What's with the gastroscope?

Gastroscope gastroscopy is the most reliable method to diagnose esophageal, gastric and duodenal diseases at present, and any other examination methods, including barium meal radiography of upper digestive tract, electrogastrogram and color B-ultrasound of gastrointestinal tract, can not be replaced. The earliest gastroscope was the Cusmore tube invented by the German in 1868. In fact, it is a long metal tube with a mirror at the end. However, this kind of gastroscope was quickly abandoned because it was easy to puncture the patient's esophagus. 1950, Japanese doctor Yuji Dalang successfully invented the embryonic form of soft gastroscope-intragastric camera. With the help of a slender and soft tube, it extends into the stomach, so that doctors can directly observe the lesions of esophagus, stomach and duodenum, especially for minor lesions. Gastroscopy can directly observe the real situation of the examined site, and further diagnose it through pathological biopsy and cytological examination of the suspected lesion site. It is the first choice for upper digestive tract diseases. At present, the most advanced gastroscope in clinic is electronic gastroscope. Electronic gastroscope has the advantages of good image quality, large screen, clear image, high resolution, slender and soft body, large bending angle and flexible operation, which is beneficial to diagnosis and various endoscopic treatments, and has many functions such as storage, video recording, photography, etc., which is convenient for reference and data preservation. Gastroscopy is the most reliable method to diagnose esophageal, gastric and duodenal diseases at present, and any other examination methods, including barium meal radiography of upper digestive tract, electrogastrogram and color B-ultrasound of gastrointestinal tract, can not be replaced. Gastroscope is more advanced than fiber gastroscope in technical means. Since 1950s, fiberscope has been used to diagnose diseases. Up to now, there are many fiberoptic endoscopes used for digestive tract examination, such as fiberoptic esophagoscopy, fiberoptic gastroscope, fiberoptic duodenoscopy, fiberoptic colonoscopy, fiberoptic choledochoscope and so on. This kind of fiber endoscope is thin, soft and easy to bend, with little pain for patients. Doctors can directly see some conditions of the organs under examination, which is better than X-ray barium meal examination. It can find the lesion and its nature, and it can also take small specimens from the lesion site for pathological examination, and it is more helpful to see what the diseased cells look like under the microscope. In recent years, electronic gastroscope has appeared, which can reflect the examination situation on the screen. Surgeons and more people can find the lesions through the screen, and can also record them as information for future reference. Generally, the working length of fiber gastroscope and duodenoscope is 70 ~ 140 cm, and there are many models with different lengths. You can see it from the esophageal opening to the duodenum. There are diseases in these parts, such as inflammation, erosion, ulcer, bleeding, esophageal varices, hemangioma, tumor (benign or malignant) mucosal atrophy, gastrointestinal diverticulum, wall elasticity, whether the upper gastric opening and cardia are normally closed, and whether duodenal juice flows back into the stomach from the pylorus of the lower gastric opening. Patients with bleeding can not only do emergency gastroscopy to check the location and nature of bleeding, but also give drugs through gastroscope to stop bleeding. In order to prevent hepatitis infection, the gastroscopy of patients with hepatitis and those without hepatitis should be separated, and the liver function and hepatitis B surface antigen should be checked before gastroscopy. In order to clearly see the mucosa of the digestive tract, it is necessary to make the examined part very clean, that is, there is no food and no blood clot left. If you have a gastroscope in the morning, don't eat, drink or smoke after 8 pm the day before the examination. Eat less residue and digestible food for dinner the night before. Because patients can change the color of gastric mucosa even if they drink a small amount of water, for example, in the natural lesions of obvious atrophic gastritis, the gastric mucosa can turn red after drinking water, which leads to diagnostic errors. If you have a gastroscope in the afternoon, you can let the patient drink some sugar water before 8 o'clock in the morning, but you can't eat anything else, and don't eat anything at noon. Such as patients with pyloric obstruction. Gastric lavage must be carried out the night before the examination, and the contents of the stomach must be thoroughly cleaned until the reflux liquid is clear. After gastric lavage and before pulling out the gastric tube, the patient takes a supine position with his head down and his feet high, so that the residual liquid in the stomach can be completely discharged. Gastric lavage is not allowed on that day, because gastric lavage will change the color of gastric mucosa. If you have done barium meal examination, this barium meal may attach to gastrointestinal mucosa, especially ulcer lesions, which brings difficulties to the diagnosis of fiberoptic gastroscopy, so gastroscopy must be done 3 days after barium meal examination. In order to reduce saliva secretion, reflex and tension, atropine 0.5 mg and diazepam 10 mg or lumina 0. 