Endoscopy: Reflection of Body Cavities

During an endoscopy, the doctor inserts a probe and optics into a body cavity. Depending on the region, for example, there are lung, stomach, intestinal or abdominal reflections

Endoscopes are rigid or flexible depending on the cavity

Depending on the body region, either rigid probes or flexible tubes are suitable as endoscopes. The optics at the top can in the simplest case consist of a mirror as in the indirect laryngoscope reflection. Often these days, however, these are high-quality miniature cameras that transmit the image to a monitor in real time during the procedure.

There are types of endoscopy in which the doctor introduces the endoscope through a natural body opening: he can control the larynx, lungs and stomach via the nose or mouth, the large intestine via the anal opening, the bladder via the urethra. Other types of endoscopy require small cuts in the skin to reach the area. Examples include joints or the abdominal cavity.

Interventions by endoscopic tools possible

An endoscopy is not only for the examination, but the doctors can also perform interventions: In tube-like endoscopes they introduce tools such as pliers and milling directly through the tube. In the context of joint reflections and laparoscopy, the doctor creates a skin incision a second or third access, in order to use his tools effectively. Physicians can use a bronchoscope to flush the lungs, a so-called bronchial lavage, and then aspirate the liquid used again.

The procedures in detail:

    1. Laryngoscopy (laryngoscopy)

The doctors distinguish between indirect and direct laryngoscopy. In indirect laryngoscopy, the doctor holds a small mirror and style in the pharynx while the patient is awake. In this way he can look at the vocal folds. The direct laryngoscopy, the doctor can perform only in an unconscious or anesthetized patient. Depending on the project, he uses either an intubation or a surgical laryngoscope. The spatula-shaped intubation laryngoscope is used for the correct placement of a breathing tube. With the tubular surgery laryngoscope the doctor performs interventions on the larynx.

    1. Lung reflection (bronchoscopy)

If x-ray and computed tomography of the lungs do not provide sufficient information, pulmonary mirroring is a possible diagnostic method. It also plays a role in the treatment, for example to extract viscous mucus. During lung reflection, the doctor inserts the endoscope over his nose or mouth. This endoscope consists of a soft, flexible tube with two to six millimeters in diameter. At the top of the hose sits a camera with light source.

    1. Gastroscopy (gastroscopy or esophago-gastro-duodenoscopy)

A gastroscopy is a method of examination, with the help of which complaints of the esophagus (esophagus), the stomach (Gaster) and the duodenum (duodenum) can be clarified. The gastroscope used in this case is an optical device in the form of a flexible plastic tube. In addition to the camera and the light source, the hose also has additional working channels. Using these channels, for example, the doctor can take tissue samples with pliers, so-called biopsies. He can also spray on the gastroscope dyes on the mucous membranes to make changes more visible. If the doctor also injects contrast medium from the duodenum into the bile ducts and the pancreatic duct, and then makes an X-ray, the procedure is called ERCP. This abbreviation stands for Endoscopic Retrograde Cholangiopancreaticography).

    1. Laparoscopy

During the laparoscopy, the doctor inserts a tubular endoscope into the abdominal or pelvic cavity through the abdominal wall to assess the internal organs. In addition to the diagnosis, laparoscopic surgery is also possible in the same procedure. In contrast to an open surgery on the abdomen, the so-called laparotomy, only a few small incisions are necessary for procedures with the laparoscope. Through these small cuts, the doctor can bring both the endoscope and the surgical equipment in the abdominal cavity. Because of the small access, one also speaks of keyhole surgery.

    1. Small intestinal reflection (capsule endoscopy)

capsule-endoscopy

The small intestine is difficult to reach by tube. Therefore, there is a special form of endoscopy with the help of a camera capsule. This capsule is only about 2.5 inches long and has a diameter of just over one centimeter. The patient ingests the capsule, which then passes naturally through the gastrointestinal tract. Meanwhile, she sparks photos outside. These images record a receiver worn by the patient during the examination. The patient can therefore move freely during the examination. Subsequently, a trained doctor evaluates the automatically recorded images. Capsule endoscopy is used primarily when it comes to the question of bleeding in the small intestine or chronic inflammatory bowel disease (Crohn’s disease).

    1. Colonoscopy (colonoscopy)

colonoscopy

A colonoscopy reveals various diseases on the colon (colon) and at the end of the small intestine (terminal ileum). In addition, it is a very reliable method to detect colon cancer and its precursors. The precursors are benign mucosal growths and are called polyps. The doctor can also remove these polyps by means of colonoscopy. To prepare for the exam, the patient must remain sober the day before at noon and take laxative as prescribed by the physician. If the examination only covers the lowest sections of the colon, no oral laxatives are necessary. Depending on the extent of the examination, the doctor then talks about proctoscopy, rectoscopy or sigmoidoscopy

    1. Bladder reflexion (cystoscopy)

In the case of cystoscopy, the doctor examines the lower urinary tract with a special examination device (cystoscope). The lower urinary tracts include the urethra and the bladder. With cystoscopy, the doctor can detect and assess changes such as urethral narrowing, enlargement of the prostate, changes in bladder sphincter function, tumors or bladder stones. If necessary, minor surgical interventions in the context of a bladder reflex are possible with anesthesia. In ureteroscopy, the doctor also examines the ureters, which transport the urine from the kidneys to the bladder.

    1. Articulation (arthroscopy)

Joint Surgery is a surgical procedure in which the physician inserts an endoscope into the joint cavity. This intervention can serve both the diagnosis and the treatment. However, the need for diagnostic arthroscopy has declined significantly due to the further development of magnetic resonance imaging. Therapeutic arthroscopy, on the other hand, can often replace major surgery, for example when replacing a torn ACL in the knee joint.

