Endoscopy

Question 1

What are the 4 purposes of endoscopes (have light source)

Answer 1

• visualize organ/joint
• obtain biopsy specimen (with forceps or brushes)
• coagulate blood vessels
• remove tissue

Question 2

Rigid vs. Flexible Endoscopes

Answer 2

rigid: 1st type available
→ still used in arthroscopy

flexible: most often used in pulmonary and GI endoscopy
→ allow transmission of images over flexible, light carrying bundles of glass wire
→ have accessory lumens for insertion of water or medication or suctioning of debris

Question 3

Patients of Endoscopic procedures should always be prepped for?

Answer 3

open procedure in-case complications arise

Question 4

Genitourinary endoscopy is considered not?

Answer 4

sterile

Question 5

Prophylactic IV antibiotics should be given pre-operatively to endoscopic procedures in what type of patients?

Answer 5

-Cardiac valvular disease (endocarditis)
-prosthetic joint (seeding of joint)
→ aka replacing whole joint

Question 6

During laparoscopy, CO2 is instilled into?

This can result in?

Answer 6

1. ) peritoneal cavity

2. ) can cause significant gas pains

Question 7

During cystoscopy/arthroscopy saline is used to ? Why?

What happens to the saline

Answer 7

• saline is used to distend bladder/joint capsule to allow for better visitation of the bladder mucosa/joint
• Amount of saline is recorded that went in… want the same if not close that same number coming out

Question 8

Patient coming out of pulmonary endoscopy or upper GI tract endoscopy must follow what POST OP procedure?

Answer 8

usually pt is NPO status 2 hrs afterward so pt needs to stay until they can swallow/pass gas and their gag reflex works to make sure everything is working properly

Question 9

What complications can arise in endoscopic procedures/ what are the symptoms of each complication (5 complications)?

Answer 9

-organ/cavity perforation
→ abdominal distention, tenderness, pain

-Bleeding from biopsy site
→ increase in respirations
→ increase in HR
→ paleness

-Respiratory depression
→ treat with naloxone (for opiates)
→ treat with flumazenil (for Benzo’s)

-infections and transient bacteremia
→ fever in children
→ confusion in elderly

-cardiovascular problems
→ bradycardia (treat with atropine)

Question 10

What are the indications to do arthroscopy?

Answer 10

• pain (knee/shoulder common)
• locking
• swelling
• instability

Question 11

1. ) How long does the arthroscopy procedure usually take?

2. ) Will pt be in pain after

Answer 11

1.) 30 mins -2 hours

2. )
   - Patients receiving local anesthesia have transient discomfort from injection of local anesthetic and tourniquet pressure
   - Joint may be painful and slightly swollen for several days or weeks, depending on surgery performed

Question 12

Arthroscopy is done through?

Answer 12

small trocars placed into joint

Question 13

C/I’s for arthroscopy?

Answer 13

• pts with ankylosis (stiff joints due to bone fusion)
• skin infections
• recent arthrogram (residual inflammation from injection of constrat dye)

Question 14

Colonoscopy:

1. ) how long does procedure take?
2. ) allows for view of what organs in the body?

Answer 14

1. ) 30-60 mins

2. ) rectum → colon → small bowel

Question 15

Indications for colonoscopy (4 things)?

Answer 15

pts who have:

• change in bowel habits
• blood in stool
• abdominal pain
• look for colorectal cancer, IBD, polyposis

Question 16

C/I’s for colonoscopy (6 things)

Answer 16

• Uncooperativepatients
• Unstable patients
→ test requires sedation, which may induce hypotension

• Patients bleeding profusely from rectum
→ lens will become covered with blood clots, preventing visualization
• Patients with suspected colon perforation

• Patients with toxic megacolon

• Patients with recent colon anastomosis
→ within past 14 to 21 days

Question 17

Laryngoscopy and Bronchoscopy:

1. ) procedure preformed by?
2. ) instrument used?
3. ) which procedure goes past vocal cords and which one doesn’t?

Answer 17

1. ) ENT
2. ) short bronchoscope
3. ) bronchoscopy (goes past vocal cords)

Question 18

Laryngoscopy Indications

Answer 18

-Diagnostic
• Identify:
• cancers
• polyps
• inflammation
• infections of those structures
• vocal cord motion can be evaluated also

-Therapeutic
• Assist with Endotracheal intubation
• Anesthesiologists use laryngoscopy to visualize vocal cords to intubate for general anesthesia

Question 19

Laryngoscopy Pre-Procedure (5 steps)

Answer 19

1. ) NPO 4-8 hrs prior
2. ) thorough mouth care (brushing teeth)
3. ) take out dentures
4. )
   - adminster atropine to counteract vagal stimulation
   - benzos for anxiety
   - antimuscarinics meds to reduce secretions
5. ) tell pt not to swallow lido spray

Question 20

Bronchoscopy allows for visualization of?

Where is the test usually preformed?

