Endoscopic methods Flashcards
What is an endoscope?
Direct imaging technique inside the body
Consists of a long, thin, flexible telescope with a light source and a camera at the end
Inserted through any orifice to look at any surface of the body directly with the naked eye
What are common systems observed via endoscopic methods?
GI tract Small incisions - laparoscopy Respiratory tract The female reproductive system The urinary tract The ear
Which areas of the GI tract can be observed via an endoscope?
EGD (esophagogastroduodenoscopy) - oesophagus, stomach and duodenum
Enteroscopy - small intestine
Colonoscopy/ sigmoidoscopy - colon
Different length and diameter of scope for ways of access
What is laparoscopy?
Endoscopy through a small surgical cut
The basis for minimally invasive surgery (keyhole surgery)
Most common procedure: laparoscopic cholecystectomy
What areas of the respiratory tract can be observed?
Rhinoscopy - the nose
Bronchoscopy - the lower respiratory tract
What areas of the female reproductive system can be observed using endoscopy?
Coposcopy - the cervix
Hysteroscopy - the uterus
Falloscopy - the fallopian tubes
What is the endoscopic method called for observing the urinary tract?
Cystoscopy
What is the endoscopic method called for observing the ear?
Otoscopy
Procedure of a colonoscopy
Carried out usually by a consultant gastroenterologist, training gastroenterologist or endoscopy nurse
Passed specific test to screen for bowel cancer in patients with positive FOBT
Investigation involves looking directly at the lining of the bowel with a colonoscopy
Colonoscopy usually requires sedation and analgesia together with a smooth muscle relaxant
What population normally undertakes a colonoscopy?
Those who tested positive in FOBT
Which professionals carry out a colonoscopy?
Consultant gastroenterologist
Training gastroenterologist
Endoscopy nurse
What is an example of a smooth muscle relaxant?
Buscopan
Patient preparation for a colonoscopy
Information leaflet and bowel preparation pack
Clear communication prior to the procedure is very important - with nurse
Follow a low residue diet for three days before the procedure
Take a laxative to get the best view possible
What is an example of a laxative taken in the patient preparation
Picolax
Why is it important to undergo appropriate patient preparation?
Critical - waste of time and money if the patient does not stick to the preparation procedure, as the doctor will not get a clear view of the walls of the large intestine
Procedure of the colonoscopy
Patients lie on their left side or back as the colonoscope is slowly inserted
Carbon dioxide is pumped into the colon to allow clearer visualisation of the colon wall
More soluble than air
Once the tip of the colon or the last portion of the small intestine is reached, the colonoscope is slowly withdrawn and the lining of the colon examined
What is the duration of a colonoscopy?
Can last between 20-60 minutes
Depends on patient
Have to negotiate with the curvature of the large intestine
What are the possible of a colonoscopy?
Id the colon cannot be fully visualised, the colonoscopy may have to be attempted again on another day using a different bowel preparation
The patient may need a CT or X-ray alternatively or cameras in pills
What is the disadvantage of the alternative methods to colonoscopy?
Cannot take biopsies of the colon
Why is bowel cancer good to treat?
Has an identifiable, treatable, pre-malignant stage
These are called polyps
What are polyps?
Growth in the mucosa of the colon or rectum, caused by excessive cell replication
What are the two types of polyps that exist?
Hyperplastic or metaplastic growth
What is metaplasia?
Replacement of one differentiated adult cell type with another
May be reversible
In some cases these processes may herald the beginning of development of a neoplasm
What is neoplasia?
An irreversible growth
A tumour may be benign or malignant
What is hyperplasia?
Reversible increase in cell number
How common are polyps?
Very common
Affects 15-30% of the population
Clinical presentation of polyps
Usually asymptomatic
Can cause bleeding, pain, and changes in bowel habit
Polyps which bleed should be picked up by the gFOBT
What should be done if polyps are detected?
Should be removed since they may become cancerous if left in place
What percentage of polyps become cancer?
1-10%
How are polyps removed?
Can be removed during colonoscopy in painless fashion
Cauterising wire loops passed down the colonoscope tube
Once retrieved they are taken to the lab to be analysed
What is a biopsy?
Sample of tissue taken from the body for further investigation by cellular pathologists
Where are most colorectal cancers located?
In the sigmoid colon and rectum
Accounts for 60% of colorectal cancers
Left side of the colon
What are the possible appearances of polyps?
Polyploid
Infiltrative
Ulcerative
What percentage of people who undergo colonoscopies have normal results?
50%
What percentage of colonoscopies will result in a polyp being identified?
40%
What percentage of colonoscopies will result in cancer being identified?
10%
