Endoscopy Flashcards
What are the 4 purposes of endoscopes (have light source)
- visualize organ/joint
- obtain biopsy specimen (with forceps or brushes)
- coagulate blood vessels
- remove tissue
Rigid vs. Flexible Endoscopes
rigid: 1st type available
→ still used in arthroscopy
flexible: most often used in pulmonary and GI endoscopy
→ allow transmission of images over flexible, light carrying bundles of glass wire
→ have accessory lumens for insertion of water or medication or suctioning of debris
Patients of Endoscopic procedures should always be prepped for?
open procedure in-case complications arise
Genitourinary endoscopy is considered not?
sterile
Prophylactic IV antibiotics should be given pre-operatively to endoscopic procedures in what type of patients?
-Cardiac valvular disease (endocarditis)
-prosthetic joint (seeding of joint)
→ aka replacing whole joint
During laparoscopy, CO2 is instilled into?
This can result in?
- ) peritoneal cavity
2. ) can cause significant gas pains
During cystoscopy/arthroscopy saline is used to ? Why?
What happens to the saline
- saline is used to distend bladder/joint capsule to allow for better visitation of the bladder mucosa/joint
- Amount of saline is recorded that went in… want the same if not close that same number coming out
Patient coming out of pulmonary endoscopy or upper GI tract endoscopy must follow what POST OP procedure?
usually pt is NPO status 2 hrs afterward so pt needs to stay until they can swallow/pass gas and their gag reflex works to make sure everything is working properly
What complications can arise in endoscopic procedures/ what are the symptoms of each complication (5 complications)?
-organ/cavity perforation
→ abdominal distention, tenderness, pain
-Bleeding from biopsy site
→ increase in respirations
→ increase in HR
→ paleness
-Respiratory depression
→ treat with naloxone (for opiates)
→ treat with flumazenil (for Benzo’s)
-infections and transient bacteremia
→ fever in children
→ confusion in elderly
-cardiovascular problems
→ bradycardia (treat with atropine)
What are the indications to do arthroscopy?
- pain (knee/shoulder common)
- locking
- swelling
- instability
- ) How long does the arthroscopy procedure usually take?
2. ) Will pt be in pain after
1.) 30 mins -2 hours
- )
- Patients receiving local anesthesia have transient discomfort from injection of local anesthetic and tourniquet pressure
- Joint may be painful and slightly swollen for several days or weeks, depending on surgery performed
Arthroscopy is done through?
small trocars placed into joint
C/I’s for arthroscopy?
- pts with ankylosis (stiff joints due to bone fusion)
- skin infections
- recent arthrogram (residual inflammation from injection of constrat dye)
Colonoscopy:
- ) how long does procedure take?
- ) allows for view of what organs in the body?
- ) 30-60 mins
2. ) rectum → colon → small bowel
Indications for colonoscopy (4 things)?
pts who have:
- change in bowel habits
- blood in stool
- abdominal pain
- look for colorectal cancer, IBD, polyposis
C/I’s for colonoscopy (6 things)
• Uncooperativepatients
• Unstable patients
→ test requires sedation, which may induce hypotension
• Patients bleeding profusely from rectum
→ lens will become covered with blood clots, preventing visualization
• Patients with suspected colon perforation
• Patients with toxic megacolon
• Patients with recent colon anastomosis
→ within past 14 to 21 days
Laryngoscopy and Bronchoscopy:
- ) procedure preformed by?
- ) instrument used?
- ) which procedure goes past vocal cords and which one doesn’t?
- ) ENT
- ) short bronchoscope
- ) bronchoscopy (goes past vocal cords)
Laryngoscopy Indications
-Diagnostic • Identify: • cancers • polyps • inflammation • infections of those structures • vocal cord motion can be evaluated also
-Therapeutic
• Assist with Endotracheal intubation
• Anesthesiologists use laryngoscopy to visualize vocal cords to intubate for general anesthesia
Laryngoscopy Pre-Procedure (5 steps)
- ) NPO 4-8 hrs prior
- ) thorough mouth care (brushing teeth)
- ) take out dentures
- )
- adminster atropine to counteract vagal stimulation
- benzos for anxiety
- antimuscarinics meds to reduce secretions - ) tell pt not to swallow lido spray
Bronchoscopy allows for visualization of?
Where is the test usually preformed?
