Endoscopy

Question 1

What are the 6 specialised types of endoscope?

Answer 1

Gastroscope, colonoscope, side viewing (ERCP) scope, enteroscope (bit inbetween small bowel), capsule, endoscopic ultrasound.

Question 2

How can video be viewed from a capsule?

Answer 2

Electrodes are stuck onto chest which allows beaming of video so it can be viewed.

Question 3

What does an EUS (ultrasound) scope allow?

Answer 3

Sampling of organs.

Question 4

What conditions can endoscopy give a visual diagnosis of?

Answer 4

Oesophagitis, gastritis, ulceration, coeliac disease, Crohn’s disease, ulcerative colitis, sclerosing cholangitis.

Question 5

What are the 3 types of vascular abnormalities that an endocope can see?

Answer 5

Varices (enlarged veins), ectatic blood vessels (vessels grow on mucosal surface), angiodysplasia (small vascular abnormalities).

Question 6

What are the downsides of staining the oesophagus with indigo carmine and iodine?

Answer 6

It is messy, time consuming, patchy, and iodine is sore.

Question 7

What is narrow band imaging?

Answer 7

Where the frequencies of light that is used is changed.

Question 8

What are the 3 types of samples that endoscopes can take from the body?

Answer 8

1. Biopsy (for histology).
2. Brushings (for cyotology).
3. Aspirates and biospies (for microbiology, rarely).

Question 9

What are the 3 main treatments that can be given by an endoscope?

Answer 9

GI bleeding, nerve blocks and resection of early cancer.

Question 10

What are the 3 GI bleeds that can be fixed by endoscopy?

Answer 10

Variceal bleeding, arterial bleeding (can be done to ulcers), angiodysplagia.

Question 11

What is vomiting and defecating blood called?

Answer 11

Vomiting - haematemesis. Defecating - melaena.

Question 12

What are the 3 ways an endoscope can treat variceal bleeding?

Answer 12

Injecting fibrinogen, banding and histocryl glue.

Question 13

Describe the process of banding.

Answer 13

Band is put on end of endoscope, endoscope sucks up varix, band is flicked off endoscope, leads to sealed off varix.

Question 14

What is sclerosant?

Answer 14

An injectable irritant used to treat varices by producing thrombi in them.

Question 15

What are the 3 ways an endoscope can treat arterial bleeding?

Answer 15

Injection therapy (adrenaline), heater probe, clips (ligate).

Question 16

What are the 2 ways angiodysplasia can be treated by an endoscope?

Answer 16

Argon plasma coagulation, recent work with radio frequency ablation.

Question 17

What is the possible endoscopic treatment for strictures?

Answer 17

Stenting.

Question 18

What are the possible complications of stenting?

Answer 18

Foreign body sensation, reflux, fever, septicaemia, fistula formation, bleeding, perforation, pain, migration, tumour in/overgrowth.

Question 19

What are the 2 ways that endoscopy can be used to treat tumours?

Answer 19

Polypectomy, endoscopic mucosal removal.

Question 20

How would an endoscopic mucosal resection be done?

Answer 20

Raise lesion on a bed of adrenaline and saline, loop and convert to polyp, snare.

Question 21

How would you remove stones from the bile duct?

Answer 21

Sphincterotomy, balloon and pull out stones.

Lithotripsy (use of high energy waves to break down stones).

Question 22

What tubes can be inserted using an endoscope to provide nutrition?

Answer 22

PEG, PEJ, naso-jejunal tube.

Question 23

How would you do a PEG insertion?

Answer 23

Gastroscopy, identify insertion site, transabdominal passage of wire, pull wire out of mouth, tie PEG tube to wire and pull into position, fix in place and set up connectors.

Question 24

How you you insert a naso-jejunal tube?

Answer 24

Pass tube under direct vision, pull out endoscope, feed in nasal overtube, draw NJ tube into overtube, withdraw through nose, fix in place.

Question 25

What diseases need endoscopic surveillance to detect complications early?

Answer 25

Ulcerative colitis (extensive, long standing), colonic polyps and colorectal cancer, Barret’s oesophagus.

Question 26

Give an example of a contraindication for endoscopy.

Answer 26

Recent MI.

Question 27

What does bleeding diathesis mean and can you do an endoscopy if one is present?

Answer 27

Susceptibility to bleeding e.g. anticoagulant therapy. No.

Question 28

What kinds of things put you at risk of infection from endoscopy?

Answer 28

Prosthetic valves, shunts, immunosuppression.

Question 29

What kind of preaparations need to be done before an endoscopy/colonoscopy?

Answer 29

Explanation to patient, consent, fasting, bowel prep, monitor bleeding diathesis, infection prophylaxis.

Question 30

What are the potential complications of endoscopy?

Answer 30

Respiratory arrest, aspiration, cardiac arrest, bleeding, perforation, infection.

Question 31

What is the GMC guidance on obtaining consent to carry out an endoscopy?

Answer 31

Work in partnership with patients, respect patients view, discuss what treatment involves, share info to make decisions, allow to make decisions, respect those decisions.