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Diagnostic Methods > Endoscopic Studies > Flashcards

Endoscopic Studies Flashcards

1
Q

What is endoscopy?

A

General term referring to inspection of internal body organs/cavities by using an instrument called an endoscope

Procedures are specifically name for the organ/cavity to be visualized/treated

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2
Q

What does endoscopy allow for?

A 
Direct observation
Biopsy of Suspicious tissue
Removal of polyps
Injection of variceal blood vessels
Performance of Surgical Procedures
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3
Q

What is an endoscope?

A

Tubular instrument with light source and lens for observation

Can be inserted through body orifice or small incision

Has accessory lumen for insertion of water or medication or the suctioning of debris

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4
Q

What is the purpose of using an endoscope?

A

Visualization of organ/joint
Obtain biopsy specimens with forceps or brushes
Coagulate blood vessels
Provide laser beams to coagulate vessels or remove tissue

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5
Q

What are the two basic types of endoscopes?

A

Rigid

Flexible

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6
Q

What is a rigid endoscope?

A

First type available

Still used in operative endoscopy for arthroscopy

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7
Q

What is a flexible endoscope?

A

Most often used in pulmonary and GI endoscopy

Allow transmission of images over flexible, light carrying bundles of glass wire

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8
Q

What does endoscopy eliminate the need for?

A

Open surgery

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9
Q

How is an endoscopy performed?

A

Via video camera over viewing lens

Image is transmitted to nearby TV monitor where body cavities or organs are viewed

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10
Q

What must be done pre-operatively for an endoscopy?

A

Patient must be prepped for general anesthesia and must be told that if complications arise, they may undergo open surgery

Routine pre-op care and teaching must be performed

Area to be examined should be shaved to remove hair

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11
Q

What type of endoscopy is considered clean but not sterile?

A

Genitourinary endoscopy

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12
Q

What is used in laparoscopy to distend the abdominal cavity?

A

CO2

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13
Q

What are complications of CO2 being used in laproscopic procedure?

A

Significant gas pains or referred shoulder pain

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14
Q

What is used in cystoscopy to distend the bladder which allows visualization of the bladder mucosa?

A

Water

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15
Q

What is done post-op?

A

Patient should be monitored as any post-op patient would be

Patient must be observed by staff and have someone sit with them until sedatives have worn off

Someone else must drive patient home

Patient is NPO status for 2 hours after pulmonary endoscopy or upper GI tract endoscopy so that they can regain swallowing and cough mechanism

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16
Q

What are complications of endoscopy?

A

Perforation of organ or cavity

Persistent bleeding from biopsy site

Assess vital signs closely, inspect body secretions for blood

Respiratory depression as a result of oversedation; carefully assess patient for respiratory depression

Infections and Transient Bacteremia = observe for signs and symptoms of sepsis, encourage pt. to drink fluids

Aspiration when upper airway or upper GI tract was evaluated = patient NPO

Cardiovascular problems = Arrythmias/MI or vasovagal-induced bradycardia

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17
Q

What is Arthroscopy?

A

Endoscopic procedure that allows examination of interior of joint with a specially designed endoscope

Uses rigid scope

Performed by orthopedic surgeon in OR

30 min. - 2 hrs.

Done under general anesthesia and/or sedation

Joint may be painful and swollen for several days or weeks after

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18
Q

What are normal findings of arthroscopy?

A

Normal ligaments
Menisci
Articular surfaces of joint

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19
Q

What are indications for an arthroscopy?

A

Pain in Knee or shoulder
Locking
Swelling
Instability

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20
Q

What procedures can be performed using arthroscopy?

A

Meniscectomy
ACL/PCL repair
Biopsy
Irrigation and Drainage

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21
Q

What is the advantage to arthroscopic procedures?

A

Recovery is faster and more comfortable

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22
Q

What are contraindications for arthroscopy?

A

Patients with ankylosis because you can’t maneuver scope

Local skin or wound infection

Recent arthrogram because some residual inflammation from injection of contrast dye might be present

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23
Q

What are potential complications of arthroscopy?

A 
Infection
Hemarthrosis 
Swelling
Thrombophlebitis
Joint Injury
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24
Q

What is a colonoscopy?

