need before an endoscope
Sedative or anaesthetic
What are endoscopes used for?
Diagnostics - cancer, inflammation and ulcers
Therapeutics - Biopsy abnormalities
Treat things - to stop a bleeding ulcer
Screening - early diagnoses of cancers - Colorectal cancer screening. taking a healthy population to try and pick up pre-malignant cells and cure them
Surveillance - people with an illness that we want to keep an eye on.
What is Barrett’s oesophagus
a metaplasia caused by a chemical irritation
cells undergo a metaplastic change to thick, cuboidal cells so that it is more like the stomach, so not as badly effected by acid reflux
What can be diagnosed through visual diagnoses?
Oesophagitis Gastritis Ulceration Coeliac disease Crohn's dsease Ulcerative colitis Sclerosing cholangitis
What are the two different types of tumours
Malignant and Benign tumours
What are some vascular abornalities
Varices
Ectatic blood vessels (GAVE, Dieulafoy)
Angiodysplasia
What miscellaneous conditions that can be diagnosed / treated through endoscope
Mallory-Weiss tears Diverticulae Foreign bodies Stones Worms
What are the therapeutics of Endoscopy?
Ability to treat down the endoscope
GI bleeding
Nerve blocks
Resection of early cancer
What are 3 types of bleeding?
Variceal bleeding
Arterial bleeding
Angiodysplasia
Describe haematemesis
Vomit which is full of blood
Describe malena
Stool with blood with a disgusting smell
What is Variceal Bleeding?
A medical emergency
How do we manage a patient with Variceal Bleeding?
ABC resusitate
Injection sclerotherapy
Banding (putting on rubber bands from the endoscope)
Hystocryl glue
What is the aim of injecting a sclerosant
To cause intesive inflammation in the blood vessel and stop bleeding
What is one of the drawbacks of using glue?
The scope can end up glued to the surface you are trying to fix. This needs to be changed quickly!
How can we treat arterial bleeding?
Injection therapy (adrenaline: tamponade, vasoconstriction) Heater probe (coagulation Clips (ligate)
How can we treat strictures (narrowing)
Dilation (using balloons)
Stenting (usually reserved for malignancy)
Removable stents - can treat perforations with a reduction in long term sequelae. Some are not biodegradable
What are the main types of stents
Plastic (removable - not often used now)
Metal self expanding (permanent)
How does polypectomy work
Raise polup on a bed of adrenaline / saline
SNare
Hot biopsy
What are polypectomy used for
Colonic polyps
How does endoscopic mucosal resection (EMR) occur?
Raise lesion on a bed of adrenaline / saline
Loop and convert polyp
Snare
What can we remove through ERCP
Stones and foreign body
Describe the removal of a stone
Sphincterotomy
Balloon and trawl
Litotripsy
How is a foreign body removed?
Snare or basket
Overtube
GA with endotracheal tube
How does a PEG insertion occur?
Gastroscopy Identify insertion site Transabdominal passage of wire Pull wire out of mouth Tie PEG tube to wire and pull into position Fix in place and set up connectors
What is the purpose of screening>
Prevention of colorectal cancer
Detect polyps and remove them
Early detection of cancer
What are the complications of Endoscopy
Respiratory arrest Aspiration Cardiac Arrest Bleeding Perforation Infection (bacterial endocarditis)
What determines whether a patient is for endoscopy
Patients not for endoscopy include:
Indication (justified)
Contraindications (recent infarct)
Bleeding diathesis (including anticoagulant therapy)
Infection risk (prosthetic valves, shunts, immunosuppression)
How is a patient prepared for endoscopy?
Indication (clear, justified) Explaination to patient Consent Fasting Bowel preparation Monitor bleeding diathesis Infection prophylaxis (endocarditis, shunt, immunosuppresion)
