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Applied Clinical Veterinary Nursing > GI Endoscopy > Flashcards

GI Endoscopy Flashcards

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1
Q

how does transmission work in endoscopy?

A

light source transmits light into body cavity

resulting image is transmitted to eyepiece/monitor

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2
Q

what are the overall roles of endscopy?

A

diagnostic and therapeutic

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3
Q

how can endoscopy aid diagnostics?

A

observation and sampling

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4
Q

what types of sampling can be done via endoscopy?

A

fluid (BAL)

brush cytology (cells from lining)

FNA

biopsies

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5
Q

how can endoscopy be therapeutic?

A

foreign body removal

stricture dilation

feeding (gastrotomy) tube placement

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6
Q

what are the benefits of endoscopy?

A

minimally invasive

low morbidity/mortality (mainly GA related)

no convalescence required

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7
Q

why is it advantageous that there is no significant convalescence required after endoscopy?

A

commonly used for diagnosis of chronic inflammatory enteropathies (immune-mediated) - no need to delay to start steroids like there would be with surgical biopsy

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8
Q

what are the limitations of endoscopy?

A

cannot visualise whole GI tract

assesses appearance, not function

mucosal evaluation only (visual and histopathological)

cannot evaluate extra-GI disease

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9
Q

why can’t the whole GI tract be visualised?

A

GI tract 12ft long, can only access proximal and distal 3 feet

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10
Q

how can the entire GI tract be visualised?

A

capsule endoscopy - cannot visualise

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11
Q

what are the contraindications to endoscopy?

A

known GI surgical disease (perforation, mass lesion)

inadequate investigation of other causes

unsuitable for anaesthesia (CP/hepatic/renal function impaired)

coagulopathy

inadequate preparation - gut not cleansed properly

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12
Q

how does gastric distension affect the endoscopist?

A

challenging pyloric intubation due to increased angle of lesser curvature

increased antro-pyloric motility

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13
Q

how does gastric overdistension affect the anaesthesia?

A

caudal vena compression –> reduced venous return –> reduced CO –> reduced BP

diaphragmatic splinting –> decreased tidal volume

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14
Q

what are the possible complications during endoscopy?

A

acute bradycardia +/- AV block due to vagal reflex

aspiration (inc during recovery)

bacteraemia (transient during colonoscopy)

GI perforation

haemorrhage - mucosal or laceration of major vessels

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15
Q

how can acute bradycardia +/- AV block be reduced during endoscopy?

A

abolish with atropine or glycopyrrolate

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16
Q

how can risk of bacteraemia be reduced?

A

prophylactic abs if at risk e.g. patients with pacemaker

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17
Q

why might GI perforation occur during endoscopy?

A

usually if pre-existing ulcer/severe pathology

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18
Q

does haemorrhage commonly occur from mucosal biopsy?

A

rare unless underlying coagulopathy

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19
Q

when might laceration of a major vessel happen during endoscopy?

A

FB removal (fish hook)

stricture dilation

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20
Q

what are the different parts of the endoscopy system>

A

light source

air/water insufflator

suction pump

endoscope + insertion tube

forceps/other biopsy equipment

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21
Q

why isn’t tungsten halogen light used for endoscopy any more?

A

cheap but not bright, red hue

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22
Q

what light is commonly used in endoscopes today?

A

xenon arc - brighter, white light, long-lasting

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23
Q

what is housed by the light source?

A

air pump for insufflation

separate suction pump for deflation

water reservoir for washing lens

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24
Q

what type of illumination is fibre-optic?

A

non-coherent

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25
Q

what are the fibre optics made of?

A

individual glass fibre, coated in lower optical density glass ‘cladding’

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26
Q

how is light transmitted in fibre optics?

A

by total internal reflection

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27
Q

how are the fibres arranged in fibre optic light transmission?

A

coherent bundles

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28
Q

how is the image transmitted in video endoscopy?

A

via wire, from video chip (CCD) behind lens

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29
Q

what are the advantages of fibre optic endoscopes?

A

portable
wide range of sizes
moderate cost

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30
Q

what are the disadvantages of fibre optic endoscopes?

A

faceted image (appears as ‘honeycomb’)

fragile

size of endoscope dictates image quality

eye piece vs video

31
Q

is video endoscopy any different to fibre optic mechanically?

A

identical

32
Q

what type of illumination does video endoscopy utilise?

A

non-coherent

33
Q

how is the image transmitted in video endoscopy?

A

CCD detects image and transmits it to screen

34
Q

what is the advantage of not having an eyepiece on an endoscope?

A

more hygienic

35
Q

what are the advantages of video endoscopy?

A

excellent image obtained
image control buttons available

36
Q

what are the drawback of video endoscopy?

