Ezofagoskopiya

Description:

Ezofagoskopiya is the main method of a research of a gullet. It is made as as rendering emergency medical service, for example during removal of foreign bodys of a gullet, and for survey of walls of a gullet at gullet injuries, suspicion of a tumor, etc.

Before an ezofagoskopiya conduct the general and special examination. Specify a condition of the patient, a contraindication to an ezofagoskopiya. Special inspection means X-ray inspection of a laryngopharynx, a gullet and stomach with a contrast weight.

Tools. Bryunings, Mezrin, Friedel's bronchoscopes and fibrous optics. Besides, in an office for a research there has to be a suction machine, a set of nippers for removal of foreign bodys and capture of pieces of fabrics for a histologic research.

Training of the patient. Manipulation is made on an empty stomach or in 5-6 h after the last meal. In 30 min. prior to the beginning of an ezofagoskopiya to the adult patient subcutaneously enter 1 ml of 0,1% of solution of sulfate of atropine and 1 ml of 2% of solution of Promedolum. Removable dentures have to be removed.

Anesthesia. Adults and children of advanced age can see off Ezofagoskopiya under anesthetic or local anesthesia, to small children - only under anesthetic.

Local anesthesia is applied when there are no local and general burdening factors (perforation or wound of a gullet, the general diseases, etc.). For anesthesia at adults use 10% solution of cocaine or 2% Dicainum solution with addition of 0,1% of solution of adrenaline. After double spraying of a throat by the same structure consistently grease a mucous membrane of a throat and a throat. Anesthesia comes when the patient does not react gagging and cough to greasing of a laryngopharynx and area of an entrance to a gullet.

Anesthesia. The endotracheal anesthesia is always preferable, it is absolutely shown when the ezofagoskopiya is carried out in the presence of the local or general burdening factors. The foreign body, wound or an inflammation of a wall of a gullet, bleeding from a gullet, unfortunate attempt of removal of a foreign body under a local anesthesia, etc. belong to local factors the big sizes. It is necessary to carry to the general factors mental diseases, a surdomutism, dysfunctions of cardiovascular system, the general diseases breaking these or those vital functions of an organism.

Position of the patient. If the ezofagoskopiya is made under local anesthesia, the patient sits on a special chair of Bryunings. Behind the patient there is an assistant holding his head and shoulders in the necessary situation if the anesthesia is given, and also at children the ezofagoskopiya is made in position of the patient lying on spin.

Equipment of an ezofagoskopiya. Before an ezofagoskopiya choose the corresponding size a tube (taking into account the level of injury of a gullet or the got stuck foreign body). If the ezofagoskopiya is made under local anesthesia, the patient widely opens a mouth and puts out tongue. Breath has to be equal. The doctor imposes a napkin on the put-out part of language and takes fingers of the left hand language the same as at an indirect laringoskopiya. The right hand the doctor enters an esophagoscope tube from a mouth corner into a stomatopharynx, then transfers it to a laryngopharynx, the end of a tube has to be strictly on the average line. At this moment it is necessary to examine epiglottis poles. Removing a tube beak a kpereda epiglottis, the tube is advanced for arytenoid cartilages. In this place in a gleam of a tube the entrance to a gullet in the form of a press is surveyed. Further under control of sight of the patient ask to make the deglutitory movement that promotes disclosure of a mouth of a gullet. The tube moves ahead below. An indispensable condition of further advance of the esophagoscope is coincidence of an axis of a tube and axis of a gullet.

At survey the pink mucous membrane collected in longitudinal folds is visible. At correctly made ezofagoskopiya narrowing and expansion of a gleam of a gullet synchronously decides on the respiratory movements. At immersion of a tube in the lower third of a gullet it is visible that its gleam becomes narrow, getting a slit-like form when passing level of a diaphragm. It is necessary to take a tube slowly. At the same moment, directing to roundabouts the distal end on a mucous membrane, make careful survey.

Ezofagoskopiya under anesthetic has a number of features. First, the doctor fingers of the left hand opens widely a mouth of the patient lying on spin. Through a mouth corner the esophagoscopic tube is carried out to an entrance to a gullet. Absolutely without efforts the tube through a mouth of a gullet is entered into its gleam, however by a gleam gaping as at an ezofagoskopiya under local anesthesia, at the same time does not occur.