Endoscopic Studies Flashcards

Question

What side if a patient placed on for colonoscopy?

Answer 1

Normal Rectum Colon Distal Small bowel

Answer 2

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

Answer 3

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

Answer 4

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

Answer 5

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

Answer 6

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

Answer 7

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

Answer 8

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

Answer 9

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

Answer 10

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

Answer 11

Atropine = counteracts Vaal stimulation Benzodiazepines = for anxiety Anticholinergics = reduce secretions

Answer 12

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

Answer 13

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

Answer 14

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

Answer 15

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

Answer 16

Identifies: ``` Cancers Polyps Inflammation Infections of structures Vocal cord motion can be evaluated ```

Answer 17

Assist with endotracheal intubation Anesthesiologists use this to visualize vocal cords to incubate for general anesthesia

Answer 18

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

Answer 19

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

Answer 20

Macroscope with light source and a magnifying lens

Answer 21

``` 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

Answer 22

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

Answer 23

The need for 90% of cone biopsies

Answer 24

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

Answer 25

patients with heavy menstrual flow

Answer 26

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

Answer 27

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

Answer 28

Endoscopic procedure that visualized bladder Diagnostic cystoscope can be done in urologists office in about 10 min. Flexible scope is used

Answer 29

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

Answer 30

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

Answer 31

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

Answer 32

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

Answer 33

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

Answer 34

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

Answer 35

Perforation of bladder of ureters Sepsis Hematuria Urinary retention

Answer 36

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

Answer 37

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

Answer 38

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

Answer 39

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

Answer 40

Versed and atropine

Answer 41

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

Answer 42

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

Answer 43

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

Answer 44

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 ```

Answer 45

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

Answer 46

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

Answer 47

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

Answer 48

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

Answer 49

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

Answer 50

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

Answer 51

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

Answer 52

Uterine adhesions Polyps Fibroids Detect displaced intrauterine devices (IUDs)

Answer 53

Excise uterine adhesions and small fibroids Endometrial ablation

Answer 54

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

Answer 55

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

Answer 56

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 ```

Answer 57

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

Answer 58

Acute/chronic abdominal or pelvic pain Suspected advanced cancer Abdominal mass of uncertain cause Endometriosis Ectopic pregnancy Ruptured ovarian cyst Salpingitis

Answer 59

Cholecystectomy Hiatal hernia repair Inguinal hernia repair Video-assisted colectomy

Answer 60

NPO after midnight Open laparotomy may be required so be sure the patient is aware of that Shave abdomen prior to incision

Answer 61

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

Answer 62

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

Answer 63

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

Answer 64

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

Answer 65

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

Answer 66

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

Answer 67

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

Answer 68

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

Answer 69

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