Post on 07-Jul-2018
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Endoscopia digestiva superioara
1.Etapa endoscoapelor rigide 1795 – 1932
2.Etapa endoscoapelor semifexibile 1932 –
1958 1928 – J. odge !aird – "brele optice
1953 – #op$ins % &apan' – "bre opticecoerente
1958 – #irsc(o)it* – "broendoscopul
3.Etapa "broendoscopiei 1958+1985
+
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Endoscopul fexibil
nitate centrala / procesor de imagine
Endoscopul propriu+*iso 0ortiune proximala
o ub
o 0ortiune distala
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Endoscoape cu unctie speci"ce
Endoscopul cu magni"catie
Endoscopul operator
Endoscopul cu ac(i*itie de imagine inbanda ingusta narro) band imaging + 4!6
Ec(oendoscopul
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0regatirea pacientului
btinerea acordului inormat
0regatirea segmentelor ce vor " examinate
0remedicatiao anti(istaminice
o psi(otrope
o antibiotice
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edare si aneste*ie
nalge*ie locala
edare + ben*odia*epine
neste*ie generalao .v. + 0ropool
o generala cu ...
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:ontraindicatii
bsoluteo insu"cienta cardiaca sau respiratorie grava
o peroratia digestiva
o psi(opatie
o deormari toracice mari
o anevrisme de aorta
o lipsa de cooperare a pacientului
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:ontraindicatii
;elativeo varste extreme
o insu"cienta cardiaca
o mari (ipertensivi
o tulburari de ritm cardiac
o
cardiopatie isc(emica cronica
o insu"cienta respiratorie cronica
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i l
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natomie normala esoag
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ndicatiile esoagoscopiei
n toate ca*urile de sindrom esoagian< caprima examinare sau dupa examenulradiologic
n toate steno*ele esoagiene< de obiceidupa examenul radiologic
n ac(ala*ie< examinarea constituind prinea insasi un test diagnostic
n tumorile esoagiene de toate tipurile<
benigne sau maligne
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ndicatiile esoagoscopiei
n (epatitele cronice si ciro*ele (epaticepentru depistarea varicelor esoagiene
n angina pectorala< mai ales daca semaniesta prin epigastralgii< pentruexcluderea esoagitei de refux si a (erniei(iatale< care pot constiuti cau*a
simptomatologiei
n diverticulo*a esoagiana
n (emoragiile digestive superioare
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0=E E>=
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#. #
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ndicatiile gastroscopiei
oate sindroamele dispeptice care nu auexpresie radiologica
oate (emoragiile digestive superioare< depreerat in urgenta< dar si in aara(emoragiei< sau la distanta de aceasta
oate ulcerele gastrice< indierent decomportamentul clinic< de aspectul radiologicsau de statusul secretor. !iopsia esteobligatorie< indierent de aspectul endoscopic
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ndicatiile gastroscopiei
n cancerele gastrice< c(iar avansate sidiagnosticate radiologic< caci uneori se potdescoperi tumori benigne sau alte boli#odg$in< limoame< :ro(n6
0olipii gastrici cu biopsie si polipectomieobligatorie< daca este posibil
tomacul operat< in ca*ul in care bolnaviipre*inta tulburari dispeptice sau modi"cariradiologice si in toate ca*urile de stomac
operat la care re*ectia s+a acut cu mai mult
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0=E @:
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ndicatiile duodenoscopiei
oate ulcerele duodenale cunoscute pentrustabilirea pre*entei actuale a ulcerului
rmarirea endoscopica a vindecarii cicatri*area6ulcerului< mai ales in ca*urile de discordanta clinico+radiologica sau pentru testarea e"cientei unui miAlocterapeutic
oate insu"cientele evacuatorii< pentru diagnosticul
corect al steno*elor pilorice sau duodenale< benignesau maligne
#emoragiile digestive superioare< cu atentiedeosebita la nivelul genunc(iului superior si a
portiunii a doua a duodenului
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0=E BBE4
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E;:0
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:olangiopancreatogra"a endoscopicaretrograda :0E;%E;:06
19C8 – @c. :une
197, + &a)ai
+ Bemling
+ :lassen
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E;:0 – ndicatii diagnostice
a nivel duodeno+papilar endoscopic6
o Biagnosticul tumorilor ampulare
o Evidentierea diverticulilor de ereastraduodenala Auxtapusi sau interpusi
o Evidentierea de ormatiuni tumorale duodenalesi a diverticulilor duodenali
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E;:0 – ndicatii diagnostice
:aile biliare intra si extra(epaticecolangiogra"c6
o litia*a ve*icularao litia*a coledociana
o steno*e ale cailor biliare de etiologie benignasau maligna
o dispo*itii modale ale caii biliare principale
o le*iuni iatrogene ale cailor biliare
o "stule biliare interne si externe
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E;:0 – ndicatii diagnostice
a nivel pancreatic radiologic6
o tumori pancreatice
o pseudoc(ist pancreatic
o
litia*a intrapancreatica
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E;:0 – ndicatii terapeutice
indicatiile terapeutice se reera la tratamentulD
o litia*ei de cale biliara principala si pancreas
o stentarea stricturilor benigne sau maligne
o stentarea pro"lactica sau curativa a ductuluiirsung
o drenaAul psudoc(isturilor pancreatice
o tratamentul "stulelor biliare externe
o tratamentul aectiunilor sclerogene oddiene
o decomprimarea preoperatorie biliara in icterele
obstructive
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E;:0 – :ontraindicatii speci"ce
nsu"cienta cardio+respiratorie grava
ulburari de coagulare
nsu"cienta pluriorganica
arcina
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E;:0 % 0E – complicatii
ngiocolita
0ancreatita acuta
#emoragii la nivelul transei de sectiuneendoscopica
0eroratii retroduodenale
nclavarea sondei de extractie a litia*ei inori"ciul papilar cu imposibilitatea indepartariiacesteia din calea biliara principala
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0=E :4
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0=E ;E:
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