Endoscopy

Question 1

Endoscopy definition

Answer 1

“Endo” = Inside
“Skopeein” = To see

Question 2

Endoscopy
What is it and what does it do?

Answer 2

1. What is it:
   - Very small cameras attached to either a flexible or rigid tube.
2. Direct viewing of the interior of an organ is often helpful in determining the cause of a problem & helpful in establishing a diagnosis, especially small animal GI disorders.

Question 3

What are the types of Endoscopies? (5)

Answer 3

1. Endoscopy
   - Visualization of the esophagus, stomach, and duodenum.
2. Colonoscopy
   - Visualization of colon
3. Cystoscopy
   - Visualization of the urinary bladder
4. Bronchoscopy
   - Visualization of the trachea & bronchi
5. Rhinoscopy
   - Visualization of nasal passages & pharynx

Question 4

Indications of GI endoscopy (3)

Answer 4

1. Evaluation: gastro motility disorders, remove foreign bodies, evaluation of mucosal lesions of the esophagus, stomach, duodenum or colon.
2. Sampling: for mucosal biopsies of GI tract for histopathological examination or fluid aspiration for analysis.
3. Therapeutic procedures: esophageal stricture dilation
   - Placement of gastrotomy tube in stomach for nutritional support.

Question 5

T/F: Endoscopy is a minimally invasive diagnostic medical procedure used to evaluate interior surfaces of an organ

Answer 5

True!

Question 6

Flexible vs Rigid endoscopes

Answer 6

Flexible:
- GI, urinary bladder, airway visualization.
Rigid:
- Nasal, joint (arthroscope), body cavity (laparoscope) visualization.

Question 7

What are the three basic parts to a fiberoptic endoscope?

Answer 7

1. Insertion tube
2. Hand piece
3. Umbilical cord

Question 8

Endoscopy equipment needs… (4)

Answer 8

1. Scope
   - Rigid or flexible
2. Light source
   - Halogen or xenon
3. Air & water source
4. Instrument attachments
   - Biopsy, graspers, snares
   - Others

Question 9

Advantages of endoscopy (4)

Answer 9

1. Diagnostic as well as therapeutic applications
2. Minimum stress & mortality
3. Less traumatic than standard Sx
4. Amount & duration of anesthesia much less than standard surgical procedure

Question 10

Disadvantages of endoscopy (4)

Answer 10

1. Requires expensive, flexible equipment, & specialized operator training.
2. Biopsies usually adequate, but not as good as full thickness surgical biopsies.
3. Cannot examine entire intestinal tract; lesion may be beyond reach of scope.
4. Inexpert handling of the endoscope may lead poor diagnostics & complications such as punctured organ or vagal effects or over inflation.

Question 11

Patient GI endoscopy prep/set up (5)
Hint: Think of patient positioning!

Answer 11

1. Patient is well fasted
2. General anesthesia with intubation
3. EKG strongly recommended
4. Oral speculum must be placed
5. Patient placed in left lateral recumbency

Question 12

Endoscopy biopsy steps (3)

Answer 12

1. Multiple samples are taken (about 5) from each region of the stomach & duodenum.
2. Gently placed on balsa wood or cassette with 22G needle.
3. Rapidly placed in formalin or test medium to prevent drying.

Question 13

Helicobacter Testing, what is it? (2)

Answer 13

1. Direct visualization on histopathology
2. Urease production test (CLOtest)
   - Positive within 4 hours

Question 14

Foreign body removal from the GI tract with endoscopy must be done with ___ care in order to protect the ___.
This is limited to the gastric objects that can be brough back through the ______ junction that instruments can grasp.

Answer 14

1. Extreme
2. Esophagus
3. Gastroesophageal

Question 15

Colonoscopy indications (4)

Answer 15

1. Chronic diarrhea
2. Recurring constipation
3. Chronic tenesmus
4. Chronic blood, mucous in feces

Question 16

Colonoscopy patient prep (3)

Answer 16

1. Patient fasted for at least 24hrs
2. Go-lytely or other osmotic for 2 days
3. Warm water enemas (no irritant additives) if fecal material in colon seen on radiographs just prior to procedure.

Question 17

Colonoscopy instrumentation (3)
Hint: Similar to GI endoscopy

Answer 17

1. Colonoscope is shorter, larger diameter then upper GI endoscope.
2. Patient usually placed in sternal recumbency.
3. General anesthesia!

Question 18

Rhinoscopy
1. Indications (4)
2. Patient prep (3)

Answer 18

1. Indications:
   - Chronic nasal discharge
   - Epistaxis
   - Violent sneezing
   - Nasal stridor
2. Prep
   - General anesthesia
   - Topical lidocaine
   - Sternal recumbency

Question 19

Rhinoscopy
Instrumentation (6)

Answer 19

1. Rigid scope (arthroscope)
2. Flexible endoscope (retroflex view)
3. Light

Question 20

What are the TWO goals of endoscopy equipment care?

Answer 20

1. Patient safety!
2. Maintaining proper endoscope function

Question 21

What does endoscopy equipment care entail? (not goals) (3)

Answer 21

1. Proper cleaning & disinfection.
2. Routine inspection of the instrument
3. Careful inspection of each stage of instrument use:
   - Before use
   - During use
   - After use

Question 22

Endoscopy handling (4)

Answer 22

1. Extreme care to NOT BEND the flexible scope aggressively!
   - Tight bends in the scope result in fiber breakage.
2. Use mouth gag on patients.
   - Biting the scope will cause severe damage to the fibers of the scope.
3. Once broken fiber obscures the image, the instrument must be discarded!
4. Do not drop the scope!

Question 23

Endoscopy leak testing things you need to know (3)

Answer 23

1. Leak testing should occur before cleaning, before use, & after use.
2. Submersion of an endoscope that has a leak will allow water to enter into the instrument & potentially ruin it.
3. Teeth of animals have a high risk of damaging (causing leaks) the flexible scope & care must be used over the teeth.

Question 24

Signs of endoscopy leak (3)

Answer 24

1. Image stains
2. Foggy images
3. Electrical malfunction

Question 25

To conduct a leak test, apply ___ pressure to the inside of the endoscope ___ tube and watch for either a drop in the pressure ___ or for ___ ___ where there are leaks in the exterior or a channel wall.

Answer 25

1. Air 2. Insertion 3. Gauge 4. Air bubbles

Question 26

Endoscope cleaning steps (5)

Answer 26

1. Immediately after procedure, copious amounts of fresh water suctioned thru channels. 2. Manual cleaning with enzymatic detergent. Then rinse with fresh water. - Including: brushing/flushing channels 3. Air blown thru instrument & air dried. - Remove all possible parts for this step. 4. Alcohol on cotton used for hand piece parts. 5. Instrument MUST be sealed prior to submersion.

Question 27

T/F: Cold sterilization & sterile rinse only needs to occur after procedures with the endoscope

Answer 27

False. This should be done immediately PRIOR to procedures. - Do keep in mind the "cold tray" has been known to grow on culture mediums, so take this with a grain of salt.

Question 28

Bronchoscopy

Question 29

Bronchoscopy

Question 30

Arthroscopy

Question 31

Laparoscopy

Question 32

The Loresectoscopy

Question 33

Cystoscopy/Urethroscopy