Sa Tech Lab 3 - Endoscopy 1

Front 1

what are the 5 parts of an endoscope tip?

Back 1

1. biopsy channel
2. light guide
3. air and water output
4. outer lens with CCD/fiberoptic bundle
5. light guide

Front 2

what are 7 specifications of an ideal GI endoscope?

Back 2

1. outside diameter < 8mm
2. biopsy channel 2.8 mm
3. 120 cm (1.2 m) working length
4. automatic air/water insufflation
5. totally immiscible
6. 4-way tip deflection
7. excellent quality optics

Front 3

what are limitations of GI endoscopy with regards to
- duodenoscopy?
- colonoscopy?
- biopsy?
- retrieving foreign bodies
- treating narrow passages such as strictures

Back 3

- duodenum: limitations as to length and diameter
- colon: limited length
- biopsy forceps size small
- foreign body retrieval forceps small and cumbersome
- balloon dilators limited in size

Front 4

what are three general complications of upper GI endoscopy?

Back 4

1. perforation
2. aspiration pneumonia
3. esophagitis/stricture

Front 5

what is the #1 complication of GI endoscopy?

Back 5

perforation

Front 6

what are some complications of perforation due to GI endoscopy (5)

Back 6

1. mediastinitis/peritonitis
2. hemorrhage
3. gastric distention
4. respiratory compromise due to gastric distention
5. bradycardia due to gastric distention

Front 7

what are five limitations of GI endoscopy?

Back 7

1. only access mucosal lesions
2. only can reach the orad and aborad aspects of the small intestines
3. organs are much larger than the scope
4. anatomic displacement
5. cannot assess function, only morphology

Front 8

what are 7 gross descriptive terms used to describe lesions in GI endoscopy?

Back 8

1. hyperemia - redness of mucosa
2. friability - mucosa bleeds excessively on contact with endoscope (normally very tough)
3. granularity (how smooth/rough is the mucosa)
4. erosion/ulcer
5. narrowed/dilated lumen
6. mass - pedunculated/sessile
7. foreign body

Front 9

what is a limitation of assessment of an erosion/ulcer with endoscopy?

Back 9

can't tell how deeply it goes

Front 10

when using an endoscope, what hand
- holds the instrument?
- controls the knobs?
- advances the endoscope?
- controls water and suction?

Back 10

- holds the instrument: left
- controls the knobs: right
- advances the endoscope: right
- water and suction: left

Front 11

what are three basic tools to collect samples via the GI endoscope?

Back 11

1. foreign body forceps
2. cytology brush
3. biopsy forceps

Front 12

what is the basic 3-step procedure for advancing the endoscope?

Back 12

1. centralize the lumen
2. insufflate
3. advance only if lumen is visible

Front 13

what are 4 indications for esophagoscopy?

Back 13

1. foreign body removal
2. biopsy (mass, irregular mucosa)
3. stricture dilation
4. regurgitation with normal esophagram

Front 14

how long should food be withheld for esophagoscopy?

Back 14

12 hours - don't let them eat grass

Front 15

what is the main reason why an animal is put under general anesthesia, rather than heavily sedated, for esophagoscopy?

Back 15

restraint. The endoscope is very expensive if they bite it and break it

Front 16

besides an endotracheal tube, what else is put in the mouth of an animal receiving esophagoscopy?

Back 16

mouth speculum

Front 17

how should the patient be positioned for:
- simple esophagoscopy?
- esophagoscopy with gastroduodenoscopy?

Back 17

- esophagoscopy: any position
- gastroduodenoscopy: left lateral recumbency

Front 18

if performing gastroduodenoscopy, what extra precautions, versus simple esophagoscopy, should be taken before the procedure?

Back 18

1. prolonged fast if delayed gastric emptying
2. avoid narcotics in premedication: sphincters

Front 19

when an animal is placed in left lateral recumbency and anesthetized for gastroduodenoscopy:
- how is the ET tied?
- where is the mouth gag placed?

Back 19

- ET tied around muzzle, not behind the head
- gag on left (down) side of animal

Front 20

what is the procedure for esophagoscopy after the animal is anesthetized and until you reach the gastroesophageal sphincter?

