the endoscope and the GI tract

Question 1

what are the 4 parts of the basic endoscope?

Answer 1

screen
light source, air water
control head
flexible tip

Question 2

name 6 types of specialised endoscope

Answer 2

gastroscope (stomach)
colonoscope (colon)
side viewing (ERCP) scope (liver/biliary tree)
enteroscope (push, double balloon)
Capsule
Endoscopic ultrasound

Question 3

list 4 uses of endoscopes

Answer 3

diagnosis
therapy (emergency and elective)
screening
surveillance

Question 4

what visual disgnoses can be made via endoscopy?

Answer 4

oesophagitis
gastritis
ulceration
coeliac disease
crohns disease
ulcerative colitis
sclerosing cholangitis

Question 5

what is contained within the endoscope?

Answer 5

camera
tube to suck up blood etc
light

Question 6

how do capsules work?

Answer 6

swallowed
has battery (so must pass through, cant get stuck or will cause damage), light and camera which produces video of GI tract as it passes through

Question 7

what does EUS scope do?

Answer 7

press up against wall
produces image of organs etc via altrasound
can take samples via needle

Question 8

describe the endoscopy technique

Answer 8

endoscope tip inserted

direction of the endoscope operated with left hand by endoscope controls

Question 9

what type of vascular abnormalities can be discovered by endoscopy?

Answer 9

varices
ectatic blood vessels (GAVE, dieulafoy)
angiodysplasia

Question 10

name some miscellaneous conditions that can be picked up on by endoscopy

Answer 10

Mallory-Weiss tears
diverticulae
foreign bodies (bezoars, food, razor blades etc)
stones
worms

Question 11

what are the benefits of early diagnosis?

Answer 11

can pick up pre-malignant conditions
can remove tissue in minimally invasive way
easy to follow up
screening

Question 12

what is barrets cancer?

Answer 12

.

small initial lesion can be removed if caught early

Question 13

what is lugals iodine used for?

Answer 13

squirted onto oesophagus, makes abnormal mucosa more obvious

chromoendoscopy

Question 14

what is narrow band imaging?

Answer 14

uses different lights to illuminate deeper tissue

Question 15

how are diagnoses made via microscopy?

Answer 15

biopsy and histology
brushings and cytology
rarely, aspirates and biopsies for microbiology

Question 16

what is a therapeutic endoscopy?

Answer 16

endoscopy with the ability to treat down the endoscope

Question 17

what 3 types of bleeding can occur in the GI tract?

Answer 17

variceal bleeding
arterial bleeding
angiodysplasia

Question 18

what clinical observations indicate GI bleeding?

Answer 18

haematemesis (vomiting dark, bloody, thick sunstance)

Malaena (dark brown, bloddy, thick, feaces)

Question 19

How is variceal bleeding treated?

Answer 19

medical emergency
Banding
injection fibrinogen
histocryl glue
ABC, resuscitate

Question 20

how is arterial bleeding treated?

Answer 20

injection therapy (adrenaline: tamponade, vasoconstriction)
heater probe (coagulation)
Clips (ligate)

Question 21

what is angiodysplasia and how is it treated?

Answer 21

small vascular malformation of the gut
treated with:
- argon plasma coagulation
radio frequency ablation

Question 22

how are strictures treated?

Answer 22

stenting (usually in malignancy)

Question 23

what are the 2 types of stent and where are they used?

Answer 23

used in oesophagus, biliary tree, colon
Plastic (removable)
Metal self expanding (permanent)

Question 24

what are the possible complications of a stent?

Answer 24

reflux
fever
septicaemia
fistulae
foreign body sensation
bleeding

Question 25

name 2 methods of dilatation

Answer 25

balloon | bouginage

Question 26

.

Answer 26

.

Question 27

via what 2 methods can early stage tumours be removed?

Answer 27

polypectomy | endoscopic mucosal removal

Question 28

what is a polypectomy?

Answer 28

removal of polyp before it turns cancerous 1)raise polyp on a bed of adrenaline/saline 2)snare 3)hot biopsy Usually for colonic polyps

Question 29

what is an endoscopic mucosal removal?

Answer 29

removal of early stage cancer/precancerous growths 1) raise lesion on bed of adrenaline/saline 2) loop and convert to poly 3) snare

Question 30

give 2 examples of intraluminal objects that would need to be removed

Answer 30

stones (ERCP) | foreign bodies

Question 31

.via what 3 methods can stones be removed?

Answer 31

.sphincterotomy balloon and trawl lithotripsy

Question 32

name 3 methods of foreign body removal

Answer 32

snare or basket overtube GA with endotracheal tube

Question 33

how are endoscopes used in nutrition?

Answer 33

PEG insertion PEJ naso-jejunal tube insertion

Question 34

what is PEG insertion?

Answer 34

``` gastroscopy 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 35

What is anaso-jejunal tube?

Answer 35

``` pass tube under direct vision pull out endoscope feed in nasal overtube draw NJ tube into overtube withdraw through nose fix in place ```

Question 36

what are the aims of screening?

Answer 36

prevention of colorectal cancer detect polyps and remove them early detection of cancer

Question 37

what things is surveillance used for?

Answer 37

ulcerative colitis (IBD) colonic polyps and colorectal cancer Barrets oesophagus

Question 38

how are patients selected for endoscopy?

Answer 38

indications contraindications (recent infarct) bleeding diathesis (eg. anticoagulants) infection risk (prosthetic valves)

Question 39

how must a patient be prepared for endoscopy?

Answer 39

``` clear indication explanation to patient consent fasting bowel preparation (emptying) monitor bleeding diathesis infection prophylaxis ```

Question 40

what complications can arise from endoscopy?

Answer 40

``` resp arrest aspiration cardiac arrest bleeding perforation infection ```