Term
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Definition
- refers to the visual examination of any cavity of the body by means of an endoscope.
- Endoscopes used in veterinary medicine for examination of the gastrointestinal tract are either rigid or fully flexible fiberoptic or video endoscopes. |
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Term
| List some uses for endoscopy in small animals. |
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Definition
- exam of the inside of the GI tract and the obtaining of pinch biopsies (small pieces of tissue) from various regions of the esophagus, stomach, small intestine, or colon
- The retrieval of foreign bodies (bones, rocks, rawhides, etc.) that have lodged in the esophagus, stomach, or intestine.
- The evaluation of animals that have difficulty swallowing, regurgitation, chronic vomiting, or chronic diarrhea
Other than anesthetic considerations there are no absolute contraindications (reasons not to do this test) to performing gastrointestinal endoscopy. Gastrointestinal endoscopy is discouraged in animals that are not adequately fasted or in animals with bleeding disorders. |
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Term
| List some possible complications in performing gastrointestinal endoscopy. |
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Definition
- Perforation of the gastrointestinal wall, with resultant infection of that area (mediastinitis, pleuritis, or peritonitis).
- Overdistension of the stomach with air during the procedure can cause the stomach to turn on itself or can result in a drop of blood pressure
- Rupture of major blood vessels can occur during removal of foreign bodies
- These and other complications are actually uncommon, and information gained from this procedure can be helpful.
- Obviously, one of the great benefits of endoscopy is avoiding surgery, which is much more invasive.
- It is not unusual to note a dark discoloration to the stool for 24 to 36 hours after obtaining intestinal biopsies because of mild bleeding associated with tissue collection. This is typically self-limiting and does not warrant gastric protectants such as Zantac or Pepcid AC. |
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Term
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Definition
| - examination of the colon with a flexible endoscope and is indicated for animals with persistent straining to defecate, or animals with excessive mucus or obvious blood in their stool. |
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Term
| Why are fleet enemas not recommended in preparation for a colonoscopy on a dog? |
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Definition
- Fleet enemas and rectal administration of bisacodyl laxatives both alter protoscopic and histologic appearance of the mucosa.
- Fleet enemas have been associated with fatal hyperphosphatemia and hypernatremia in cats. |
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Term
| What can be a complication of the stomach after an endoscopic procedure? |
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Definition
- It is not unusual to note a dark discoloration to the stool for 24 to 36 hours after obtaining intestinal biopsies because of mild bleeding associated with tissue collection.
- typically self-limiting and does not warrant gastric protectants such as Zantac or Pepcid AC. |
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Term
| List some reasons for performing an endoscopy on dogs. |
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Definition
- exam of the inside of the GI tract and the obtaining of pinch biopsies (small pieces of tissue) from various regions of the esophagus, stomach, small intestine, or colon
- The retrieval of foreign bodies (bones, rocks, rawhides, etc.) that have lodged in the esophagus, stomach, or intestine.
- The evaluation of animals that have difficulty swallowing, regurgitation, chronic vomiting, or chronic diarrhea
- Other than anesthetic considerations there are no absolute contraindications (reasons not to do this test) to performing gastrointestinal endoscopy. Gastrointestinal endoscopy is discouraged in animals that are not adequately fasted or in animals with bleeding disorders.
- facilitate dilation and differentiation of esophageal strictures (from gastroesophageal reflux, esophageal foreign bodies, neoplasia, and the ingestion of caustic substances)
- facilitating placement of stomach feeding tube (percutaneous endoscopic gastronomy tube) for long-term nutritional support of anorectic animals, megaesophagus, difficulty swallowing |
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Term
| Describe the two basic types of endoscopes. |
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Definition
- two basic types – rigid and flexible
- Rigid endoscopes are used for arthroscopy, laparoscopy, thoracoscopy, and rhinoscopy (especially evaluation of the sinuses). An external light source provides illumination for the procedure.
- The insertion tube is made of metal and should not be bent or flexed.
- The operator can observe directly through the eyepiece, but more commonly a video camera and screen are used for viewing.
- Rigid endoscopes are relatively short in length (most are <18 inches) compared to flexible endoscopes, which are up to 3 m (9 feet) long.
- The flexible fiberoptic endoscope is basically a flexible, nonmetallic tube that houses two bundles of fibers; one bundle carries light from an external, stationary light source to the tip of the endoscope, and the other bundle returns a visual image from the tip back to the operator's eyepiece.
- The tube also contains a system of wires and interlocking rings that allow the tip to be moved or deflected in different planes; this allows the endoscope to be directed around curves and corners and provide views in multiple directions.
- Most endoscopes have additional internal channels for passing instruments (such as biopsy or grasping forceps) and channels for air, water, and/or suction systems |
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Term
| What are the three main parts of the flexible endoscope? |
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Definition
- control handpiece, insertion tubing, light guide cable
- control handpiece contains the eyepiece, deflection knobs, air, suction and water controls, and entrances to instrument channels.
- insertion tubing is the long tube that is inserted into the patient; it is usually marked with gradations for length at 10 cm intervals.
- The light guide cable connects the control handpiece to the external light source and transmits light to the light fiber bundle |
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Term
| What is the job for the assistant when an endoscope is performed? |
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Definition
- support and advance the insertion tubing into the patient, under the guidance of the operator.
