ESOPHAGOGASTRODUODENOSCOPY

ESOPHAGOGASTRODUODENOSCOPY

ESOPHAGOGASTRODUODENOSCOPY

ESOPHAGOGASTRODUODENOSCOPY

ESOPHAGUS

ESOPHAGOGASTRODUODENOSCOPY

ESOPHAGOGASTRODUODENOSCOPY

STOMACH

ESOPHAGOGASTRODUODENOSCOPY

ESOPHAGOGASTRODUODENOSCOPY

DUODENUM

ESOPHAGOGASTRODUODENOSCOPY

ESOPHAGOGASTRODUODENOSCOPY

VISUALIZE

Esophagogastroduodenoscopy (EGD) is a type of endoscopic procedure that permits direct visualization of the upper GI tract using an endoscope (an illuminated optic instrument for the visualization of the interior of a body cavity or organ).

Philip Bozzini – created the Litchleiter to examine the urinary tract, rectum and pharynx.

Antoine Jean Desormeaux – developed the instrument used to examine the urinary tract and bladder. (“Endoscope”)

• Dr. Adolph Kussmaul - succeeded in taking a look inside the stomach of a living human body for the first time

• Dr. Rudolph Schindler invented a flexible gastroscope, that allowed examinations even while the tube is bent.

This procedure is useful for examining clents who have:

1.esophageal, gastric, or duodenal abnormalities (ex. Gatroesophageal reflux disease)

2.acute or chronic GI bleeding3.pernicious anemia4. masses,

5. Strictures 6. dysphagia 7. substernal pain 8. epigastric discomfort 9. inflammatory bowel disease.

PROCEDURE

Endoscope

Biopsy Forceps Cytology Brush

Pre-procedure Care and Nursing Considerations

• Perform a complete history and perform a physical examination to determine whether EGD is appropriate.

• Certain medications (such as aspirin and NSAIDS) should be discontinued at least seven days before an EGD to reduce the risk of bleeding.

• Clients undergoing endoscopic procedures require a signed consent.

• If the client is going home within 24 hours after the procedure, someone should be available to drive.

• For clients with a history of cardiac valve disease or replacement, antibiotic prophylaxis may be required.

• To prevent aspiration of stomach contents into the lungs, keep the client NPO for 8 to 12 hours before the procedure. Assess the oral cavity, and report any loose teeth or lesions to the gastroenterologist.

• Remove the client’s dentures and any removable bridges.

• Even with anesthesia, the client may experience some discomfort, nausea, or pressure. Tell the client to breathe through the nose during the procedure.

• Explain that the room will be cool and dark and that he or she will not be able to talk while the endoscope is in place.

• The patient should be in NPO for 6-8 hours prior to the procedure

Intraprocedure Care

• During the procedure, monitor for cardiac and respiratory complications.

• Specific antagonists to benzodiazepines and opioids should be available for emergency reversal of drug effects.

Postprocedure Care

• To prevent aspiration, place the client in the Sims position until the sedation and local anesthesia wear off. Withhold fluids and solids for 2 to 4 hours after the procedure or until the gag reflex returns. Test for return of the gag reflex by stroking the back of the client’s throat with a tongue blade to determine whether gagging occurs. Once the gag reflex returns, the physician may order anesthetic throat lozenges or normal saline gargles to ease throat irritation or hoarseness.

• Monitor for bradycardia or other dysrhytmias that may occur as a result of sedatives or anesthetics.

• Assess for signs of esophageal or gastric perforation. Esophageal perforation may cause crepitus (crackling) in the neck (from air leakage), fever, bleeding, or pain.

Complications:1.Bleeding

2.Infection

3.Perforation

4.Cardiopulmonary problems

An abnormal EGD may be the result of:

Celiac disease - Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food.

• Esophageal rings - a thin band of tissue that encircles the lining of the esophagus.

• Esophageal varices (a sign of end-stage liver disease) - a complex of longitudinal tortuous veins at the lower end of the esophagus, enlarged and swollen

• Esophagitis – inflammation of the mucosal lining of the esophagus

• Gastroesophageal reflux disease - – backflow of contents of the stomach into the esophagus

Lower esophageal ring - abnormal ring of tissue that forms where the esophagus and stomach meet.

• Inflammation of the stomach and duodenum

• Mallory-Weiss syndrome - tear in the esophagus

• Strictures or narrowing of the esophagus

• Tumors or cancer in the esophagus, stomach, duodenum (first part of small intestine)

• Ulcers - gastric (stomach) or duodenal (small intestine)

• Zenker diverticula (abnormal pouches in the lining of the intestines)

PrecautionsUpper GI endoscopy should not be

performed in clients with:• Severe cardiovascular disease• Severe upper gastrointestinal

bleeding• History of bleeding disorders

such as platelet dysfunction or hemophilia

• Esophageal diverticula• Suspected perforation• Recent UGI surgery