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Advanced Clinical Nursing Theory > GI Endoscopy > Flashcards

GI Endoscopy Flashcards

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1
Q

what does endoscopy mean?

A

to view within

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2
Q

what does viewing images during endoscopy rely on?

A

light source within the body cavity and the resulting image transferred to an eyepiece or monitor

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3
Q

what are the 2 main types of endoscope?

A

flexible
rigid

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4
Q

what are flexible endoscopes used for?

A

bronch
GI

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5
Q

what are rigid endoscopes used for?

A

rhino
cystoscopy in female patients

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6
Q

what are the 2 main roles of endoscopy?

A

diagnostic
theraputic

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7
Q

what are the diagnostic roles of endoscopy?

A

observation
sampling

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8
Q

what are the therapeutic uses of endoscopy?

A

FB retrieval
oesophageal / colonic stricture dilation
gastrotomy tube placement

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9
Q

what sampling may be performed via endoscopy?

A

fluid (e.g. BAL)
brush cytology
FNA
biopsies

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10
Q

what are the benefits of endoscopy?

A

minimally invasive
low morbidity / mortality
no convalescence

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11
Q

what is most endoscopy morbidity and mortality related to?

A

anaesthetic rather than scope itself

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12
Q

why may no convalescence be useful in endoscopy?

A

usually final investigation of CIE which can be treated with steroids
steroids cannot be started until healing has ended

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13
Q

why may endoscopic biopsies be better for patient welfare than surgical?

A

GA risk
surgery trauma
no convalescence so steroids can be given straight away as no healing required

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14
Q

what are the limitations of endoscopy?

A

cannot visualise the whole GIT
can assess morphology but not function
mucosal evaluation only
cannot evaluate extra GI disease

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15
Q

what other type of endoscopy may be performed instead of of traditional endoscopy to view the whole GI tract?

A

capsule endoscopy

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16
Q

how does capsule endoscopy work?

A

camera within a capsule is fed to patient and images taken as it moves through the GIT

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17
Q

what is the downside of capsule endoscopy?

A

no biopsies

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18
Q

how can the mucosa be evaluated in GI disease?

A

visual
histopathalogical

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19
Q

how is GI function assessed?

A

clinical signs
bloods

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20
Q

what are the known contraindications for endoscopy?

A

know GI surgical disease
inadequate investigations to rule out extra GI disease
patient unsuitable for anaesthesia
coagulopathy
inadequate patient prep

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21
Q

how can GI surgical diseases be ruled out before endoscopy?

A

imaging and bloods

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22
Q

what are examples of known GI surgical diseases?

A

perforation
mass lesion

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23
Q

what can make a patient unsuitable for anaesthesia?

A

inadequate cardio/pulmonary function
inadequate hepatic / renal function to manage drug clearence

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24
Q

who can gastric over distension affect?

A

endoscopist
anaesthetist

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25
Q

how does gastric over distension affect the endoscopist?

A

challenging pyloric intubation
increase in antro-pyloric motility

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26
Q

how does pyloric distension make pyloric intubation harder?

A

increases acuteness of angle between cardia and pylorus

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27
Q

how does gastric over distension affect the anaesthetist?

A

caudal vena cava compression
diaphragmatic splinting

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28
Q

how does compression of the caudal vena cave affect the patient?

A

reduction in venous return so reduced cardiac output and so reduced blood pressure

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29
Q

how does gastric over distension cause diaphragmatic splinting?

A

stomach prevents diaphragm from working fully and reduces compliance

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30
Q

what can diaphragmatic splinting lead to?

A

reduced tidal volume

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31
Q

what are the main complications seen in GI endoscopy?

A

gastric overdistension
acute bradycardia and AV block
aspiration
bacteraemia
GI perforation
haemorrhage

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32
Q

how can GI endoscopy cause acute bradycardia / AV block?

A

GI tract linked closely to vagus nerve
endoscopy may trigger vagal reflex leading to bradycardia and AV block

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33
Q

how vagally mediated bradycardia be treated?

A

atropine
glycopyrrolate

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34
Q

how can aspiration be prevented during endoscopy?

A

adequate cuff
aspirate pharynx and oesophagus as procedure ends to ensure patient is dry

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35
Q

when may bacteraemia occur?

A

transiently during colonoscopy

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36
Q

how can bacteraemia risk be managed?

A

prophylactic antibiotics if at risk

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37
Q

what patients may be at risk from bacteraemia during endoscopy?

A

those with a pacemaker

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38
Q

when does GI perforation usually occur during endoscopy?

A

pre-exisiting ulcer/severe pathology

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39
Q

what may suggest gastric rupture due to endoscopy?

A

abdominal swelling as gas from stomach enters abdominal cavity

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40
Q

what may haemorrhage arise from during endoscopy?

A

mucosa
laceration of major vessels

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41
Q

is mucosal haemorrhage following biopsy common?

