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    Endoscopy For Undergraduates

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    buddhiprakash577
    This document discusses different types of endoscopy procedures including nasal, laryngoscopy, bronchoscopy, and oesophagoscopy. It provides a brief history of developments in endoscopy from the 19th century to present. Flexible fibreoptic endoscopy is described as safer, more comfortable for patients, and allowing for longer examinations compared to rigid endoscopy. Patient preparation, anesthesia options, and potential complications are outlined for different endoscopy procedures. Key anatomy and indications for direct laryngoscopy, bronchoscopy, and oesophagoscopy are summarized.

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    Endoscopy For Undergraduates

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    buddhiprakash577
    168 views27 pages
    This document discusses different types of endoscopy procedures including nasal, laryngoscopy, bronchoscopy, and oesophagoscopy. It provides a brief history of developments in endoscopy from the 19th century to present. Flexible fibreoptic endoscopy is described as safer, more comfortable for patients, and allowing for longer examinations compared to rigid endoscopy. Patient preparation, anesthesia options, and potential complications are outlined for different endoscopy procedures. Key anatomy and indications for direct laryngoscopy, bronchoscopy, and oesophagoscopy are summarized.

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    lecture for mbbs students

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    Endoscopy for Undergraduates

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    This document discusses different types of endoscopy procedures including nasal, laryngoscopy, bronchoscopy, and oesophagoscopy. It provides a brief history of developments in endoscopy from the 19th century to present. Flexible fibreoptic endoscopy is described as safer, more comfortable for patients, and allowing for longer examinations compared to rigid endoscopy. Patient preparation, anesthesia options, and potential complications are outlined for different endoscopy procedures. Key anatomy and indications for direct laryngoscopy, bronchoscopy, and oesophagoscopy are summarized.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    168 views27 pages

    Endoscopy For Undergraduates

    Uploaded by

    buddhiprakash577
    This document discusses different types of endoscopy procedures including nasal, laryngoscopy, bronchoscopy, and oesophagoscopy. It provides a brief history of developments in endoscopy from the 19th century to present. Flexible fibreoptic endoscopy is described as safer, more comfortable for patients, and allowing for longer examinations compared to rigid endoscopy. Patient preparation, anesthesia options, and potential complications are outlined for different endoscopy procedures. Key anatomy and indications for direct laryngoscopy, bronchoscopy, and oesophagoscopy are summarized.

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    of 27

    ENDOSCOPY

    AK Mishra MS,DNB, MNAMS

    Types of Endoscopy
    Nasal Endoscopy Laryngoscopy Rigid / Flexible Bronchoscopy Rigid / Flexible Oesophagoscopy Rigid / Flexible

    HISTORY
    Kussmaul (1868): oesophagoscopy technique from sword swallower Chevalier Jackson: Early 20th century
    Distally lighted rigid scopes Art of removal of FBs

    HH Hopkins: telescopic rod lens system Ikeda (1958): Flexible fibreoptic broncho- & esophagoscope

    Advantages: Flexible fibreoptic scopes


    Safer, more comfortable for patient Easier, More informative for physician Periphery of bronchial tree accessible Longer, more detailed examination under LA Convenient for photography & documentation

    Preparation of Patient
    Medical problems Bleeding disorders Adverse reactions to drugs Appropriate Radiographic studies Psychological preparation

    Anesthesia
    General
    in children Adults if not cooperative for rigid DL, B-scopy Rigid Esophagoscopy

    Local
    Adult rigid DL, B-scopy Flexible fibreoptic scopy

    Direct Laryngoscopy
    Is the specular examination of larynx Direct visualisation of larynx Is supplementary to IDL, not a substitute No reversal of image

    Endoscopic anatomy of larynx


    Base of tongue Glosso-epiglottic folds Epiglottis Aryepiglottic folds Pyriform sinus False vocal cords True vocal cords Subglottis

    Indications for DL
    DIAGNOSTIC: IDL is not possible or not conclusive but symptoms point to laryngeal pathology eg Persistent hoarseness(>3 wks), dyspnoea, stridor, dysphagia See hidden areas of larynx Infra hyoid epiglottis, Ant commissure, Ventricles, subglottis See hidden areas of hypopharynx Base tongue, valleculae, Lower part of pyriform fossa Neoplasms biopsy , Extent of growth Trauma to neck evaluation & possible stenting VC paralysis evaluation vs Cricoarytenoid arthritis Unknown primary with cervical mets