- Since endoscopy is usually performed on standing, awake horses, additional staff may be required to restrain the patient. |
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Term
| What is the most common use of the endoscope in equine practice? |
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Definition
- examination of the upper respiratory tract.
- usually performed with the horse at rest, using a treadmill, a dynamic examination can now be performed to visualize problems that may not be apparent at rest
- Upper respiratory examinations are conducted by introducing the endoscope through a nostril and passing it through the nasal cavity; most horses resent this procedure and must be physically and/or chemically restrained. The procedure is similar to nasogastric intubation, and the same safety precautions used for nasogastric intubation should be followed whenever the endoscope is introduced through the nares. |
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Term
| What is the indication for using endoscopy for a Gastroscopy on a horse? |
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Definition
- to assess gastric ulceration in horses
- Standard endoscopes (<110 cm) are not long enough to reach the stomach except perhaps in miniature horses and young foals; for adults, a scope 3 meters long is recommended.
- Endoscopes for gastroscopy are therefore more expensive than standard scopes.
- endoscope is passed through a nostril to the pharynx and then down the esophagus to the stomach, similar to the path used for nasogastric intubation.
- Once the endoscope tip is in the stomach, the stomach is inflated with air to facilitate visualization; this may produce some patient discomfort
- Gastroscopy requires patient fasting before the examination and sedation during the examination for best results. |
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Term
| How long should an endoscope be to reach the stomach in a horse? |
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Definition
| - Standard endoscopes (<110 cm) are not long enough to reach the stomach except perhaps in miniature horses and young foals; for adults, a scope 3 meters long is recommended |
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Term
| What is the maintenance to care for the endoscope? |
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Definition
- inspected before each use for cracks in the external surface of the insertion tubing and debris on the tip.
- Damage to the fiber bundles is assessed by looking through the eyepiece; if the image is blurred or dim, and cleaning the lenses and adjusting the eyepiece focus do not improve the image, it is likely that fiber damage has occurred. The endoscope should not be used if it is damaged; repairs are necessary.
- Mobility of the tip should be checked by turning the deflection knobs and watching the response of the tip; do not manually bend the tip to check its mobility.
- Deflection cables can stretch or even break; if the scope does not bend appropriately, the deflection cables may need to be replaced.
- All connections of the endoscope to the light source, including air, water, and suction systems, should be checked before use.
- The water source should be filled before the examination; distilled water is preferred to tap water. In some cases, sterile fluids may be indicated. |
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Term
| What is the most important rule for handling an endoscope? |
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Definition
- never to bend any part of the tubing at an acute angle and never twist or crush the insertion tubing.
- Sharp bending and/or twisting can break fibers. Likewise, compression can break fibers.
- Broken fibers cause small black dots (pixels) to appear on the image, and if the image is compromised by the black dots, expensive repairs will be necessary to replace the fiber bundles.
- An important note to remember is that cold conditions increase the likelihood of fiber breakage. |
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Term
| How to clean an endoscope after an exam |
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Definition
- Immediately after an endoscopic examination, the equipment should be cleaned thoroughly.
- Secretions, lubricants, and medications can dry and crust on the outer surface and tip of the insertion tube and clog the tube's internal channels. The manufacturer's specific cleaning instructions should be followed.
- The external surface of the endoscope tubing can be cleaned with water and mild surgical soap, using a soft cloth or soft brush.
- Cotton swabs can be used to clean the tip of the scope, especially the lenses and channel openings.
- The internal channels of the scope are cleaned by immersing the tip of the endoscope in a solution of water and mild soap or mild surgical soap and then applying suction. If suction cannot be applied, cleaning solutions can be flushed through the channels with large syringes. A channel cleaning brush (provided with the scope) is used to further clean the instrument channels of debris. All soap should be thoroughly rinsed before storing the scope or using it on another patient. Clean water or distilled water is then used for a final rinse of the channels. Residual water should be flushed from the channels with an air flush or air suction.
- Endoscope control handpieces are either fully immersible or nonimmersible. Immersible scopes can be placed in disinfecting solutions or water after protective caps are placed on the handpiece.
- The control handpiece on nonimmersible scopes should not get wet and must be cleaned with a damp cloth.
- The outside of the instrument should be dried with a soft towel, and the endoscope hung to dry. The drying rack should support the control handpiece and allow the insertion tubing to hang vertically for gravity drainage.
- If disinfection is necessary, the manufacturer's recommendations for acceptable disinfectant solutions should be followed. A tray, plastic basin or clean sink can serve as a reservoir for the disinfectant solution, allowing the endoscope tubing to be loosely coiled and immersed in the disinfectant for the appropriate contact time.
- Disinfecting solutions cannot substitute for proper physical cleaning of the
instrument.
- Sterilization may be required, especially after use on suspected infectious cases. Cold sterilization by immersing the control handpiece and insertion tube in liquid sterilizing solutions is the most common way to sterilize an endoscope. Special sterilizing basins are available for immersion of the scope. Gas sterilization with ethylene oxide may sometimes be used to sterilize an endoscope. Steam autoclaving is not a sterilizing option for the endoscope but may be possible for some of the endoscope accessories The manufacturer's recommendations for sterilization procedures should be consulted. |
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