A

Test performed by physician trained in GI endoscopy

Takes 30-60 min.

Performed in endoscopy suite or OR

Patient is heavily sedated so they won’t feel pain and can’t recall procedure

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25
Q

What side if a patient placed on for colonoscopy?

A

Left side

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26
Q

What are normal findings of a colonoscopy?

A

Normal Rectum
Colon
Distal Small bowel

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27
Q

What are indications for a colonoscopy?

A

Patients with change in bowel habits
Obvious or occult blood in the stool
Abdominal pain
Surveillance tool for patients who have had colorectal cancer, Inflammatory bowel disease or polyposis

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28
Q

What does a colonoscopy test for?

A

Direct visualization of rectum, colon, and small bowel

Benign or Malignant neoplasms
Polyps
Mucosal inflammation
Ulceration
Sites of active hemorrhage

Biopsy specimens of cancers, polyps and inflammatory bowel diseases

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29
Q

What are the contraindications for colonoscopy?

A

Patients who are uncooperative

Unstable patients like those with hypotension

Patients bleeding profusely from the rectum

Patients with suspected perforation of colon because air can worsen fecal peritoneal soilage

Patients with toxic megacolon

Patients with recent colon anastomosis within 14-21 days

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30
Q

What is a bronchoscopy?

A

Endoscopic procedure which permits visualization of larynx, trachea, and bronchi

Performed by physician (pulmonary specialist or surgeon

30-45 min.

Minimal discomfort felt

Performed either bedside or in endoscopy room

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31
Q

What are the diagnostic indications for a bronchoscopy?

A

Direct visualizataion of tracheobronchial tree

Biopsy of tissue from observed lesions

Aspiration of “deep” sputum for culture and sensitivity and for cytology determinations

Direct visualization of larynx for identification of vocal cord paralysis

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32
Q

What are the therapeutic indications for a bronchoscopy?

A

Aspiration of retained secretions in patients with airway obstruction or post-op atelecstasis

Control of bleeding within bronchus

Removal of aspirated foreign bodies

Brachytherapy, which is endobronchial radiation therapy using an iridium wire placed via bronchoscope

Palliative laser obliteration of bronchial neoplasticism obstruction

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33
Q

What is a rigid bronchoscope?

A

Wide bore metal tube that permits visualization of only LARGE airway

Used mainly for removal of large foreign bodies

Diminished utilization since advent of flexible fiber optic bronchoscope

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34
Q

What is a Flexible fiberoptic bronchoscope?

A

Consists of 4 channels:

2 that provide a light source

One vision channel

One open channel that accommodates instruments of allows administration of an anesthetic or oxygen

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35
Q

What is the pre-procedure for a bronchoscopy and laryngoscopy

A

NPO for 4-8 hours prior

Perform thorough mouth care

Remove dentures, glasses, and contacts

Administer pre-procedures meds

Tell patient not to swallow the lido spray

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36
Q

What are the pre-procedure meds given to the patient undergoing a bronchoscopy or laryngoscopy?

A

Atropine = counteracts Vaal stimulation

Benzodiazepines = for anxiety

Anticholinergics = reduce secretions

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37
Q

What are the contraindications for a bronchoscopy?

A

Patients with hyper apnea and severe shortness of breath who cannot tolerate interruption of high-flow oxygen

Can be performed through O2 mask or endotracheal tube so that the patient can receive oxygen as needed

Patients with severe tracheal stenosis because it may be difficult to pass the scope through

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38
Q

What is the procedure for a bronchoscopy?

A

1) Nasopharynx/oropharynx is anesthetize with lido spray before insertion of bronchoscope
2) Patient is in sitting or supine position and scope is inserted into nose or mouth and into pharynx
3) Scope passes through larynx and past glottis where more lido spray is that administered into trachea to minimize the cough reflex
4) Scope is then passed farther into trachea, bronchi, 1st and 2snd geernation bronchioles for exam of bronchial tree
5) Biopsy specimens are taken if needed and if being performed to pulmonary hygiene, each bronchus is aspirated until clear

39
Q

What will occur after the bronchoscopy or laryngoscopy is performed?