Answer 20

1. ) larynx, trachea, and bronchi

2. ) usually preformed bedside or in endoscopy room

Question 21

Bronchoscopy
Indications
Diagnostic vs. therapeutic

Answer 21

Diagnostic:
• Direct visualization of tracheobronchial tree

• Biopsy of tissue from observed lesions
• Aspiration of “deep” sputum for culture and sensitivity and for cytologic determinations
• Direct visualization of larynx for identification of vocal cord paralysis

Therapeutic
• Suction retained secretions in patients with airway obstruction or postoperative atelectasis
• Control bleeding within bronchus
• Removal of aspirated foreign bodies
• Brachytherapy (endobronchial radiation therapy) using an iridium wire placed via bronchoscope
• Palliative laser obliteration of bronchial neoplastic obstruction

Question 22

rigid vs flexible bronchoscope

Answer 22

Rigid: permits visualization of larger airway only
→ used mainly for removal of large foreign bodies

Flexible:
• 4 channels
    • two provide light source 
    • one vision channel
    • one open channel:
             • instruments
             • admin of     anesthetic/ oxygen

Question 23

Bronchoscopy C/I’s (3 things)

Answer 23

pts with:

• hypercapnia
• severe SOB (can be preformed through oxygen mask)
• severe tracheal stenosis (difficult to pass the scope)

Question 24

Bronchoscopy Post-Procedure Steps (4 things)

Answer 24

• Pt. NPO until gag reflex has returned

• Observe sputum for hemorrhage if biopsy specimens taken
→ small amount of blood streaking expected and normal for several
hours
→ large amounts of bleeding can cause chemical pneumonitis

• Observe for evidence of impaired respiration or laryngospasm
→ vocal cords may go into spasm after intubation

• Emergency resuscitation equipment should be readily available

Question 25

1. ) Post-bronchoscopy fever often develops within? Is this normal? 2. ) When would a chest x-ray film be ordered post Laryngoscopy/Bronchoscopy procedure?

Answer 25

1.) Post-bronchoscopy fever often develops within 24 hours • low-grade fever normal 2.) Chest x-ray film ordered to eval for pneumothorax if a deep biopsy was obtained

Question 26

Purpose of laparoscopy?

Answer 26

Used to directly visualize abdominal and pelvic organs when pathologic condition is suspected

Question 27

Laparoscopy Indications | Diagnostic vs. therapeutic

Answer 27

``` Diagnostic • Acute/chronic abdominal or pelvic pain • Suspected advanced cancer • Abdominal mass of uncertain cause • Endometriosis • Ectopic pregnancy • Ruptured ovarian cyst • Salpingitis ``` ``` Therapeutic • Cholecystectomy • Hiatal hernia repair • Inguinal hernia repair • Video-assisted colectomy ```

Question 28

Laparoscopy Pre-Procedure steps

Answer 28

• NPO after midnight b/c open laparotomy may be required → Confirm patient is aware that open procedure could occur • Shave abdomen prior to incision

Question 29

Laparoscopy C/I's

Answer 29

• Patients who have had multiple abdominal surgical procedures → adhesions • Patients with suspected intraabdominal hemorrhage → visualization through scope obscured by blood

Question 30

Laparoscopy Procedure

Answer 30

• Patient is initially placed in supine position • After abdominal skin cleansed, blunt-tipped needle inserted through small incision in periumbilical area and into peritoneal cavity • Or slightly larger incision is placed in skin and abdominal wall is separated under direct vision • Peritoneal cavity is entered, adhesions can be lysed under direct vision • Peritoneal cavity filled with 2-3 L of CO2 to separate abdominal wall from intraabdominal viscera • Laparoscope inserted through trocar to examine abdomen • Other trocars can be placed as conduits for other instrumentation • After procedure complete, laparoscope is removed and CO2 is allowed to escape • Incision(s) closed with skin stitches and covered with dressing

Question 31

Laparoscopy Post-Procedure

Answer 31

asses for: -signs of bleeding (tachycardia and hypotension) - perforated organ (abdominal tenderness and ↓ bowel sounds) - Patient may complain of shoulder or subcostal discomfort from diaphragmatic irritation caused by pneumoperitoneum

Question 32

Endoscopic Retrograde Cholangiopancreatography 1. ) what is it?how long does it take? 2. ) This test is used to evaluate what type of patients?

Answer 32

* Endoscopic test which usually takes approximately 1 hour | * Used to eval patients with unexplained upper abdominal pain or suspected pancreatitis

Question 33

Indications of ERCP indications Diagnostic vs. Therapeutic

Answer 33

Diagnostic • eval of jaundiced patient • tissue and brushings of common bile duct can be obtained for pathologic review • Manometric studies of sphincter of Oddi/pancreatobiliary ducts can be performed → used to investigate unusual functional abnormalities of these structures Therapeutic • Incision of papillary muscle in ampulla of Vater can be performed through scope so common bile duct gallstones can be removed • Stents can be placed through strictured bile ducts allowing bile of jaundiced patients to be internally drained