上消化道的內窺鏡檢查

Medizinische UpperGastrointestinal上消化道的內窺鏡檢Dr.StefanUntererDiplomateECVIM EndoscopicProcedures內窺鏡檢查?minimallyinvasive,non-traumatic??obtainsamplesforcytologicandhistologictherapeuticprocedures治療規(guī)removalofforeignbodiesdilationofesophagealorcoloniccementofgastricorjejunalfeeding安放胃飼管或空腸飼Medizinische Indications適應UpperGastrointestinalEndoscopy上消化道內 chronicvomiting Regurgitation Hematemesis Melena黑 Anorexia厭 chronicdiarrhea foreignbodyremoval stricturedilation擴張 PEG DiagnosislimitedtoMORPHOLOGICchangesMUCOSAL診斷僅限于粘膜表面的形態(tài)學變Contraindications?GI?Notstablefor全麻不穩(wěn)?BadpatientFoodinGI胃腸道中有食Complications并發(fā)GIperforation胃腸道穿Especiallyinpre-damagedGItract(e.g.deepulcer,neosia)尤其在已有損傷的消化道（如潰瘍，腫瘤?Severlygas-distented胃嚴重臌DiminishedvenousCirculatoryMonitoringthrough麻醉師PatientPatientPreparation患畜準GastroduodenoscopyNofoodfor12-24(passagedelayedinpatientwithGIdisease)禁食12-24小時（患消化道疾病GAincl.Leftlalrecumbency(rightlalforPEGtubecemant)Mouthblocko 不使用阿片類藥increasepyloricsphincter增加幽門括約肌張AtropinreducedmuscletoneandObarium,sucralfateorprokineticspriortoInsertCranialesophageal Usually Insufflationandminimalpressure吹氣及壓EsophagusEmptyorsmallamountofclearMucusmembranespink,moist,Inanesthetizedanimaldilatedanddonotconfusewith不可與巨食道癥相Pullbackendoscope拉回內Keepstraight保持拉直狀Insufflateair吹Centralize將內鏡放?MikeMucosaSmoothPink粉紅LumenAtonicdilated遲緩，NottobeconfusedContents內容SmallamountofNofoodCat:proximal2/3striateddistal1/3smoothHerringbone魚骨狀花PhysiologicEsophagus生理性食?le :sr ,Esophagitis食管CausesTraumae.gforeignbodyGastricacidReflux(e.g.anesthesia返流（如：麻醉Frequentvomiting反復Overproduction產生過Causticsubstances腐蝕性物e.gDoxycycline如：多西環(huán)Esophagitis食道Therapy治Prokineticsreflux促動力藥（返流Metoclopramide胃復Cisapride西沙必Antacids抗酸H2-Blockere.gFamotidine)Protonpumpinhibitors(e.g.質子泵抑制劑（如奧美拉唑StomachtubeEosphagealNeosia食道腫Rare罕? 纖維肉瘤/(Spirocercalupi，尾線蟲?Cat:SuqamousCell?InvasionandEsophagealForeignBody食道異Rareincats罕見于?Bottlenecks‘ThoracicinletHeartbaseDiaphragm橫s ForeignbodyPerforation EsophagealEsophagealForeign食管異EmergencyEndoscopicPushforwardinto(e.gBones骨頭Afterretrieval取出Endoscopy內Chest TherapyNofood/feedingSucralfate硫糖Antacids抗酸EsophagealObstruction食道堵StrictureEsophagealObstruction食道堵StrictureBreakIncreasingdiameter(monitorpressure?)Repeatprocedure(every3Usually2-4proceduresEsophagealObstruction食道堵?Esophagitis/strictureProkinetics促動力Metoclopramide胃復Antacids抗酸H2-Blockere.gFamotidineH2阻斷劑（法莫替丁Protonpumpinhibitors(e.g.質子泵抑制劑（奧美拉唑SteroidtopreventstrictureLocalvsSystemic局部vs全Feedingtube飼EsophagealEsophagealObstruction食道堵CongenitalVascular血管環(huán)異VesselsconstrictRegurgitationCongenitalVascular血管環(huán)異RegurgitationafterRuntsPrecord