    1. Endoscopy of other parts of the body

endoscopy-of-other-parts-of-the-body

Also, a reflection of the salivary glands is possible, the ENT specialist then speaks of a sialendoscopy. He can examine the nose and paranasal sinuses by means of a sinus copy. He examines the ear by ear funnels and calls it otoscopy. He can clarify the causes of snoring by means of somnoendoscopy (a kind of pharyngeal reflection) under anesthesia.

The examination of the ocular fundus is called ophthalmoscopy, although the ophthalmologist uses only a concave mirror, magnifying glass or slit lamp in front of the eye.

Gynecologists reflect vagina and cervix with a colposcopy. The uterus is examined by hysteroscopy and the breast ducts by a ductoscopy.

Bronchoscopy: Reflection Of The Lungs

The doctor can use the bronchoscope to examine the lungs and airways. In addition, the method helps in the treatment, for example, to extract viscous mucus. During lung reflection, the doctor introduces a bronchoscope into the airway via the mouth or nose. Modern bronchoscopes consist of a soft, flexible tube with a diameter of two to six millimeters. At the top of the tube sits a camera with light source. This camera sends its images in real time to a monitor on which the doctor examines the patient’s airways.

In addition, the bronchoscope can inject and aspirate liquid and thereby perform a so-called bronchial lavage. In addition, very small pliers or brushes can be advanced through the tube and tissue samples taken. These biopsy specimens will be examined later by the doctor under a microscope. In addition, a miniature ultrasound head can image the environment of the airways.

For what reasons does the doctor perform a bronchoscopy?

A bronchoscopy may be necessary for both treatment and diagnosis, for example if there is suspicion of lung cancer in the room or if treatment is to be scheduled for a known lung tumor. Doctors can also use this method to introduce radioactive substances into the lungs in order to irradiate tumors locally. Restrictions of the respiratory tract can be clarified by bronchoscopy. Similarly, the doctor can investigate reduced ventilation of partial areas of the lung, so-called atelectasis. With the lung reflection and bronchial lavage cells and germs can also be extracted from the lungs.

bronchoscope-to-examine-the-lungs

Doctors also use lung plasmas to look for and remove foreign bodies. In ventilated patients, the position of the breathing tube can also be corrected with it. In addition, secretions such as mucus plugs can be washed away with the bronchoscope and inserted so-called stents, which seemed to the airways from the inside and keep them open.

How is an examination with the bronchoscope going?

On the day of the examination the patient comes sober. He receives a spray that stuns the throat and suppresses the gagging. Then, the patient is virtually always injected with a short narcotic into the vein, so that he feels nothing at all from the examination. If necessary, sedatives are also used.

The doctor introduces the bronchoscope through the mouth or nose into the trachea. Afterwards, he examines the mucous membrane of the airways, which can be imagined as a “bronchial tree” with more and more ramifications. The doctor examines all bronchi to a maximum of the third or fourth diversion. This usually takes 10 to 15 minutes. The airways themselves are insensitive to pain.

If a bronchial lavage is needed, the doctor injects about 20-100 milliliters of sterile fluid into the lower respiratory tract and then sucks it off. It extracts bacteria and cells from the surface of the respiratory tract and subsequently examines them in the laboratory.

After the examination, the patient should abstain from eating and drinking for about two hours until the anesthetic of the throat has subsided. Otherwise there is a risk of swallowing. If the patient has been given tranquilisers or anesthesia, they are not allowed to drive the same day.

What other types of bronchoscopy are there?

In addition to the lung reflection with a flexible tube, there is still the investigation with a rigid tube. This tube can, for example, better remove foreign matter from the lungs. Even if a tumor severely restricts the airways, rigid bronchoscopy has advantages. Sometimes the doctor can remove tumors directly using laser devices or argon bombers. Argon beamer are coagulation devices that transfer energy via argon gas and soil the tissue two to three millimeters deep. The doctor uses them to destroy tissue and stop bleeding. If he has to use stents to stretch a constriction, it works better with the rigid bronchoscope.

Is a bronchoscopy dangerous?

The bronchoscope may cause nosebleeds or sore throat with difficulty swallowing, hoarseness or coughing, and very rarely injure the larynx. Even short-term fever sometimes occurs afterwards, especially in lavages. Severe incidents are very rare in bronchoscopy.

Removing the tissue samples may cause slight bleeding. Therefore, one should expect in the first two days that you abhustet blood to a small extent. Every now and then, the bleeding is so severe that they have to be breastfed by the endoscope.

In some cases, injury to the alveoli causes the lungs to leak and form a so-called pneumothorax. This means that air flows into the space between the lungs and the surrounding lung cavity and causes the feeling of being short of air. Then, if necessary, the application of a chest tube is necessary: ‚Äč‚ÄčThis plastic tube through the chest wall conveys the infiltrated air to the outside.

Possible exclusion reasons

A bronchoscopy can be problematic in generally very poor condition or serious comorbidities: If a heart failure or an acute myocardial infarction present, the function of the lungs massively reduced or the blood clotting are disturbed, you should consider the need for the investigation carefully and together with the doctor benefits and consider possible disadvantages.

Possible exclusion reasons

A bronchoscopy can be problematic in generally very poor condition or serious comorbidities: If a heart failure or an acute myocardial infarction present, the function of the lungs massively reduced or the blood clotting are disturbed, you should consider the need for the investigation carefully and together with the doctor benefits and consider possible disadvantages.