|
|
|
CG PEDICON 2006, 7-8TH OCT 2006, RAJNANDGAON, CHATTISGARH
Dr. Manohar Tule,
M.S.;M.Ch.;Dip.P.U(U.K.);F.A.C.S.:
F.I.S.;F.A.I.S,;M.B.
Director, N.D.Memorial Institute of Paediatric Endoscopy
Nagpur (M.S.)
|
|
Introduction :-
|
- 300 Children die every year (due to Foreign body in Respiratory Tract)
- Oldest Endoscopy is Bronchoscopy
- Bozzini 1806 Mirror with Candle
- Kussumal- 1860- Oesophagoscope
- Swoard swallower 1870- Technique
- Ikeda 1970- Pediatric endoscopy
Principles of Endoscopy 100years
- Hopkin Rod Lens Optical system
- Fiberoptic Glass fibers- T / Reflection
- Coherent - Image
- No coherent - Light
Microchip & Xenon Light processor
|
| Bronchoscopy:
|
Procedure
- Never as outdoor procedure
- In operation theater
- Backup of intensive care facility
- No pre-endoscopy sedation
- Discontinue Repeat- No Longtime
Types -
| |
Rigid - 2.5 mm - 6 mm/23 to 30 cm
Good ventilation Narrow Passage
Better exposure / Adequate time
Better manipulation Different
|
| |
Flexible |
- |
Therapeutic |
|
|
| |
|
- |
Can admit |
- |
Endotracheal tube |
| |
|
|
|
- |
Rigid bronchoscope
|
| |
|
- |
Upper lobe |
- |
Lavage |
| |
Negative RB |
- > |
Indication |
- > |
FB -> Suspicious FB |
Indications Plenty
- FB
- Strider
- Bleeding
- H-type TOF
- Asthma / Cough M. Plugs
- Stenosis leaser treatment
- Primary TB
- Cough 3 months
- Atelectasis / - Pneumonia
- Bronchial lavage Pressure -NaCI+ Salbutamol
Relative Contraindications :-
- Bleeding Diathesis
- Hemodynamic Instability
- Arrhythmias
- Hypoxemia
- Pulmonary Hypertension
Effect of Foreign Body - 1
- Immediate RDS. Forgotten
Moveable F.B.- Irritate S/S
- Late changes Entirely Forgotten
Chronic Foreign Body Syndrome
Drowned Lung / Lung Abscess/
Stricture/ Bronchiectasis
Effect of Foreign Body - 2
- Allergic Bronchitis Mechanical
Check Valve Atelectasis
Stop valve- Emphysema / perforation
- Pathological Changes -
Vegetable bronchitis
Symptoms of Foreign Body -1
- Sudden RDS / Chocking / Gaggling
- Wheezing
- Paroxysmal cough / Hemoptysis
- Aphonia
- Refractory Bro - Asthma
Symptoms of Foreign Body - 2
- Recurrent of Persistent pneumonia in single lobe
- Asymptomatic Forgotten Initial
- Negative Radiology 10%
- Site related Trachea Audible Sap / Palpable thud
- X-ray Emphysema / Collapse / Consolidation
Fluoroscopy Exp./ Inspiration Film
Complications -
- Prolonged sleep Hypoventilation
- Edema Glottis / Sub-glottis
- Perforation Pneumo - Thorax / Mediastinum
- Bleeding
- Infection
Post Bronchoscopy
- Oxygenation
- X-ray chest Complete Recovery
- Pneumothorax
- No Residual FB
Peculiarities of PRT (Paediatric Respiratory Tract)
| |
Bronchi |
- |
Few alveoli
|
| |
No Atelectasis |
- |
Faster Air Flow System
|
| |
|
- |
Strong Diaphragm
|
| |
|
- |
Antiatelectatic Factor Surfactant
|
| |
Mucociliary Clearance |
- |
Faster Short passage |
| |
Small vascular Bed |
- |
Alveolar surface
|
|
| Oesophago Gastro Intestinal Endoscopy-
|
Introduction -
- Only radiological
- Ekeda 1970 Paed. Endoscopy
- Gastroscope 50-75 cm small Bowel
- Colonoscope 10-20 cm terminal ileum
- Hischowitz 1958- First Fiberglass scope
- 5.8mm/8mm Video- Endoscopy With Chip Camera
Oesophagoscopy
- Rigid / Flexible Fibrescope
- Sclerotherapy possible Both
- Gastric Varices Fibrescope Only
- Tamponade Effect Rigid Endoscope
- Banding Fibrescope
- Done Under G.A
Indications - 1
Diagnostic-
- Dysphagia Mechanical / Neuronal / Neurogenic
- TOF H- type
- GEReflux
- Upper Abdominal Pain
- Corrosive Injury
- Upper G. I. Bleeding
Indications - 2
Therapeutic -
- Dilation
- Foreign Body removal
- Sclerotherapy / banding
- Electro coagulation 3F Ureteric Cath
- Intraluminal Laser Therapy
Complications -
- Overinflation
- Perforation Inexperienced Endoscopist
- Massive Hemorrhage
- Psychogical Disturbance
|
| Colonoscopy :
|
a) More difficult than Gastroscopy
b) Easier in children -> adults
c) Barium Enema Still best
d) Expensive / Infrequent Utility
e) Depend on Audit Gastroenterologist
|
|
Paediatric laparoscopy:
|
Introduction
- All Non Invasive modalities exhausted
- Not Substitute modalities exhausted
- Systematic tour of Abdomen
- Finding Pathology should not stop
Indications 1
Diagnostic-
- Acute / Chronic AP
- Liver Biliary Pathology
- Trauma
- Chylous Ascitis Leak
- Intersex
- Cryptorchidism
- Oncology Resectility / Biopsy / L. Node
Indications - 2
Therapeutic
- Appendicectomy
- Cholecystectomy
- Meckels Diverticulum
- Adhesiolysis
- Cryptorchidism
- Ovarian Cyst
|
Last Updated on 15-03-2007
|
| How to cite this url |
|
CG Pedicon 2006 - Conference Abstracts.Pediatric Oncall [serial online] 2007 [cited 15 March 2007(Supplement 3)];4. Available from:
http://www.pediatriconcall.com/fordoctor/Conference_abstracts/
cgpedicon2006/Fascin.asp
|
