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Proctoscope
Surgery OSCE GI
| Question | Answer |
|---|---|
| How is a proctoscope passed? | with introducer |
| what are the indications for proctoscopy/ | bleeding per rectum |
| describe proctoscope | handle, shaft, introducer. more modern proctoscope provide their own light source (with older device assistant needed to provide light |
| how is proctoscopy performed? p1 | 1. Informed consent 2. place pt in LLP knee to chest 3. drape 4. inspection 5. dre 6. lubricate scope, inform it may b uncomfy 7. line up tip of instrument towards umbilicus and place to hilt. 8, remove introducer |
| what is the use of haemorrhoids? | aid in anal continence (esp flatus) |
| why is a dre important b4 proctoscope? | in order to assess anal verge which is not visualised by the proctoscope |
| proctoscopy performed p2 | 8. remove introducer 9. when removing device (slowly) assess anal mucosa. If lesion seen, biopsy it |
| are there any painful perianal conditions that may preclude you from passing proctoscope? | yes. Anal fissure, perianal abscess, thrombosed haemorrhoid |
| What are types of sigmoidoscope? | Rigid, Flexible |
| advantage of rigid sigmoidoscope? | accuracy in measuring distance of lesion from anal verge to plan surgery |
| how do you treat rectal cancer? | 1. Local resection 2. Radiotherapy 3. Anterior resection 4. Abdominoperineal resection |
| anal canal length? | 4-5cm |
| rectum length | 12-15cm |
| how long is a rigid sig | 25cm |
| how much of the anatomy can the rig sig visualize? | anus, rectum, and 5 cm of distal sigmoid colon (more of an anorectoscope) |
| describe rig sig | Shank (25cm), 3 ports 1. visualisation port with rubber seal, that can also be operated thru, 2. longer, glass covered port: fibreoptics 3. insufflation port (short & patent) and introducer there is also a fibreoptic, and a bulb to insufflate air |
| for which is bowel prep necessary 1. procto b. sigcopy | B. Sigmoidoscopy |
| How is a bowel prep done? p1 | |
| Medication for bowel prep | usually polyethylene glycol preparations, sodium picosulfate, |
| how is a sigmoidoscopy performed? p1 | 1. Bowel prep 2. Sedation 3. LLP 4. Prepare & lube scope 5. Inspect 6. dre 7. aim tip of scope towards umbilicus (with introducer). Place in up to 5cm and stop. Remove introducer. Lock trap door. attach fibreoptic source & insuffl bulb. |
| how is a sigmoidoscopy performed? p2 | contd everything now done under vision. the anal canal and rectum are perpendicular in LLP w/ rectum towards sacrum. therefore scope tip must be turned in that way. if mucosa abuts scope do not force, but insuf air |
| how is a sigmoidoscopy performed? p3 | when air insuff canal able to be seen and scope may be advanced. if lesion present, should be biopsied. then view entire rectum. gradually remove scope while still observing mucosa. go thru same 90 deg manoever |
| what Ix is used to see entire sigmoid colon? | FLEXible sigmoid. visualises up to splenic flexure |
| at what point in the rigid sig procedure do u visualise anal canal? | On removal, as introducer was in place up to the 5cm of the anal canal |
| what position may the pt be placed in for the rectum and anus to be in a st8 line with less risk of perforation? | Kneeling position (knee to chest) |
| what instruction would you give the pt after a rigid sig and why? | Due to risk of perf, if patient feels unwell, experiences fever, has abd pain/distention, must head to hospital immediately |
| How would you confirm a rectal perf? | erect CXR which will display pneumoperitoneum |
| how would you find a perf in a difficult case? | perform a diversion colostomy, allow fistula to heal |
Created by:
IonaDel
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