LOWER GI ENDOSCOPY IN SURGICAL PRACTICE.pptx

Lower gi endoscopy in surgical practice

1. LOWER GI ENDOSCOPY IN SURGICAL PRACTICE BY:DR.GHAIYOOR AHMED PGT-1 M.S. GENERAL SURGERY

2. WHAT IS ENDOSCOPY? Endoscopy is Greek word “ Endo”means inside “ Skopeein”means to see Examination of the interior of a canal or hollow viscus by means of a special instrument known as endoscope Direct viewing interior of an organ is very helpful in determining the cause of disease and helps in diagnosis

3. PARTS OF ENDOSCOPE A thin long tube - rigid or flexible A lens / lens system A light transmitting system Eyepiece Control system Channel through which tiny instruments such as scissors can be manipulated

4. Colonoscope

5. TYPES OF ENDOSCOPY Upper GI Endoscopy Enteroscopy Lower GI Endoscopy(colonoscopy)

6. Endoscopy Principle It is a minimally invasive diagnostic procedure for evaluation of interior surface of an organ Endoscope may be rigid or felixible tube inserted into body cavity which looks inside the body using a variety of small cameras attached to flexible or rigid tube An endoscope equipped with lens and light source Illumination is done by help of numbers of optical fibers Video endoscopy is performed byattaching microchip camera at the insertion tube setup image viewed on a video monitor

7. Colonoscopy procedure

8. TOOLS FOR EXAMINATION OF LOWER GI Anoscope-10cm Proctoscope-13cm Rectoscope (Rigid sigmoidoscope)25cm Flexible sigmoidoscope-60cm Colonoscope-110-140cm

9. COLONOSCOPY Introduction: Colonoscopy is a procedure to see inside the colon and rectum. It is helpful to diagnose unexplained changes in bowel habbit,abdominal pain ,bleeding per rectum and weight loss. It also helpful for looking early signs of colorectal cancer

10. INDICATION OF COLONOSCOPY Lower GI bleeding Screening and surveillance of colorectal polyp and cancer a)colon cancer b)surveillance after polypectomy, c) colorectal cancer post resection surveillance d)IBD Acute and chronic diarrhoea Therapeutic indication for colorectal cancer

11. Therapeutic Indication a)excision and ablation of lesion b)treatment of lower gi bleed c)colonic decompression d) dialation of colonic stenosis e)foreign body removal Miscellaneous indication a)abnormal radiological examination i.e RIF mass in usg s/o colonic origin b)unexplained abdominal pain

12. CONTRA INDICATION OF COLONOSCOPY Inadequate bowel preparation Uncoperative patients Patients refusal Inadequate sedation Known or suspected colonic perforation Clinically unstable patients Recent MI Peritonism

13. COMPLICATION AND RISK Risk of perforation Infection Injury of blood vessel causing bleeding More complication arise from therapeutic colonoscopy i.e polypectomy

14. COLONOSCOPY PREPARATION Emptying the content of the colon is the key requirement for successful colonscopy If bowel preparation is not adequate polyp and lesion can be missed Advise low fiber diet few days before colonoscopy Avoid solid food day before colonoscopy On the day of colonoscopy only clear fluid is advise. Dissolve 1 packet of PEG in 2lts of fluid and asked pt to consumed Give sodium picu sulphate enema.

15. Pt will purge several time so bowel will get clean Colonoscopy can be done under iv sedation.

16. BASIC RULES OF COLONOSCOPY Don’t advanced the endoscope without the clear view of the lumen Don’t advanced the endoscope if there is any resistance When in doubt pull back Use a little air as possible and as much air as necessary Pay attention to pts pain reaction

17. Abnormal Findings in Colonoscopy

18. Therapeutic use of Colonoscopy

19. Snare Polypectomy

20. Endoscopic Mucosectomy

21. SEMS- for Malignant Strictures

22. Haemostasis in Colorectal Pathologies

23. Removing Foreign Bodies

24. Sigmoidoscopy Sigmoidoscopy  is the  minimally invasive   medical  examination of the large  intestine  from the  rectum  to sigmoid colon . Types of sigmoidoscopy:  flexible sigmoidoscopy , which uses a flexible  endoscope rigid sigmoidoscopy , which uses a rigid device. Flexible sigmoidoscopy is generally the preferred procedure. A sigmoidoscopy is similar to, but not the same as, a  colonoscopy . A sigmoidoscopy only examines up to the  sigmoid , the most distal part of the colon, while colonoscopy examines the whole large bowel

25. Flexible sigmoidoscopy With flexible sigmoidoscopy, the physician can see  intestinal bleeding ,  inflammation , abnormal growths, and  ulcers  in the descending colon and rectum. the sites which can be observed represent areas which are most frequently affected by diseases such as  colorectal cancer , for example the  rectum . Flexible sigmoidoscopy takes 10 to 20 minutes.. Preparation same as Colonoscopy

26. Rigid sigmoidoscopy Rigid sigmoidoscopy may be useful in ano -rectal diseases such as bleeding per rectum or inflammatory rectal disease, particularly in the general practice and pediatrics. P osition of rigid sigmoidoscopy- Sims' position . The bowels are previously emptied with a  suppository , and a  digital rectal examination  is first performed. The sigmoidoscope is lubricated and inserted with  obturator  in general direction of the  navel . The direction is then changed and the obturator is removed so that the physician may penetrate further with direct vision. A  bellows  is used to insufflate air to distend the rectum. Lateral movements of the sigmoidoscope's tip negotiate the  Houston valve  and the  recto-sigmoid junction .

27. Rigid Sigmoidoscopy

28. Flexible Sigmoidoscopy