A

Patient is NPO until tracheobronchial anesthesia has worn off and the gag reflex has returned

Observe sputum for hemorrhage if biopsies were taken = small amounts are normal but large amounts can cause chemical pneumonitis

Observe for evidence of impaired respiration or laryngspasm

Emergency resuscitation equipment should be readily available

Low grade fever is normal within 24 hours after procedure

If tumor is suspected, collect post bronschopy sputum sample for a cytology determination

Warm saline gargles and lozenges help with sore throat

Chest x-ray can be ordered to identify a pneumothorax if a deep biopsy was obtained

40
Q

What is a laryngoscopy?

A

Most commonly performed by an ENT surgeon

Often uses a short bronchoscope to allow inspection of the larynx and perilaryngeal structures

Endoscopic laryngoscopes is attached to camera that projects image of vocal cords onto a monitor

41
Q

What are the diagnostic indications for a laryngoscopy?

A

Identifies:

Cancers
Polyps
Inflammation
Infections of structures 
Vocal cord motion can be evaluated
42
Q

What are the therapeutic indications for a laryngoscopy?

A

Assist with endotracheal intubation

Anesthesiologists use this to visualize vocal cords to incubate for general anesthesia

43
Q

What is the procedure for a laryngoscopy?

A

1) Oro-nasopharynx anesthetize with lido spray before insertion of bronchoscope
2) Patient is placed in sitting or supine position and scope inserted through the nose or mouth and into pharynx
3) Visualization of vocal cords is performed

44
Q

What is a colposcopy?

A

Provides in Situ macroscopic examination of vagina and cervix with a colposcope

Performed by physican, NP, or PA in 5-10 minutes

Allows provider to see tiny areas of dysphasia, carcinoma in Situ, and invasive cancer

45
Q

What is the colposcope?

A

Macroscope with light source and a magnifying lens

46
Q

What are the diagnostic indications for a colposcopy?

A 
Performed on patients with:
Abnormal vaginal epithelial patterns
Cervical lesions
Suspicious Pap test results
Women who were exposed to DES in uterine

Used to identify malignant and pre-malignant lesions of the vagina and cervix

Biopsy specimens can be obtained

47
Q

What are the therapeutic indications for Colposcopy?

A

Useful only in identifying a suspicious lesion and definitive diagnosis required biopsy of tissue

A biopsy performed without a colposcopy may not necessarily represent lesions’ true pathological condition

48
Q

What is eliminated with experienced colposcopist performing a colposcopy?

A

The need for 90% of cone biopsies

49
Q

When would a patient still need to have a cone biopsy performed even after having a colposcopy?

A

When colposcopy and endocervical curettage do not explain problem or match the cytologic findings of the Pap test within one grade

Entire transformation zone (b/n squamous and columnar epithelium) is not seen

Lesions extends up the cervical canal beyond the vision of the colposcope

50
Q

What is the contraindication for a colposcopy?

A

patients with heavy menstrual flow

51
Q

How is the colposcopy performed?

A

1) Patient is placed in lithotomy position and vaginal speculum used to expose vagina and cervix
2) An endocervical curettage performed to minimize any dropping of endocervical cells onto external surface of the cervix
3) . After cervix is sampled for cytologic findings, it is cleansed with a 3% acetic acid solution to remove excess mucus and cellular debris
4) The colposcopy is focused on the cervix which is then carefully examined
5) Photographs of the cervix may be taken and usually the entire lesion is visualized and biopsy is performed

52
Q

What is the post-procedure for a colposcopy?

A

1) Cervix cleaned with normal saline solution and hemostasis ensured
2) vaginal bleeding is not unusual if biopsy specimens were taken
3) Tell patient that until healing of biopsy is confirmed they must abstain of intercourse and do not insert anything except a tampon into the vagina

53
Q

What is a cystoscopy?

A

Endoscopic procedure that visualized bladder

Diagnostic cystoscope can be done in urologists office in about 10 min.

Flexible scope is used

54
Q

What are the diagnostic indications for a cystoscopy?

A

Evaluate patients with suspected pathological conditioned involving the urethra, bladder, and lower ureters

55
Q

What are the therapeutic indication for a cystoscopy?