    Indications for DL Scopy


    Therapeutic:
    Benign neoplasms, nodules, polyps - excision Removal of FBs

    Contraindications: Dis of cervical spine Marked airway obstruction Recent cardiac decompensation

    Technique
    Boyce position ( Barking dog position)
    Neck flexed on chest by elevating head 10-15 cm Head extended on atlanto occipital jt

    Standard Laryngoscope Anterior Commissure laryngoscope Suspension laryngoscope

    Post op care
    Coma position Respiration / laryngospasm Laryngeal oedema Bleeding

    Complications: - Injury to teeth/ lips/ tongue - Bleeding - Laryngeal oedema

    Bronchoscopy- anatomy
    Trachea : 12/10 cm long
    13 x 18mm 18 C shaped rings

    Carina a sharp ridge Rt main Bronchus: 2.5 cm long, 25 degree Lt main Bronchus : 5 cm long, 45 degree Secondary bronchi-3 on Rt, 2 on Lt Tertiary bronchus: Bronchopulmonary segments

    Bronchopulmonary segments
    Rt Lung

    Apical Post Ant Lat Med Apical Med basal Ant basal Lat basal Post basal

    Lt Lung Apical-post Ant Sup Lingular Inf Lingular Apical Med basal Ant basal Lat basal Post basal

    Bronchoscopy- endoscopic anatomy


    Tracheal rings Thyroid gland- narrowing Innominate artery pulsation Arch of aorta Carina sharp vertical crest
    Moves on respiration & cardiac pulsation

    Main bronchus: Rt is larger, more of a continuation of trachea


    Expand in inspiration

    B-scopy: Indications
    In nearly all patients with respiratory diseases that are not self limited and of short duration ! A primary method of investigation in patients with diseases of respiratory system

    Bronchoscopy Indications
    Diagnostic
    Airway obstruction (e.g. tracheomalacia,

    bronchomalacia)
    Persistent/recurrent pneumonia Tracheo-oesophageal fistula Brushings for cytology Transbronchial biopsy for histology Failure to wean from ventilator Haemoptysis

    Bronchoscopy Indications
    Therapeutic
    Removal of foreign body Suctioning mucus plugs (e.g. in cystic fibrosis) Facilitate endobronchial intubation for one lung anaesthesia Laser therapy Balloon dilatation of trachea/bronchus

    Suggested ETT and rigid bronchoscope sizes for children


    Age Premature Term newborn 6 months 1 yr 2 yr 3 yr 5 yr 10 yr 14 yr Cricoid airway diameter (mm) 4.0 4.5 5.0 5.5 6.0 7.0 8.0 9.0 11.0 Tracheal tube size ID ED (mm) 2.53.0 3.54.0 3.03.5 4.04.9 3.54.0 4.95.4 4.04.5 5.46.2 4.55.0 6.26.9 5.05.5 6.97.4 5.56.0 7.47.9 6.5 cuffed 6.5 cuffed Bronchoscope size Size ID 2.5 3.2 3.0 4.2 3.0 4.2 3.5 4.9 3.5 4.9 4.0 5.9 5.0 7.0 5.0 5.0 ED 4.0 5.0 5.0 5.7 5.7 6.7 7.8

    A larger bronchoscope may be helpful if there is a large air leak and IPPV is being used.

    B-scopy - technique
    Rigid bronchoscope may be passed into main bronchi Flexible scopes may be passed upto 4th order bronchi or even distally Biopsy Bronchial washings Bronchial brushings

    Endoscopy Flexible Fibreoptic


    OPD Procedure LocalAnesthesia In cervical ankylosis, trismus Less complications

    Oesophagoscopy: Indications
    Diagnostic

    Dysphagia Neck Masses, VC paralysis Hemetemesis Oesophagitis


    FB Dilatation of Srictures Varices Stents in Malignancies

    Therapeutic

    Oesophagoscopy: Contraindications
    Perforation previously Cervical Ankylosis, Trauma Trismus Aneurysm of Aorta

    Oesophagoscopy: Complications
    Bleeding
    In Biopsy, Dilatation

    Perforation
    Cervical:
    Cervical Tenderness Surgical Emphysema

    Thoracic: (More serious)


    Pain Chest, radiating to Back Surgical Emphysema

    Recent Advances: Video Laryngoscope

    THANK YOU

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