Endoscope and the GI tract

Question 1

What are the parts of a basic endoscope

Answer 1

Screen, Light source, air/ water, control head and flexible tip

Question 2

What are some specialised types of endoscope and what do they look at?

Answer 2

Gastroscope - Stomach
Colonoscope - Colon
Side viewing ERCP - Some of the organs that come off of the GI tract
Enteroscope - looking at the bit you cant see with the Gastroscope (Small bowel)
Capsule - pill cam
Endoscopic Ultrasound - lumen of the stomach - can scan the organs from inside out

Question 3

How big are capsule?

Answer 3

1-2cm

Question 4

What are the risks with capsule?

Answer 4

They contain a battery which must come out
Difficult to swallow
Relatively expensive

Question 5

What are the drawbacks of the EUS Scopes

Answer 5

Very expensive

Question 6

What do patients need before an endoscope

Answer 6

Sedative or anaesthetic

Question 7

What are endoscopes used for?

Answer 7

Diagnostics - cancer, inflammation and ulcers
Therapeutics - Biopsy abnormalities
Treat things - to stop a bleeding ulcer
Screening - early diagnoses of cancers - Colorectal cancer screening. taking a healthy population to try and pick up pre-malignant cells and cure them
Surveillance - people with an illness that we want to keep an eye on.

Question 8

What is Barrett’s oesophagus

Answer 8

a metaplasia caused by a chemical irritation
cells undergo a metaplastic change to thick, cuboidal cells so that it is more like the stomach, so not as badly effected by acid reflux

Question 9

What can be diagnosed through visual diagnoses?

Answer 9

Oesophagitis 
Gastritis
Ulceration
Coeliac disease
Crohn's dsease 
Ulcerative colitis 
Sclerosing cholangitis

Question 10

What are the two different types of tumours

Answer 10

Malignant and Benign tumours

Question 11

What are some vascular abornalities

Answer 11

Varices
Ectatic blood vessels (GAVE, Dieulafoy)
Angiodysplasia

Question 12

What miscellaneous conditions that can be diagnosed / treated through endoscope

Answer 12

Mallory-Weiss tears
Diverticulae 
Foreign bodies 
Stones
Worms

Question 13

What are the therapeutics of Endoscopy?

Answer 13

Ability to treat down the endoscope
GI bleeding
Nerve blocks
Resection of early cancer

Question 14

What are 3 types of bleeding?

Answer 14

Variceal bleeding
Arterial bleeding
Angiodysplasia

Question 15

Describe haematemesis

Answer 15

Vomit which is full of blood

Question 16

Describe malena

Answer 16

Stool with blood with a disgusting smell

Question 17

What is Variceal Bleeding?

Answer 17

A medical emergency

Question 18

How do we manage a patient with Variceal Bleeding?

Answer 18

ABC resusitate
Injection sclerotherapy
Banding (putting on rubber bands from the endoscope)
Hystocryl glue

Question 19

What is the aim of injecting a sclerosant

Answer 19

To cause intesive inflammation in the blood vessel and stop bleeding

Question 20

What is one of the drawbacks of using glue?

Answer 20

The scope can end up glued to the surface you are trying to fix. This needs to be changed quickly!

Question 21

How can we treat arterial bleeding?

Answer 21

Injection therapy (adrenaline: tamponade, vasoconstriction)
Heater probe (coagulation
Clips (ligate)

Question 22

How can we treat strictures (narrowing)

Answer 22

Dilation (using balloons)
Stenting (usually reserved for malignancy)
Removable stents - can treat perforations with a reduction in long term sequelae. Some are not biodegradable

Question 23

What are the main types of stents

Answer 23

Plastic (removable - not often used now)

Metal self expanding (permanent)

Question 24

How does polypectomy work

Answer 24

Raise polup on a bed of adrenaline / saline
SNare
Hot biopsy

Question 25

What are polypectomy used for

Answer 25

Colonic polyps

Question 26

How does endoscopic mucosal resection (EMR) occur?

Answer 26

Raise lesion on a bed of adrenaline / saline Loop and convert polyp Snare

Question 27

What can we remove through ERCP

Answer 27

Stones and foreign body

Question 28

Describe the removal of a stone

Answer 28

Sphincterotomy Balloon and trawl Litotripsy

Question 29

How is a foreign body removed?

Answer 29

Snare or basket Overtube GA with endotracheal tube

Question 30

How does a PEG insertion occur?

Answer 30

``` Gastroscopy Identify insertion site Transabdominal passage of wire Pull wire out of mouth Tie PEG tube to wire and pull into position Fix in place and set up connectors ```

Question 31

What is the purpose of screening>

Answer 31

Prevention of colorectal cancer Detect polyps and remove them Early detection of cancer

Question 32

What are the complications of Endoscopy

Answer 32

``` Respiratory arrest Aspiration Cardiac Arrest Bleeding Perforation Infection (bacterial endocarditis) ```

Question 33

What determines whether a patient is for endoscopy

Answer 33

Patients not for endoscopy include: Indication (justified) Contraindications (recent infarct) Bleeding diathesis (including anticoagulant therapy) Infection risk (prosthetic valves, shunts, immunosuppression)

Question 34

How is a patient prepared for endoscopy?

Answer 34

``` Indication (clear, justified) Explaination to patient Consent Fasting Bowel preparation Monitor bleeding diathesis Infection prophylaxis (endocarditis, shunt, immunosuppresion) ```