A

Biopsy
Transurethral resection of prostate (TURP)
Transurethral resection of superficial bladder tumors
Removal of ureteral and bladder calculi
Retrograde cystoscopy
Ureteral stent placement

56
Q

What is performed prior to a cystoscopy?

A

Enema to clear bowels

Have patient drink lots of fluids to ensure continuous flow of urine and minimize bacteria multiplication

If procedure done under general anesthesia = NPO night before and IV fluids will be given, administer pre-procedure meds 1 hour before the procedure, and sedatives decrease spams of bladder sphincter

57
Q

How is the cystoscopy performed?

A

1) Urethra anesthetize with anesthetic gel
2) Mild discomfort felt when scope passes through sphincter
3) When rigid scope used for diagnostic or therapetuc cystoscopy, general or spinal anesthesia is used
4) Performed in OR or in urologists office
5) Patient is placed in lithotomy position with feet in stirrups
6) External genitalia are cleansed with an antiseptic solution such as betadine
7) Bladder is distended with saline once scope is inserted

58
Q

What occurs after a cytoscopy?

A

Patient should not walk/stand alone immediately after legs have been removed from stirrups

Assess patients ability to void for at least 24 hours after procedure if patient is hospitalized = urinary retention may be secondary to edema caused by instrumentation

Not urine color = pink tinged is common and normal, but bright red or clots need to be reported to physician

The first few voids after cytoscopy may have burning in urethra that is intense

Encourage men to urinate while sitting to avoid a Vaal reaction related to severe dysuria

59
Q

Why and when would antibiotics be prescribed for a cytoscopy?

A

Occasionally ordered 1 day prior to and 3 days after cytoscopy in order to reduce incidence of bacteremia

60
Q

What are potential complications of Cytoscopy?

A

Perforation of bladder of ureters
Sepsis
Hematuria
Urinary retention

61
Q

What is an endoscopic retrograde cholangiopancreatography?

A

Endoscopic test which is usually performed in 1 hour

Performed by physician trained in endoscopy

X-ray images interpreted by radiologist

Combines endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems

62
Q

What are the diagnostic indications for ERCP?

A

Evaluation of jaundiced patient via tissue and brushing of common bile duct

Evaluation of patients with unexplained upper abdominal pain/pancreatitis

Manometric studies of sphincter of Oddi/pancreatobiliar ducts which are used to investigate unusual functional abnormalities of these structures

63
Q

What are the therapeutic indications of ERCP?

A

Incision of papillary muscle in ampulla of Vater can be performed through scope so common bile duct gallstones can be removed

Stents can be placed through strictured bile ducts allows bile of jaundiced patients to be normally drained

64
Q

What is the pre-procedure for ECRP?

A

NPO night before

Tell patient no discomfort associated with dye injection but gagging may occur during initial introduction of scope into oral pharynx

Administer appropriate premedication if ordered

65
Q

What are the two medications possibly administered to patient before ECRP?

A

Versed and atropine

66
Q

What is the ECRP procedure?

A

1) KUB x-ray taken to ensure barium from previous studies will not obscure visualization of bile duct
2) Patient is placed in supine position or on left side
3) Patient usually sedated with narcotic and sedative/hypnotic
4) Phyarynx sprayed with lido to inactivate gag reflex andt to lesssion discomfort caused by passage of scope
5) Side viewing fiberoptic duodenoscope insertedt through oropharynx and passed through esophagus and stomach and into duodenum
6) IV glucagon often administered to minimize spasm of duodenum and improve visualization of ampulla of Vater
7) Simethicone may be instilled to diminish any bubbles present that may inhibit visualization of ampulla
8) Through accessory lumen within scope, small catheter is passed through ampulla and into common bile or pancreatic ducts
9) . Radiographic dye is injected and Xray images are taken

67
Q

What are the potential complications from ERCP?

A

Perforation of stomach, esophagus, and duodenum

Gram negative sepsis which usually occurs in patients with obstructive jaundice

Pancreatitis resulting from pressure of the dye injection

Aspiration of gastric contents

Respiratory arrest as a results of oversedation

68
Q

What are the post-procedure guidelines for ERCP?