1 g were given 30 minutes before the examination, and 2 ~ 3 ml of defoamer was drunk after the injection. With the continuous progress of medical science and technology, gastroscopy is more and more widely used in clinic. Gastroscopy is the most intuitive method to diagnose stomach diseases. It is very important to master the nursing cooperation before, during and after the examination. 15280 cases of electronic gastroscope nursing cooperation process is summarized as follows. Clinical data 1997 10 to 2002 10, we used Japanese electronic gastroscope PENTAXEG-2 930K, and examined 5280 patients/kloc-0, aged 5-82 years. There were 76,265,438+0 cases of superficial gastritis, 2,767 cases of hemorrhagic erosive gastritis, 559 cases of duodenitis, 2,993 cases of peptic ulcer, 429 cases of bile reflux, 4,065,438+0 cases of esophageal varices, 295 cases of gastric cancer and esophageal cardia cancer, and 65,438+053 cases of normal. There were 786 cases of complications, including 776 cases of throat injury, 9 cases of mandibular joint dislocation, and generalized convulsion 1 case. Preoperative nursing: It is the duty of doctors to know the medical history in detail, and it is also the important work of nurses in gastroscope room. Knowing the medical history can make the operator know fairly well and give the patient proper care. Special attention should be paid to the contraindications and allergic history of narcotic drugs, and blood pressure, pulse and respiration should be measured. If there is any abnormality, the doctor should be informed to deal with it in time. Dentures, if any, should be removed before the checkpoint to prevent suffocation. Pay attention to psychological nursing. Gastroscopy is an invasive operation. Many patients think that this kind of examination is painful, and they are worried about the safety and disinfection effect of gastroscope, resulting in fear, and they are not clear about how to cooperate during operation and matters needing attention after operation. Therefore, we must do a good job of explanation before the examination and introduce them to the importance and advantages of electronic gastroscope. Gastroscopy can directly observe the abnormal changes of gastrointestinal tract, accurately judge the size and depth of lesions, and clamp living tissue for pathological examination. Electronic gastroscope is safe and convenient to use, with clearer images and high diagnostic rate, which has a direct effect that other examinations cannot replace. At the same time, it should also explain the purpose of the examination, the method of intraoperative cooperation and possible complications, patiently answer questions, eliminate concerns and ensure the success of the examination. According to different ages, occupations and cultures, patients are given targeted psychological care. Fasting for at least 5 hours on the day of preoperative preparation and fasting. In order to insert the endoscope smoothly, reduce the throat reaction and achieve the ideal anesthesia effect, the anesthesia time of the throat should be no less than 10 minute, and the spray should reach the posterior pharyngeal wall. In order to prevent anesthesia accidents, the first dose should be small, and whether there is allergic reaction should be strictly observed during local anesthesia. If you feel dizzy, dyspnea, pale face, weak pulse and other discomfort after taking the medicine, you should stop using it immediately, adapt and report to the doctor in time. The success of posture insertion is closely related to the patient's posture. At work, we think that it is better for the examinee to lie on the left side of his knees with a pillow of appropriate height, and ask the patient to loosen the collar button and belt, and then make his head lean forward slightly and chin retract to reduce lordosis. Put a towel on one side of your mouth and an arc-shaped plate on the towel to receive saliva or vomit in your mouth. During the operation, the nurse instructed the patient to hold the oral pad and gently bite it. The nurse fixed the mouth pad with her left hand and stood at the front end of the patient's body 20cm with her right hand. She instructed the patient to breathe deeply through his nose, keep his head still and relax. Gastroscope enters the oral cavity through the mouth pad. When the tongue root is inserted into the esophageal entrance, the patient is instructed to swallow, and the gastroscope can pass through the pharynx smoothly. If you encounter resistance in the process of inserting the endoscope, you can not force the patient to intubate, let the patient rest for a while, and then finish feeding by swallowing. Observe the patient's breathing, complexion, etc. In the process of inserting the mirror, at the same time, give a simple explanation to the patient and guide him to take a deep breath. Don't swallow saliva, let it flow naturally from the curved plate. Those who need biopsy should use biopsy forceps to take the focus tissue steadily, accurately, lightly and finely, put it in 10% formalin solution for fixation, and send it for inspection in time. Postoperative nursing informed patients that the patients without biopsy could not eat until about 30 minutes after anesthesia, and those with biopsy could not eat until 2 hours after anesthesia, so as to reduce the friction on the injured surface of gastric mucosa. There may be throat discomfort or pain or hoarseness after the operation. Tell the patient that he will be all right in a short time. Don't be nervous. Rinse with light salt water or use throat lozenges. Pay attention to observe whether there is active bleeding, such as hematemesis and bloody stool, abdominal pain and bloating, and whether there are important vital signs changes, such as heart rate and blood pressure. If any abnormality is found, deal with it immediately.