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Diagnostic methods > Endoscopy > Flashcards

Endoscopy Flashcards

1
Q

What are the 4 purposes of endoscopes (have light source)

A
  • visualize organ/joint
  • obtain biopsy specimen (with forceps or brushes)
  • coagulate blood vessels
  • remove tissue
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2
Q

Rigid vs. Flexible Endoscopes

A

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

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3
Q

Patients of Endoscopic procedures should always be prepped for?

A

open procedure in-case complications arise

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4
Q

Genitourinary endoscopy is considered not?

A

sterile

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5
Q

Prophylactic IV antibiotics should be given pre-operatively to endoscopic procedures in what type of patients?

A

-Cardiac valvular disease (endocarditis)
-prosthetic joint (seeding of joint)
→ aka replacing whole joint

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6
Q

During laparoscopy, CO2 is instilled into?

This can result in?

A
  1. ) peritoneal cavity

2. ) can cause significant gas pains

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7
Q

During cystoscopy/arthroscopy saline is used to ? Why?

What happens to the saline

A
  • 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
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8
Q

Patient coming out of pulmonary endoscopy or upper GI tract endoscopy must follow what POST OP procedure?

A

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

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9
Q

What complications can arise in endoscopic procedures/ what are the symptoms of each complication (5 complications)?

A

-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)

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10
Q

What are the indications to do arthroscopy?

A
  • pain (knee/shoulder common)
  • locking
  • swelling
  • instability
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11
Q
  1. ) How long does the arthroscopy procedure usually take?

2. ) Will pt be in pain after

A

1.) 30 mins -2 hours

  1. )
    - 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
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12
Q

Arthroscopy is done through?

A

small trocars placed into joint

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13
Q

C/I’s for arthroscopy?

A
  • pts with ankylosis (stiff joints due to bone fusion)
  • skin infections
  • recent arthrogram (residual inflammation from injection of constrat dye)
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14
Q

Colonoscopy:

  1. ) how long does procedure take?
  2. ) allows for view of what organs in the body?
A
  1. ) 30-60 mins

2. ) rectum → colon → small bowel

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15
Q

Indications for colonoscopy (4 things)?

A

pts who have:

  • change in bowel habits
  • blood in stool
  • abdominal pain
  • look for colorectal cancer, IBD, polyposis
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16
Q

C/I’s for colonoscopy (6 things)

A

• 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

17
Q

Laryngoscopy and Bronchoscopy:

  1. ) procedure preformed by?
  2. ) instrument used?
  3. ) which procedure goes past vocal cords and which one doesn’t?
A
  1. ) ENT
  2. ) short bronchoscope
  3. ) bronchoscopy (goes past vocal cords)
18
Q

Laryngoscopy Indications

A 
-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

19
Q

Laryngoscopy Pre-Procedure (5 steps)

A
  1. ) NPO 4-8 hrs prior
  2. ) thorough mouth care (brushing teeth)
  3. ) take out dentures
  4. )
    - adminster atropine to counteract vagal stimulation
    - benzos for anxiety
    - antimuscarinics meds to reduce secretions
  5. ) tell pt not to swallow lido spray
20
Q

Bronchoscopy allows for visualization of?

Where is the test usually preformed?

A
  1. ) larynx, trachea, and bronchi

2. ) usually preformed bedside or in endoscopy room

21
Q

Bronchoscopy
Indications
Diagnostic vs. therapeutic

A

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

22
Q

rigid vs flexible bronchoscope

A

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
23
Q

Bronchoscopy C/I’s (3 things)

A

pts with:

  • hypercapnia
  • severe SOB (can be preformed through oxygen mask)
  • severe tracheal stenosis (difficult to pass the scope)
24
Q

Bronchoscopy Post-Procedure Steps (4 things)

A

• 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

25
Q
  1. ) Post-bronchoscopy fever often develops within? Is this normal?
  2. ) When would a chest x-ray film be ordered post Laryngoscopy/Bronchoscopy procedure?
A

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

26
Q

Purpose of laparoscopy?

A

Used to directly visualize abdominal and pelvic organs when pathologic condition is suspected

27
Q

Laparoscopy Indications

Diagnostic vs. therapeutic

A 
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
28
Q

Laparoscopy Pre-Procedure steps

A

• NPO after midnight b/c
open laparotomy may be required
→ Confirm patient is aware that open procedure could occur

• Shave abdomen prior to incision

29
Q

Laparoscopy C/I’s

A

• Patients who have had multiple abdominal surgical procedures
→ adhesions
• Patients with suspected intraabdominal hemorrhage
→ visualization through scope obscured by blood

30
Q

Laparoscopy Procedure

A

• 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

31
Q

Laparoscopy Post-Procedure

A

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
32
Q

Endoscopic Retrograde Cholangiopancreatography

  1. ) what is it?how long does it take?
  2. ) This test is used to evaluate what type of patients?
A
  • Endoscopic test which usually takes approximately 1 hour

* Used to eval patients with unexplained upper abdominal pain or suspected pancreatitis

33
Q

Indications of ERCP indications

Diagnostic vs. Therapeutic

A

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

Diagnostic methods (11 decks)

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