A

NPO until gag reflex returns

Observe for development of abdominal pain and N/V which may indicate onset of ERCP-induced pancreatitis

Monitor for signs of respiratory depression

Resuscitative equipment should be present

Assess the patient for signs and symptoms of septicemia which indicates the onset of ECRP induced cholangitis

69
Q

What is Esophagogastroduodenoscopy (EGD) Gastroscopy?

A

Performed in endoscopy suite by physician in 20-30 min.

Used to visualize lumen of esophagus, stomach, and duodenum

Used to evaluate patients with:
Dysphagia 
Weight loss
Early satiety
Upper abdominal pain
Ulcer symptoms of dyspepsia
Alcoholism and suspected varices
70
Q

What would require an EGD to be performed?

A

If the results of a patients barium swallow or upper GI Xray study si suggestive of a pathological condition

71
Q

What are the diagnostic indications for gastroscopy?

A

Evaluate esophagus, stomach, and duodenum

Visualize and perform biopsy of tissue in upper small intestinal tract

Abnormalities of small intestine such as AV malformations, Tumors, celiac disease, and ulceration

72
Q

What are therapeutic indications for gastroscopy?

A

If patient is bleeding

Control active GI tract bleeding by electrocoagulation, laser coagulation, or injection of sclerosis agents such as alcohol

Benign and malignant strictures can be dilated to reestablish patently of the upper GI tract

Biliary stents and percutaneous gastroscopy tube can be placed

73
Q

What is the pre-procedure for Gastroscopy?

A

NPO after midnight

Thorough oral hygiene as tube will be passed through mouth

Anesthetize throat with lido spray to depress gag reflex

Dentures and eyewear need to be removed

74
Q

What is the procedure for Gastroscopy?

A

1) Patient is placed in LEFT LATERAL DECUBITUS position
2) patient is usually sedated to minimize anxiety and allows “light” sleep
3) Endoscope is passed through mouth and into esophagus
4) Air insufflated to dissent upper GI tract for adequate visualization
5) Esophagus, stomach, and duodenum are evaluated
6) Upper small bowel is visualized and biopsy is performed if needed
7) At completion of direct inspection and surgery, excess air and GI tract secretions are aspirated through scope

75
Q

What is the post procedure for Gastroscopy?

A

Patient is NPO until tracheobronchial anesthesia has worn off and gag reflex has returned

Monitor for signs of respiratory depression

Resuscitative equipment should be present

Sedation may cause some retrograde and antegrade amnesia for a few hours

76
Q

What is a hysteroscopy?

A

Endoscopic test usually performed by Gyno in OR

Takes approx. 30 min. For a simple hysteroscopy

Provides direct visualization of uterine cavity by inserting hysteroscope through vagina and cervix and into uterus

Can be used to identify cause of abnormal uterine bleeding, infertility, and repeat miscarriages

77
Q

What are the diagnostic indications for Hysteroscopy?

A

Uterine adhesions
Polyps
Fibroids

Detect displaced intrauterine devices (IUDs)

78
Q

What are the therapeutic indications of hysteroscopy?

A

Excise uterine adhesions and small fibroids

Endometrial ablation

79
Q

What is the pre-procedure for Hysteroscopy?

A

NPO for 8 hours prior

Schedule the procedure after menstrual bleeding has ceased and before ovulation because it allows for better visualization of the inside of the uterus and avoids damage to a newly formed pregnancy

Patient receiving local anesthesia or only light sedation may feel some cramping during procedure

Generally not a painful procedure

80
Q

What is the procedure for a hysteroscopy?

A

1) Performed in OR or in the doctor’s office
2) Local, regional, general, or no anesthesia may be used
3) Patient is placed in LITHOTOMY position
4) Vaginal area is cleansed with antiseptic solution
5) Cervix may be dilated before this procedure
6) . Hysteroscope inserted through vagina and cervix an into uterus and liquid or gas released to expand uterus for better visualization

81
Q

What is the post-procedure for Hysteroscopy?

A

Slight vaginal bleeding and cramps for a day or two after procedure are normal

Reports signs of:
Fever
Severe abdominal pain
Heavy vaginal discharge/bleeding
Discomfort from gas inserted during hysteroscopy or laparoscopy usually < 24 hours
82
Q

What is a laparoscopy?

