the endoscopy and GI tract Flashcards
what are 4 parts to a basic endoscope?
- screen
- light source, air/water
- control head
- flexible tip
wha are 6 types of specialised endoscopes?
- gastroscope
- colonoscope
- side viewing (ERCP) scope
- enteroscope (push, double balloon)
- capsule
- endoscopic ultrasound
what are 4 uses of endoscopes?
1) diagnosis
2) therapeutics
- emergency
- elective
3) screening
4) surveillance
what are 7 diagnosis that can be make by endoscope?
- oesophagitis
- gastritis
- ulceration
- coeliac disease
- Crohn’s disease
- ulcerative colitis
- sclerosis cholangitis
Yes or No.
Can endoscopes identify tumours?
= yes
- benign and malignant
what 3 vascular abnormalities can be identified by endoscope?
- varices
- ecstatic blood vessels’s (GAVE, dieulafoy)
- angiodysplasia
what are 5 miscellaneous conditions that an endoscope can identify?
- mallory-Weiss tear
- diverticulae
- foreign bodies (Bezoars, food bolus, razor blades)
- stones
- worms
how is the endoscope used as an early diagnostic tool?
- pre-malignant conditions
- ability to remove tissue in a minimally invasive way
- easy to follow up
- screening
what are newer imaging techniques developed from?
= concept of dye staining the oesophagus
- using indigo carmine and iodine
what does chromo-endoscopy looks at use and identify?
= uses Lugol’s iodine to identify early squamous carcinoma
describe narrow band imaging?
a filter goes in front of light source, only blue and green light is reflected
= blue reflects
= green goes further down
= allowing you to appreciate abnormal blood vessels.
what are 3 microscopic diagnosis that cane be done?
- biopsy & histology
- brushings & cytology
- aspirates & biopsies for microbiology
how can an endoscope act a therapeutic agent?
= treats down the endoscope - GI bleeding - nerve blocks - resection of early cancer (limited only by imaging)
what 3 types of bleeding can endoscopes treat?
- variceal bleeding
- arterial bleeding
- angio-dysplasia
describe variceal bleeding and how is it treated?
= life threatening medical emergency
Treatment;
- ABC = resuscitate
- inject fibrinogen (concentrated clotting factor)
- banding
- histocryl glue (super glue - obliterates blood vessel & stops bleeding)
what is sclerosant?
= used to treat blood vessels or blood vessel abnormalities and also those of the lymphatic system.
- A medicine is injected into the vessels, which makes them shrink.
how is arterial bleeding treated?
1) infection therapy (adrenaline, tamponade, vasoconstriction)
2) heater probe (coagulation)
3) clips (“ligate”)
what is angiodysplasia?
= abnormality with blood vessels in GI tract
what are 2 ways to treat angiodysplasia?
1) argon plasma coagulation
2) recent work with radio frequency ablation
what are strictures?
= constricting
how would you treat strictures?
by causing dilation
= Stenting (reserved for malignancy)
- removable stents can treat perforations with a reduction in long term sequlae
what are 2 types of stents (oesophageal, biliary, colonic)?
1) plastic
= removable
2) metal self expanding (permanent)
what are the complications and bleeding risks for metal self expanding stents?
Complications
- foreign body sensations
- reflux
- fever
- septicaemia
- fistula formation
Bleeding
- perforation
- pain
- migration
- tumour in/overgrowth
what 2 things that can cause dilation?
1) balloon
2) bouginage
what are 2 ways of removing tumours?
1) polypectomy
2) endoscopic mucosal removal
what is polypectomy?
= raising polyps on a bed of adrenaline/saline
- snare it then use hot biopsy
- usually for colonic polyps
what is endoscopic mucosal resection?
= raise lesions on a bed of adrenaline/saline
- loop and convert to polyp
- snare
what are 2 objects that could get stuck in the intra-lumen?
1) stones (ERCP for removal of them)
2) foreign body removal
what are 3 things can you use to remove stones (ERCP)?
- sphincterotomy
- balloon and trawl
- lithotripsy
what are 3 things can you use to remove foreign body?
- snare or basket
- overtube
- GA with endotracheal tube
what are 3 ways to help nutrition?
- PEG insertion
- PEJ
- nato-jejunal tube insertion
describe PEG insertion?
- gastroscopy
- identify insertion site
- trans-abdominal passage of wire
- pull wire out of mouth
- tie PEG tube to wire and pull into position
- fix in place and set up connection
describe the naso-jejunal tube?
- pass tube under direct vision
- pull out endoscope
- feed in nasal overtube
- draw NJ tube into overtube
- withdraw through nose
- fix in place
why is screening (asymptomatic individuals) used?
= to prevent colorectal cancer
= detects polyps and remove them
= early detection of cancer
why is surveillance (disease, early detection of complications) used?
- ulcerative colitis (extensive, long standing)
- colonic polyps and colorectal cancer
- Barrette’s oesophagus
what are 4 considerations to think about when thinking about treatment of certain conditions?
1) indication
2) contra-indicatons (recent infarct)
3) bleeding diathesis (anti-coagulant therapy)
4) infection risk (prothetic valves, shunts, immune-suppression)
what are 6 complications of possible treatment?
1) resp arrest
2) aspiration
3) cardiac arrest
4) bleeding
5) perforation
6) infection(prions, viruses, bacterial endocarditis, immuno-suppression)