Back 20

1. pull out tongue
2. insert 20 cm of endoscope via tough to enter esophagus
3. insufflate/centralize/advance
4. insufflate constantly until you reach GES

Front 21

once you reach the gastroesophageal sphincter in esophagoscopy, how do you enter the stomach?

Back 21

1. 30° directional change at the GES
2. centralize to lumen of sphincter
3. insufflate, push gently
4. four directional turns of the control knobs to enter the lumen of the stomach

Front 22

what are six aspects of the appearance of the normal esophagus when performing esophagoscopy?

Back 22

1. mucosa - light tan, smooth, very tough
2. tracheal indentation
3. pulsation of heart/major arteries
4. empty lumen
5. GES is closed
6. cats only: distal 1/3rd has transverse folds

Front 23

what is the primary diagnostic procedure for regurgitation?

Back 23

radiographs/fluoroscopy

Front 24

what are 7 indications of gastroduodenoscopy?

Back 24

1. chronic wasting
2. acute hematemesis - moderate/severe
3. removal of gastric foreign body
4. PEG tube placement
5. chronic small bowel diarrhea
6. protein losing enteropathy
7. anorexia/unexplained weight loss

Front 25

what is known as the "gastric lighthouse"?

Back 25

angularis incisura

Front 26

when scoping the stomach, what should you do before insufflation?

Back 26

evaluate the rugal folds

Front 27

when you locate and pass over the angularis incisura, how do you advance the scope to the antrum/pylorus?

Back 27

angle the scope tip down (large knob clockwise)

Front 28

in a gastroduodenoscopy, when do you obtain gastric biopsies?

Back 28

after you have scoped the duodenum

Front 29

what are 5 places/things to biopsy in a gastroduodenoscopy?

Back 29

1. lesions
2. duodenum - 6 samples
3. angularis incisura
4. cardia
5. body, along the greater curvature

Front 30

with gastroduodenoscopy, what sample(s) do you collect for suspected
- Giardia?
- Helicobacter
- SIBO?

Back 30

- Giardia: duodenal infusion/aspirate
- Helicobacter: gastric biopsy for cytology or CLO-helicobacter test
- SIBO: duodenal aspirate for quantitative aerobic/anaerobic culture

Front 31

normal appearance of the stomach for endoscopy:
- Mucosa
- Rugal folds
- Cardia
- Pylorus
- Lumen
- Contractions

Back 31

- Mucosa: pink, smooth, glistening
- Rugal folds: equally tall and wide (note: antrum lacks rugal folds)
- Cardia: submucosal blood vessels visible with distension
- Pylorus: variable appearance
- Lumen: empty - adherent white froth
- Contractions: normal when awake, 3 contractions per minute; ± abolishment of contractions under anesthesia

Front 32

what type of medication should be avoided for gastroduodenoscopy?

Back 32

narcotics

Front 33

in a gastroduodenoscopy, once you have entered the pyloric antrum by passing over the angularis incisura, how do you enter the duodenum?

Back 33

1. align to center of pylorus and make mucosal contact, which will "red out" the viewer on the scope
2. insufflate and advance with gentle pressure
3. gently rotate the control knobs, looking for the lumen
4. repeat alignment
5. dorsal recumbency
- may need pharmacologic manipulation to open the sphincter

Front 34

normal appearance of the duodenum for gastroduodenoscopy:
- Mucosa
- Structures Present
- Lumen

Back 34

- Mucosa: tan/gray, granular, more friable than stomach
- Peyer's patches and duodenal papillae
- lumen empty ± small amount of bile

Front 35

after viewing the duodenum via gastroduodenoscopy, how do you view the fundus of the stomach?

Back 35

1. scope tip in the full up position
2. withdraw insertion tube
3. clockwise and counter-clockwise torque to view the fundus (because scope will partially obscure the view)

Front 36

in gastroduodenoscopy, what parts of the duodenum do you not biopsy?

Back 36

1. major and minor duodenal papillae
2. Peyer's patches

Front 37

what are five precautions with regards to air and liquids in a gastroduodenoscopy?

Back 37

1. avoid overdistension
2. suction air and residual fluid
3. esophagus - suction refluxed fluid
4. pharynx - inspect/suction around endotracheal tube
5. oral cavity - wipe out right cheek pouch