A

Used to directly visualize abdominal and pelvic organs when pathological condition is suspected

Performed by surgeon

Patient is under general anesthesia

High difficulty

Multiple, small incisions

High expense in OR

Low expense of Post-op care

High post-op mobility

Minimal-moderate post-op pain

1-2 days of post-op hospitalization

Days for pos-op recovery

1 week until patient can return to work

83
Q

What are the diagnostic indications for laparoscopy?

A

Acute/chronic abdominal or pelvic pain

Suspected advanced cancer

Abdominal mass of uncertain cause

Endometriosis

Ectopic pregnancy

Ruptured ovarian cyst

Salpingitis

84
Q

What are the therapeutic indications for Laparoscopy?

A

Cholecystectomy
Hiatal hernia repair
Inguinal hernia repair
Video-assisted colectomy

85
Q

What is the pre-procedure for laparoscopy?

A

NPO after midnight

Open laparotomy may be required so be sure the patient is aware of that

Shave abdomen prior to incision

86
Q

What are the contraindications for a laparoscopy?

A

Patients who have had multiple abdominal surgical procedures because of adhesions

Patients with suspected intraabdominal hemorrhage because visualization through scope can be obscured by blood

87
Q

What is the laparoscopy procedure?

A

1) Patient is initially placed in supine position
2) After abdominal skin cleansed, blunt tipped needle inserted through small incision in periumbilical area and into peritoneal cavity or a slightly larger incision is placed in skin and abdominal wall is separated under direct vision
3) Peritoneal cavity is entered, adhesions can be listed under direct vision
4) Peritoneal cavity is filled with 2-3L of CO2 to separate abdominal wall from intraabdominal viscera
5) Laparoscope inserted through trochanter to examine abdomen
6) Other Trojans can be placed as conduits for other instrumentation
7) After procedure is complete, laparoscope is removed and CO2 is allowed to escape
8) Incision(s) closed with skin stitches and covered with dressing

88
Q

What is the post procedure for laparoscopy?

A

Assess for signs of bleeding:
Tachycardia
Hypotension

And perforated viscus:
Abdominal tenderness/guarding
Decreased bowel sounds

Patient may complain of shoulder or subcostal discomfort from diaphragmatic irritation caused by pneumoperitoneum

89
Q

What is an open laparotomy?

A

Moderately difficult

One large incision

Moderate expense of equipment of OR

High expense of Post-op care

Low Post-op mobility

High post-op pain

4-10 days of post-op hospitalization

Week for recovery

6 weeks until patient can return to work

90
Q

What is an upper GI endoscopy?

A

Test used to visualize lumen of Esophagus, stomach, and duodenum

91
Q

What are the diagnostic Indications for an upper GI endoscopy?

A 
Evaluates patients with:
Dysphagia
Weight loss
Early satiety 
Upper abdominal pain
Dyspepsia
Suspected varices
Abnormal results of barium swallow or upper GI Xray
92
Q

What are the contraindications for an upper GI endoscopy?

A

Severe upper GI tract bleeding

Esophageal Diverticula because the scope can fall into the diverticulum and perforate esophageal wall

Suspected perforation because it can be worsened by the insufflation of pressurized air

Recent upper GI tract surgery because anastomoses may not be able to withstand pressure of air insufflation

93
Q

What is the procedure for an upper GI endoscopy?

A

1) Patient is placed on endoscopy table in left lateral decubitus position
2) Throat topically anesthetized with lido
3) Endoscope is “gently” passed through mouth and into esophagus
4) Air is insufflated to distend upper GI tract
5) Esophagus, stomach, and duodenum are evaluated
6) Upper small bowel visualized and biopsy is performed as needed
7) At the completion of the direct inspection and surgery, the excess air and GI tract secretions are aspirated through the scope

94
Q

What occurs after an upper GI endoscopy?

A

NPO until tracheobronchial anesthesia has worn off and the gag reflex has returned

Monitor for signs of respiratory depression

Resuscitative equipment should be present

Patient may complain of shoulder or subcostal discomfort from diaphragmatic irritation caused by pneumoperitoneum

Sedation may cause some retrograde and antegrade amnesia for few hours

Diagnostic Methods (27 decks)

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