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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.)
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Introduction :-
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- 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
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| Bronchoscopy:
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Procedure -
- Never as outdoor procedure
- In operation theater
- Backup of intensive care facility
- No pre-endoscopy sedation
- Discontinue - Repeat- No Longtime
Types -
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Rigid - 2.5 mm - 6 mm/23 to 30 cm
Good ventilation - Narrow Passage
Better exposure / Adequate time
Better manipulation - Different
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Flexible |
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Therapeutic |
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Can admit |
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Endotracheal tube |
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Rigid bronchoscope
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Upper lobe |
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Lavage |
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Negative RB |
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Indication |
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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)
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Bronchi |
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Few alveoli
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No Atelectasis |
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Faster Air Flow System
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Strong Diaphragm
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Anti-atelectatic Factor - Surfactant
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Mucociliary Clearance |
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Faster - Short passage |
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Small vascular Bed |
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Alveolar surface
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| Oesophago - Gastro - Intestinal Endoscopy-
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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
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| Colonoscopy :
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a) More difficult than Gastroscopy
b) Easier in children -> adults
c) Barium Enema Still best
d) Expensive / Infrequent Utility
e) Depend on Audit Gastroenterologist
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Paediatric laparoscopy:
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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
- Meckel's Diverticulum
- Adhesiolysis
- Cryptorchidism
- Ovarian Cyst
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Last Updated on 15-03-2007
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| How to cite this url |
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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
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