A

no - unless coagulopathy

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42
Q

what procedures may cause haemorrhage due to laceration of major vessels during endoscopy?

A

FB removal (pressure necrosis or laceration from sharp FB)
stricture dilation

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43
Q

what are the main elements of the endoscopy system?

A

light source
air/water insufflator
suction pump
endoscope with insertion tube
forceps

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44
Q

what is the role of air/water insufflation within endoscopy?

A

inflation
aids viewing

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45
Q

what is the role of suction within endoscopy?

A

removal of air and fluid
sampling
increasing view

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46
Q

what light source is needed for endoscopy?

A

cold light

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47
Q

what light source is commonly used in endoscopy now?

A

xenon arc

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48
Q

what are the benefits of xenon arc lights for endoscopy?

A

bright
last up to 1000 hours
no colour alteration

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49
Q

what are other light options for endoscopy?

A

tungsten halogen (historically)
metal halide
LED

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50
Q

what is housed within the light source?

A

air pump for insufflation
separate suction pump for deflation
water reservoir for washing lens

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51
Q

what connects the endoscope to the power source?

A

light guide connector

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52
Q

what is the role of the endoscope insertion tube?

A

within patient

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53
Q

what are the controls found on the control body of the endoscope?

A

suction/flush
direction controls

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54
Q

how is light transmitted fibreoptically?

A

non-coherent via glass fibre optics

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55
Q

what is non-coherent light transmission?

A

light is bounced down the tube

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56
Q

how is the image transmitted during endoscopy?

A

fibre optics
video

57
Q

how does fibre optic image transmission work?

A

individual glass fibre is coated in lower optical density glass cladding
image is viewed through total internal reflection via individual fibre bundles

58
Q

what is the benefit of fibre optic bundles for image transmission?

A

image is viewable as is coherent

59
Q

what can happen if individual fibreoptic bundles are not kept together?

A

image becomes scrambled and cannot be interpreted

60
Q

how is image transmitted with video endoscopy?

A

not via fibre optics
via a wire from a video chip behind the lens

61
Q

what is the name of the video chip found in video endoscopy?

A

CCD

62
Q

what are the advantages of fibreoptic endoscopy?

A

portable
wide range of sizes
moderate cost

63
Q

what are the disadvantages of fibre-optic endoscopes?

A

faceted ‘honeycomb’ image due to fibreoptic bundles
fragile
size of endoscope dictates image quality

64
Q

what methods can images from fibreoptic scopes be viewed via?

A

eye piece
video via a camera adapter on eyepiece (think arthroscope)

65
Q

is the usage of video and fibreoptic endoscopy the same?

A

mechanically identical

66
Q

what type of illumination is used in video-endoscopy?

A

non-coherent

67
Q

how is the image transmitted in video endoscopy?

A

CCD detects image which is transmitted to the screen

68
Q

what are the advantages of video endoscopy?

A

more hygienic due to lack of eye piece
excellent image quality
image control buttons

69
Q

what are the disadvantages of video endoscopy?

A

expensive
no portable
smallest diameter not possible as chip must be accommodated

70
Q

what is the usual diameter of gastro- insertion tubes?

A

5.5-9.5mm

71
Q

what is the usual diameter of colono- insertion tubes?

A

10-13mm

72
Q

what is the usual length of gastric endoscopes?

A

1-1.5m

73
Q

what does length of the scope often correlate with?

A

diameter

74
Q

what are the different viewing angles seen in endoscopes?

A

end or side viewing

75
Q

how can a scope be steered?

A

uniplaner (L and R)
multiplaner (up and down as well as L and R)

76
Q

what channel is seen on endoscopes?

A

accessory/biopsy channel

77
Q

what is retroflexion?

A

scopes ability to turn back on itself

78
Q

why is retroflexion important in endoscopy?

A

visualise cardia
FB retrieval
entering duodenum

79
Q

what must be used with caution if retroflexion is occurring?

A

instruments as diameter of biopsy channel is reduced through retroflexion

80
Q

what does the size of the insertion tube dictate?

A

biopsy channel size and so accessories that can be used

81
Q

what effect does the biopsy channel have on biopsy quality?

A

larger channel = high quality biopsies

82
Q

what size should we aim for the biopsy channel to be?

A

2.2-2.8mm as minimum

83
Q

what are the main biopsy accessories available?

A

cytology brush
sheathed needles
biopsy forceps
lavage (BAL) tubes

84
Q

what types of biopsy forceps are available

A

elipsoid/ round
fenestrated/whole
with spike/no spike
swing jaw / fixed angle
alligator / smooth
rotatable / non-rotatable

85
Q

what is the downside of swing jaw biopsy forceps?

A

lower quality biopsies

86
Q

can biopsy forceps be reused?

A

yes if sterilised

87
Q

what are the key factors which determine biopsy quality?

A

cup size and pressure applied to tissue

88
Q

what size of biopsy forcep cup will improve biopsy quality?

A

bigger = better

89
Q

how should biopsy forceps be held open?

