Endoscopic Studies Flashcards
What is endoscopy?
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
What does endoscopy allow for?
Direct observation Biopsy of Suspicious tissue Removal of polyps Injection of variceal blood vessels Performance of Surgical Procedures
What is an endoscope?
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
What is the purpose of using an endoscope?
Visualization of organ/joint
Obtain biopsy specimens with forceps or brushes
Coagulate blood vessels
Provide laser beams to coagulate vessels or remove tissue
What are the two basic types of endoscopes?
Rigid
Flexible
What is a rigid endoscope?
First type available
Still used in operative endoscopy for arthroscopy
What is a flexible endoscope?
Most often used in pulmonary and GI endoscopy
Allow transmission of images over flexible, light carrying bundles of glass wire
What does endoscopy eliminate the need for?
Open surgery
How is an endoscopy performed?
Via video camera over viewing lens
Image is transmitted to nearby TV monitor where body cavities or organs are viewed
What must be done pre-operatively for an endoscopy?
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
What type of endoscopy is considered clean but not sterile?
Genitourinary endoscopy
What is used in laparoscopy to distend the abdominal cavity?
CO2
What are complications of CO2 being used in laproscopic procedure?
Significant gas pains or referred shoulder pain
What is used in cystoscopy to distend the bladder which allows visualization of the bladder mucosa?
Water
What is done post-op?
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
What are complications of endoscopy?
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
What is Arthroscopy?
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
What are normal findings of arthroscopy?
Normal ligaments
Menisci
Articular surfaces of joint
What are indications for an arthroscopy?
Pain in Knee or shoulder
Locking
Swelling
Instability
What procedures can be performed using arthroscopy?
Meniscectomy
ACL/PCL repair
Biopsy
Irrigation and Drainage
What is the advantage to arthroscopic procedures?
Recovery is faster and more comfortable
What are contraindications for arthroscopy?
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
What are potential complications of arthroscopy?
Infection Hemarthrosis Swelling Thrombophlebitis Joint Injury
What is a colonoscopy?
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
What side if a patient placed on for colonoscopy?
Left side
What are normal findings of a colonoscopy?
Normal Rectum
Colon
Distal Small bowel
What are indications for a colonoscopy?
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
What does a colonoscopy test for?
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
What are the contraindications for colonoscopy?
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
What is a bronchoscopy?
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
What are the diagnostic indications for a bronchoscopy?
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
What are the therapeutic indications for a bronchoscopy?
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
What is a rigid bronchoscope?
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
What is a Flexible fiberoptic bronchoscope?
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
What is the pre-procedure for a bronchoscopy and laryngoscopy
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
What are the pre-procedure meds given to the patient undergoing a bronchoscopy or laryngoscopy?
Atropine = counteracts Vaal stimulation
Benzodiazepines = for anxiety
Anticholinergics = reduce secretions
What are the contraindications for a bronchoscopy?
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
What is the procedure for a bronchoscopy?
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
What will occur after the bronchoscopy or laryngoscopy is performed?
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
What is a laryngoscopy?
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
What are the diagnostic indications for a laryngoscopy?
Identifies:
Cancers Polyps Inflammation Infections of structures Vocal cord motion can be evaluated
What are the therapeutic indications for a laryngoscopy?
Assist with endotracheal intubation
Anesthesiologists use this to visualize vocal cords to incubate for general anesthesia
What is the procedure for a laryngoscopy?
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
What is a colposcopy?
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
What is the colposcope?
Macroscope with light source and a magnifying lens
What are the diagnostic indications for a colposcopy?
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
What are the therapeutic indications for Colposcopy?
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
What is eliminated with experienced colposcopist performing a colposcopy?
The need for 90% of cone biopsies
When would a patient still need to have a cone biopsy performed even after having a colposcopy?
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
What is the contraindication for a colposcopy?
patients with heavy menstrual flow
How is the colposcopy performed?
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
What is the post-procedure for a colposcopy?
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
What is a cystoscopy?
Endoscopic procedure that visualized bladder
Diagnostic cystoscope can be done in urologists office in about 10 min.
Flexible scope is used
What are the diagnostic indications for a cystoscopy?
Evaluate patients with suspected pathological conditioned involving the urethra, bladder, and lower ureters
What are the therapeutic indication for a cystoscopy?
Biopsy
Transurethral resection of prostate (TURP)
Transurethral resection of superficial bladder tumors
Removal of ureteral and bladder calculi
Retrograde cystoscopy
Ureteral stent placement
What is performed prior to a cystoscopy?
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
How is the cystoscopy performed?
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
What occurs after a cytoscopy?
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
Why and when would antibiotics be prescribed for a cytoscopy?
Occasionally ordered 1 day prior to and 3 days after cytoscopy in order to reduce incidence of bacteremia
What are potential complications of Cytoscopy?
Perforation of bladder of ureters
Sepsis
Hematuria
Urinary retention
What is an endoscopic retrograde cholangiopancreatography?
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
What are the diagnostic indications for ERCP?
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
What are the therapeutic indications of ERCP?
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
What is the pre-procedure for ECRP?
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
What are the two medications possibly administered to patient before ECRP?
Versed and atropine
What is the ECRP procedure?
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
What are the potential complications from ERCP?
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
What are the post-procedure guidelines for ERCP?
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
What is Esophagogastroduodenoscopy (EGD) Gastroscopy?
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
What would require an EGD to be performed?
If the results of a patients barium swallow or upper GI Xray study si suggestive of a pathological condition
What are the diagnostic indications for gastroscopy?
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
What are therapeutic indications for gastroscopy?
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
What is the pre-procedure for Gastroscopy?
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
What is the procedure for Gastroscopy?
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
What is the post procedure for Gastroscopy?
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
What is a hysteroscopy?
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
What are the diagnostic indications for Hysteroscopy?
Uterine adhesions
Polyps
Fibroids
Detect displaced intrauterine devices (IUDs)
What are the therapeutic indications of hysteroscopy?
Excise uterine adhesions and small fibroids
Endometrial ablation
What is the pre-procedure for Hysteroscopy?
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
What is the procedure for a hysteroscopy?
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
What is the post-procedure for Hysteroscopy?
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
What is a laparoscopy?
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
What are the diagnostic indications for laparoscopy?
Acute/chronic abdominal or pelvic pain
Suspected advanced cancer
Abdominal mass of uncertain cause
Endometriosis
Ectopic pregnancy
Ruptured ovarian cyst
Salpingitis
What are the therapeutic indications for Laparoscopy?
Cholecystectomy
Hiatal hernia repair
Inguinal hernia repair
Video-assisted colectomy
What is the pre-procedure for laparoscopy?
NPO after midnight
Open laparotomy may be required so be sure the patient is aware of that
Shave abdomen prior to incision
What are the contraindications for a laparoscopy?
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
What is the laparoscopy procedure?
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
What is the post procedure for laparoscopy?
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
What is an open laparotomy?
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
What is an upper GI endoscopy?
Test used to visualize lumen of Esophagus, stomach, and duodenum
What are the diagnostic Indications for an upper GI endoscopy?
Evaluates patients with: Dysphagia Weight loss Early satiety Upper abdominal pain Dyspepsia Suspected varices Abnormal results of barium swallow or upper GI Xray
What are the contraindications for an upper GI endoscopy?
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
What is the procedure for an upper GI endoscopy?
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
What occurs after an upper GI endoscopy?
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