A

expensive
not portable
smallest diameter not possible

37
Q

what diameter insertion tubes are used for gastroscopy?

A

5.5 - 9.5mm diameter / 1 - 1.5m length

38
Q

what diameter insertion tubes are used for colonoscopy?

A

10-13mm

39
Q

what variations can be seen between insertion tubes?

A

diameter and length
viewing direction/angle
steering - uni-planar vs multi-planar
accessory channel

40
Q

why is tip retroflexion important?

A

allows visualisation of the cardia and entering duodenum

useful in foreign body retrieval

41
Q

how does size of channel affect biopsy quality?

A

smaller channel = poorer quality biopsies

42
Q

what size channel are typically used for gastroscopes?

A

2.2-2.8mm

43
Q

what endoscopy accessories might be used?

A

cytology brush

biopsy forceps

sheathed needles for FNA

lavage tubes

44
Q

what are the different types of biopsy forceps available?

A

reusable / disposable

ellipsoid / round

fenestrated / whole

no spike / spike

alligator / smooth

swing jaw / fixed angle

rotatable / non-rotatable

45
Q

what are the key factors determining biopsy quality

A

cup size and pressure

46
Q

how can we confirm endoscopy is indicated for a patient?

A

exclude extra-GI causes of signs

exclude surgical disease

consider contraindications

47
Q

how long should patients be fasted for gastroscopy?

A

12 hours for visualisation/manoeuvrability - food clogs channels

48
Q

why should we wait 24 hours after barium to perform a gastroscopy?

A

barium damages the scope

49
Q

why might 12 hours fasting not be sufficient for some patients?

A

many GI diseases cause reduced GI motility

stress impairs motility

50
Q

what is involved in patient pre for colonoscopy?

A

fast 24-36 hours

oral lavage

multiple ‘high’ enemas

51
Q

what is a ‘high’ enema?

A

enema performed as far up the colon as safe and sensible to perform

52
Q

what is used for oral lavage?

A

poly ethylene glycol (PEG) electrolyte solutions (klean-prep)

53
Q

when is klean-prep given?

A

day prior to endoscopy

54
Q

how much klean-prep is given?

A

25-30ml/kg x 3 doses (dogs)
20ml/kg x 2 doses (cats)

2-4 hours apart

55
Q

how is klean-prep administered?

A

can be orally vs NO tube (usually cats)

56
Q

what are the risks of oral lavage?

A

tracheal intubation - likely obvious

aspiration - contraindicated if significant pre-existing aspiration risks e.g. brachy, laryngeal paralysis

trauma (rare)

57
Q

what is used for ‘high’ enemas?

A

warm water

58
Q

why shouldn’t phosphate enemas be given?

A

can result in marked hyperphosphataemia

59
Q

how are multiple ‘high’ enemas administered?

A

higginson pump or enema bucket

60
Q

how much water should be used for enema?

A

1L/30kg dogs /until clear

20ml/kg cats

61
Q

when should enema be performed?

A

1-2hrs before colonoscopy - sometimes not tolerated and must be done under GA

62
Q

what are the general GA considerations for endoscopy?

A

avoid atropine impact on GI motility and tone

smooth induction (avoid aerophagia)

familiar routine

cuffed ET tube in dogs

avoid nitrous

care with gastric dilation and reflux/aspiration on recovery

63
Q

why should nitrous oxide be avoided during GI scopes?

A

accumulates in gas-filled organs

64
Q

is it ok to give opioids for endoscopy?

A

fine to give - allegedly affect sphincter tone but this is actually more dependent on endoscopist skill

65
Q

which position should a patient be in for GI endoscopy?

A

left lateral

66
Q

why is left lateral the best position for endoscopy?

A

pylorus and ascending colon air-filled - will sit dorsally and be easier to intubate

67
Q

why might we have a patient in right lateral recumbency for GI endoscopy?

A

g-tube placement

FB removal - sometimes useful to try multiple orientations

68
Q

why should spring-loaded mouth gags not be used in cats?

A

contraindicated as potential for reduced blood supply to brain and central blindness afterwards

69
Q

why should the ET tube be secured to the mandible/maxilla?

A

scope will move tube if tied to back of head

70
Q

why should endoscopic examination reports be filled out?

A

for record keeping, consistency and completeness

71
Q

how should endoscopes be cleaned/disinfected/sterilised after use?

A

ensure channels clear - blow air and water through immediately post-scope

ethylene oxide gas sterilisation

approved disinfectant

72
Q

why shouldn’t endoscopes be autoclaved?

A

will melt scope

73
Q
A

Applied Clinical Veterinary Nursing (31 decks)

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