A

fingers and thumb pushed apart

90
Q

how should biopsy forceps be held closed?

A

fingers and thumb together (all times unless actively grabbing tissue)

91
Q

what must be confirmed before endoscopy begins?

A

endoscopy is indicated

92
Q

when is endoscopy indicated?

A

exclusion of extra-GI signs
exclusion of surgical disease (imaging)
contraindications considered

93
Q

how long should patients be fasted before gastroscopy?

A

12 hours

94
Q

what is the purpose of the 12 hour fast before gastroscopy?

A

empty stomach and duodenum

95
Q

what is the benefit of an empty stomach / duodenum for endoscopy?

A

visualisation improved
maneuverability improved
food increases risk of aspiration and regurgitation

96
Q

what impact can food in the stomach have on the scope equipment?

A

clogs channels

97
Q

how long after barium studies should you wait before scoping?

A

24 hours at least

98
Q

why must you wait 24 hours after barium studies to scope patients?

A

barium causes irreparable damage to scopes

99
Q

what may be caused by some GI diseases that can impact visualisation?

A

delayed gastric emptying due to impaired motility

100
Q

how long should patients be fasted for before colonoscopy?

A

24-48 hours (max)

101
Q

what is involved in patient prep for colonoscopy?

A

oral lavage
multiple ‘high’ ememas

102
Q

what is used for oral lavage?

A

polyethylene glycol solutions (Kleen Prep)

103
Q

when should oral lavage be performed?

A

day before scope

104
Q

how often should oral lavage be performed?

A

3 doses 2-4 hours apart

105
Q

what volume of Klean Prep should be used for dogs?

A

25-30 ml/kg

106
Q

what volume of Klean Prep should be used for cats?

A

20 ml/kg

107
Q

how can oral lavage be administered?

A

attempt to give in chicken water
stomach tube

108
Q

what tube type will be used in cats for oral lavage?

A

NO tube

109
Q

what must be done if using stomach /NO tube for oral lavage?

A

ensure within stomach
check for reflux / coughing / distress

110
Q

what are the risks associated with oral lavage?

A

tracheal intubation
aspiration
trauma

111
Q

when is oral lavage contraindicated?

A

if significant pre-exisiting aspiration risks (e.g. BOAS, LP)

112
Q

when should enemas be performed before colonoscopy?

A

1-2 hours

113
Q

what is used for a pre-scope enema?

A

warm water

114
Q

what should not be used for pre-scope enema?

A

phosphate
cleansers / laxatives

115
Q

why must phosphate not be used for pre-scope enemas?

A

can cause hyperphosphataemia as phosphate is absorbed across colon wall

116
Q

what can be used to perform an enema?

A

Higginson pump
enema bucket
tube and funnel

117
Q

how much fluid should be used for an enema in dogs?

A

1L/30 kg

118
Q

how much fluid should be used for an enema in cats?

A

20 ml/kg

119
Q

when should enemas be stopped?

A

fluid runs clear
maximum volume reached

120
Q

when are enemas more effective?

A

if performed on the awake patient so they can go to the toilet after

121
Q

why may some people prefer opioids not to be given for endoscopy?

A

influence on sphincter tone - unlikely and more due to operator skill

122
Q

what drug should be avoided in endoscopy?

A

atropine

123
Q

why must atropine be avoided for endoscopy?

A

impact on GI motility

124
Q

why is a smooth induction important for endoscopy?

A

prevention of aerophagia which will cause distension before the scope is even introduced

125
Q

why is cuffing of the ET tube necessary?

A

reflux/regurge is a risk

126
Q

why must nitrous oxide be avoided in endoscopy?

A

accumulates within gas filled organs

127
Q

what are the specific endoscope considerations?

A

gastric dilation
reflux and aspiration on recovery

128
Q

what position should patients be in for GI endoscopy?

A

left lateral

129
Q

why is left lateral recumbancy preferred for GI endoscopy?

A

pylorus and descending colon will be airfilled and positioned dorsally making them easier to intubate

130
Q

what might indicate positioning in right lateral recumbancy for GI endoscopy?

A

G tube placement for access
FB removal may require position changes

131
Q

what is essential for all endoscope procedures to prevent scope damage?

A

mouth gag

132
Q

what mouth gag should not be used in cats?

A

spring loaded - risk of nerve damage and blindness

133
Q

where should the ET tube be secured?

A

mandible or maxilla

134
Q

why is it important that ET tubes are secured during endoscopy?

A

prevention of tracheal trauma when scope is moved in and out

135
Q

what must be recorded about scope procedures?

A

patient
area
indications
complications
biopsies and device used

136
Q

how can scopes be cleaned?

A

ethylene oxide gas sterilisation
approved disinfectant

137
Q

how should scopes never be cleaned?

A

autoclave

138
Q

what must be done with all scopes immediately following use?

A

ensure channels are clear by flushing through air and water

Advanced Clinical Nursing Theory (36 decks)

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