- ) larynx, trachea, and bronchi
2. ) usually preformed bedside or in endoscopy room
Bronchoscopy
Indications
Diagnostic vs. therapeutic
Diagnostic:
• Direct visualization of tracheobronchial tree
- Biopsy of tissue from observed lesions
- Aspiration of “deep” sputum for culture and sensitivity and for cytologic determinations
- Direct visualization of larynx for identification of vocal cord paralysis
Therapeutic
• Suction retained secretions in patients with airway obstruction or postoperative atelectasis
• Control bleeding within bronchus
• Removal of aspirated foreign bodies
• Brachytherapy (endobronchial radiation therapy) using an iridium wire placed via bronchoscope
• Palliative laser obliteration of bronchial neoplastic obstruction
rigid vs flexible bronchoscope
Rigid: permits visualization of larger airway only
→ used mainly for removal of large foreign bodies
Flexible:
• 4 channels
• two provide light source
• one vision channel
• one open channel:
• instruments
• admin of anesthetic/ oxygen
Bronchoscopy C/I’s (3 things)
pts with:
- hypercapnia
- severe SOB (can be preformed through oxygen mask)
- severe tracheal stenosis (difficult to pass the scope)
Bronchoscopy Post-Procedure Steps (4 things)
• Pt. NPO until gag reflex has returned
• Observe sputum for hemorrhage if biopsy specimens taken
→ small amount of blood streaking expected and normal for several
hours
→ large amounts of bleeding can cause chemical pneumonitis
• Observe for evidence of impaired respiration or laryngospasm
→ vocal cords may go into spasm after intubation
• Emergency resuscitation equipment should be readily available
- ) Post-bronchoscopy fever often develops within? Is this normal?
- ) When would a chest x-ray film be ordered post Laryngoscopy/Bronchoscopy procedure?
1.) Post-bronchoscopy fever often develops within 24 hours
• low-grade fever normal
2.) Chest x-ray film ordered to eval for pneumothorax if a deep biopsy was obtained
Purpose of laparoscopy?
Used to directly visualize abdominal and pelvic organs when pathologic condition is suspected
Laparoscopy Indications
Diagnostic vs. therapeutic
Diagnostic • Acute/chronic abdominal or pelvic pain • Suspected advanced cancer • Abdominal mass of uncertain cause • Endometriosis • Ectopic pregnancy • Ruptured ovarian cyst • Salpingitis
Therapeutic • Cholecystectomy • Hiatal hernia repair • Inguinal hernia repair • Video-assisted colectomy
Laparoscopy Pre-Procedure steps
• NPO after midnight b/c
open laparotomy may be required
→ Confirm patient is aware that open procedure could occur
• Shave abdomen prior to incision
Laparoscopy C/I’s
• Patients who have had multiple abdominal surgical procedures
→ adhesions
• Patients with suspected intraabdominal hemorrhage
→ visualization through scope obscured by blood
Laparoscopy Procedure
• Patient is initially placed in supine position
• After abdominal skin cleansed, blunt-tipped needle inserted through small incision in
periumbilical area and into peritoneal cavity
• Or slightly larger incision is placed in skin and abdominal wall is separated under direct vision
• Peritoneal cavity is entered, adhesions can be lysed under direct vision
• Peritoneal cavity filled with 2-3 L of CO2 to separate abdominal wall from
intraabdominal viscera
• Laparoscope inserted through trocar to examine abdomen
• Other trocars can be placed as conduits for other instrumentation
• After procedure complete, laparoscope is removed and CO2 is allowed to escape
• Incision(s) closed with skin stitches and covered with dressing
Laparoscopy Post-Procedure
asses for:
-signs of bleeding
(tachycardia and hypotension)
- perforated organ
(abdominal tenderness and ↓ bowel sounds) - Patient may complain of shoulder or subcostal discomfort from diaphragmatic irritation caused by pneumoperitoneum
Endoscopic Retrograde Cholangiopancreatography
- ) what is it?how long does it take?
- ) This test is used to evaluate what type of patients?
- Endoscopic test which usually takes approximately 1 hour
* Used to eval patients with unexplained upper abdominal pain or suspected pancreatitis
Indications of ERCP indications
Diagnostic vs. Therapeutic
Diagnostic
• eval of jaundiced patient
• tissue and brushings of common bile duct can be obtained for pathologic review
• Manometric studies of sphincter of Oddi/pancreatobiliary ducts can be performed
→ used to investigate unusual functional abnormalities of these structures
Therapeutic
• 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 allowing bile of jaundiced patients to be internally drained
