Endoscopy Flashcards
Name the two types of endoscope and how they can be used
Rigid-arthroscopy
flexible- GI narrow diameter four way tip deflection
What is the role of endoscopy therapeutic and diagnostic
Observation FNA Fluid sampling Biopsy Brush cytology Feeding tube FB removal Stricture dilation
Contra indications of endoscopy
Cardiac arrhythmia unable to be anaesthetised Hypoxaemia Uncorrected bleeding disorder Shock Bowel perforation Hypoproteinaemia Inadequate previous investigations Inadequate preparation
Limitations of the endoscope
Intra peritoneal lesions Sub-mucosal lesions cannot observe the entire GI tract Enzyme deficiencies Assessment of morphological not functional disorders
Complications endoscopy
Acute bradycardia-Vagal nerve stimulated on entered into the small intestine (correct atropine)
Decreased venous return( over distension of the stomach, compression vena cava, drop venous return and blood pressure, decreased tidal volume, drop in blood pressure, increased antro-pyloric contractility)
Bacteraemia- Transient bacteraemia, use intra-op antibiotics for patients at risk, GI bleed, valvular heart disease
Haemorrhage- usually associated with malignency
GI perforation- forceful insertion, poor biopsy technique, insuffination enough to rupture ulcerated area
Transmission of infection
Laceration of major vessels or
adjacent organs
o FB removal (fish hook)
o stricture dilatation
List the major components of the endoscope system
Light source (xenon) Suction/insufflation: water reservoir Flexible endoscope
Discuss the advantages and disadvantages of the two types of endoscope
Fibre optic
Portable, Cheap , Wide range of sizes
But
Fragile, loose image when broken, difficult to rotate, lower diameter lower resolution, required CCD(charged couple device) camera
Video
High quality image, flexible, video capability, image visible to assistant, better resolution
But
Expensive, not portable, very small diameter not available
Ideal endoscope characteristics
Tip, large enough diameter for good accessory channel
Length- 1 meter humans 1.5 giant breeds difficult to control
Viewing angle- panoramic examination 90-120 degrees
Steering- 180 degrees, four way tip deflection
Biopsy forceps-oval cups, fenestrations, swing jaws
Patient preparation for GI endoscopy (barium) and colon Dog
Full physical exam, lab tests, faecal exam out rule systemic disease
Gastric scope-withhold food for 12 hrs, if not danger aspiration vomiting, clogging scope, poor visualisation. If had barium delay for 24 hours and dilute it
Colon scope-withhold food 36 hours. Lavage-isosmotic solutions, kleanprep, 2-4 doses 25/30ml/kg at least two hours apart, last dose 12 hours before scope. Enema-one Litre of warm water. Lube tube insert to level of the last rib, move tube backwards and forwards as water is added. Repeated until liquid runs clear
Prep for endoscope cat
PEG / electrolyte solution
• 20 ml/kg by N/G tube infusion over four hours
• 20 ml/kg warm water enema through urinary catheter
Ga endoscope patient positioning and monitoring
Be aware risk aspiration keep ET tube inflated.
Reduced venous return blood pressure and tidal volume (over extension stomach)
Always insert a mouth gag
Do not use nitrous
Left lateral recumbency
ECG Iv access blood pressure
What are the advanced uses for endoscopy?
Advanced • enteroscopy • fluorescence • ultrasound • ERCP • GFST • confocal polypectomy • electro and laser surgery • plication
What are the advantages of using endoscopy?
it is ‘minimally invasive’
• morbidity and mortality is low
• there is no convalescence
What considerations must be made for endoscopy?
there is a small but significant risk
• it is not always the best approach
Which patients are unfit for endoscopy use?
Absolute • unfit for anaesthesia o uncorrected bleeding disorder o non-reversible hypoxaemia o unstable cardiac arrhythmias o cardiac failure • bowel perforation • poor cardiopulmonary reserve • uraemia • hypoproteinaemia o still relative anaesthetic risk o full-thickness biopsies may be needed ? • inadequate investigation • inadequate preparation
