Endoscopic & Imaging

Answer 1

• Examination fo the esophagus, gastum (stomach) & 2nd portion of duodenum
  
  • may need to add air to distend to see the lumen
  • moves in 2 dimension
  • can put different instruments on
• Z line = where LES sits

Answer 2

• 2 dimensional
• controls identical to EGD
• can examine entire colon & intervene (biopsy, inject, intentionally perforate to perform intra-abdominal surgeries
  
  • can make it to terminal ileum
• Need prep
  
  • blood, poop,
  • sometimes done as hail mary – but extremely difficult w/o prep
  • GoLYTELY – osmotic diarrhea
  • need sedation
  • risk of perforations
• looking for
  
  • confirmational change
  • color change to the mucosa
  • foreign body
  • texture change

Question 3

Landmarks

Answer 3

• depth of scope
• EGD
  
  • LES
  • fundus of the stomach
  • plicae circularis
• Colonoscopy
  
  • mesenteric attachments
    
    • transverse colon (attached posteriorly– trangle lumen)
      
      • omental attachment
      • mesocolon
    • descending/ascending (retroperitoneal portion)
      
      • relatively flat on one side & rounded on the other
    • significant 90 degree bends indicating passing splenic or hepatic flexures

Answer 4

Extensive signoidoscopy

little smaller scope, only up to slpenic flexure

• hypothesis was that most cancer polyps are on the left side
  
  • not true
• financial & business motivated
  
  • can accomplish it with out intense sedation
  • less aggressive prep
  • allow out patient physician
• No longer utilized

Answer 5

• Proctoscopy
• colorectal surgeon or general surgeon
  
  • address hemrhooids, fistulas, fissures

Answer 6

• has an “over tube” over much of the scope
• EGD as normal, when in small intestin, insert balloon, & snake inner scope as far as can reach & inflate a new balloon
  
  • deflate initial balloon & snake over tube up to where it is adjacent to the distal balloon
  • inflate proximal ballon, deflade distal balloon & keep going through small intestine
  • pressure between 2 balloons allows you to pull the scope along with the camera into the small bowel
  • can make it about 3/4 into the small bowel
• can also intervene
• Require prep
  
  • require sedation
  • general anesthetic, to secure airway
  • could take a few hours
  • not done super often

Answer 7

• Capsule endoscopy
  
  • batery, camera built in
  • has a flash & takes photos periodically
  • belt
• Requires little prep
  
  • in colon will see a bunch of poop
  • common method to evaluate small intestine
  • takes so many photos– takes a long time to look at every picture
• How you would look at mucosa of the small bowel

Answer 8

ERCP

modified EGD desigend to make it to the major duodenal papilla to look at the bile duct & pancreatic duct

can contrast and look at bile tree

bleedign risk, perforation risk – trying to get through sphincter of Oddi & cause pancreattitis

cholangiocarciona (gall blader cancer)

Answer 9

• Endoscopic ultrasound
  
  • camera and ultrasound on scope
  • evaluate pancreas
  • biopsy stuff around the pancrea
• Risk of bleed/ infection (if poking somethign)
• need sedation
• don’t ned bown prep

Answer 10

Diagnositic Laparoscopy

• surgical techniqe & get view of outsdide of the small bowel or colon

Question 11

C

Answer 11

• CT is the mianstay of imaging of the abdomen
• withor without oral contrast (in lumen, doen’t get absorbed)
  
  • demarke the countous of the lumen
• IV contrast to look at solid organs

Answer 12

Adequate blood flow where the yellow arrows are and inadequate blood flow where the red arrows are

Question 13

Question 14

Question 15

Different phase of contrast

Answer 15

Question 16

Answer 16

barium enema that cant do a colonoscopy on

Question 17

Answer 17

safe for pregnantcy

Question 18

Answer 18

great way to see biliary tree but can’t intervene