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Gastrointestinal endoscopy

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Abstract

PLEASE NOTE THAT A MORE RECENT EDITION OF THIS TITLE IS AVAILABLE IN THE LIBRARY

The history and the physical examination of a patient indicates to the clinician the probable region of the gastrointestinal (GI) tract responsible for clinical signs. Further investigations using plain and contrast radiography, ultrasonography and functional tests may permit a tentative diagnosis to be made. However, these investigative procedures rarely permit a definitive diagnosis. Until recently clinicians have been limited in their ability to diagnose GI disease morphologically because of the need to carry out an exploratory laparotomy in order to obtain biopsy samples, where such a procedure may compromise an already seriously ill patient. The ability to pass a flexible endoscope directly into the GI tract and visualize the mucosa for gross abnormalities and collect biopsy samples without resorting to surgery have revolutionized gastroenterology. This chapter explains Flexible endoscope design; Components of the endoscope; Care and cleaning of endoscopes; Common problems encountered during endoscopy; Biopsy collection; Patient preparation for the upper GI endoscopy; Oesphagoscopy; Gastroscopy; Enteroscopy; Ileoscopy; and Colonoscopy.

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Figures

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4.1 Rigid endoscopes can be used for examination of the oesophagus, removal of oesophageal foreign bodies and examination of the rectum.
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4.2 There would be a loss of light passing along non-clad fibres due to the absence of suitable cladding around the fibre. This is why only light is transmitted down non-clad fibres, while the more expensive clad fibres are used to transmit the image.
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4.3 Flexible endoscope including the insertion tube, handpiece and umbilical cord.
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4.4 The handpiece of a flexible endoscope carries various important operational controls.
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4.5 The tip of the insertion tube can be rotated through 90 degrees in three planes and 180 degrees in one plane.
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4.6 One-handed manipulation of the headpiece. All endoscopists need to learn this technique.
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4.7 There are two types of end piece available for flexible endoscopes. The end-viewing tip is more popular and is used for the majority of examinations, where the endoscopist wishes to see directly forward. The side-viewing endoscope is designed to allow good visualization of the wall of the bowel and to assist in catheterizing ducts, such as the bile duct. It is rarely used in small animal practice.
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4.8 Two types of halogen cold light source designed for fibreoptic endoscopes.
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4.9 Two types of suction unit that can be used with flexible endoscopes.
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4.10 There are various types of biopsy forceps cups that can be used to collect samples. This figure shows biopsy forceps, with and without a central spike, which are commonly used for biopsy collection.
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4.11 Basket forceps which can be used to retrieve gastric foreign bodies with the endoscope.
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4.12 ‘Red out’ occurs whenever the endoscope is passed through a sphincter or comes up against the mucosal surface.
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4.13 Gastric biopsy site and biopsy forceps as seen through the endoscope.
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4.14 The patient is placed in left lateral recumbency with the endotracheal tube tied to the mandible and with the mouth gag in place. The flexible endoscope can now pass easily along the hard palate and into the pharynx.
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4.15 Endoscopic view of the pharynx. The laryngeal opening (white arrow) and the lateral fold of the larynx (black arrow) are visible.
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4.16 View along the length of a normal cranial oesophagus.
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4.17 Annular rings seen in the caudal oesophagus of all cats.
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4.18 The cardia high pressure zone, separating the oesophagus from the stomach.
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4.19 Large cavernous oesophagus associated with megaoesophagus.
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4.20 Oesophageal foreign body lodged in the caudal oesophagus.
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4.21 Reflux oesophagitis with gastric secretions, lying in the oesophagus.
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4.22 Oesophageal stricture showing changes to the mucosal colour due to fibrosis.
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4.23 Oesophageal tumour. These are rare in dogs and cats.
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4.24 Normal gastric fundus showing the rugal folds. (Diagram reproduced from with permission from Elsevier.)
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4.25 The images show a view of the angular incisure on the lesser curvature of the stomach. This is a very important endoscopic landmark. (Diagram reproduced from with permission from Elsevier.)
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4.26 The angular incisure becomes more prominent as the stomach becomes distended with air.
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4.27 Retroflexed view of the gastric cardia with the endoscope clearly visible entering the stomach. (Diagram reproduced from with permission from Elsevier.)
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4.28 Over-distension of the stomach will result in the angular incisure closing over the antrum, leading to difficulty in intubating the antral canal and pylorus. (Reproduced from with permission from Elsevier.)
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4.29 The pylorus can usually be visualized with the endoscope in the antral canal. Often the pylorus is closed, but here it is open. Some bile-stained fluid can be seen in the antral canal.
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4.30 Some of the mucosal changes which may be observed individually, or in combination, in animals with gastric carcinoma. (a) Large gastric ulcer at the entrance to the antrum. (b) Mass and pigmentation. (c) Proliferative mass. (d) Loss of normal architecture. (e) Colour change to the mucosa.
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4.31 A flexible endoscope made with a 1.6 metre insertion tube, permitting the jejunum to be examined in dogs and cats. (Courtesy of Guide Dogs for the Blind)
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4.32 Normal duodenal mucosa has a ‘velvet’ appearance due to the presence of thousands of intestinal villi. (Diagram reproduced from with permission from Elsevier.)
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4.33 Biopsy of the ileum can be carried out via the colon.
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4.34 View along the descending colon from the rectum.
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4.35 The splenic flexure can be clearly seen, indicating the end of the descending colon and the start of the transverse colon.
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4.36 In the normal dog or cat, colonic submucosal blood vessels can be easily seen. This is not an indication of inflammation.
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4.37 Ulcerative colitis in the dog.
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4.38 Rectal adenoma obstructing the lumen of the rectum.

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