Research methodology, preparation of the patient

The study itself must precede the introduction of a doctor-endoscopist with the patient; the doctor must be familiar with the history of the disease. It is important and often gives the chance to assume the nature of expected pathology. In addition, a preliminary conversation with the patient allows to make certain conclusions about his psychological state, which has implications for the process of the research. It is known that a certain number of people tolerate any manipulation in the mouth and throat due to sharply expressed pharyngeal reflex that can serve as an obstacle to the study. Some people are just afraid of this study. Preliminary conversation endoscopist with the patient calms him, helps to overcome fear before the examination, and the doctor helps to take additional measures of preparation.
The study is performed on an empty stomach. This is required because even a very small amount of food or liquid, swallowed patients to research, may lead to diagnostic error. Food lump can "seal" ulcer crater, close any defect mucous or change its color. In addition, the stay of food in the stomach dramatically increases motor activity, which is very difficult to study. Stomach before the test, which is recommended by some authors, we do not advise and even consider harmful, because it irritates the mucous membrane of the stomach, enhances its peristalsis, and sometimes injure mucosa that may confuse a doctor.
For 40 minutes before the examination the patient inject 1 ml of 0.1% solution of atropine sulfate and 1 ml of 1 % solution of morphine. Immediately before the study was conducted with local anesthesia of the mouth and throat 1 % solution dikaina. There are different ways of application of an anesthetic substance - spraying gun, lubrication swab dipped in dikaina, burying through the nasal passages, and others For anesthesia enough 2-3 ml of 1% solution dikaina. In order to avoid toxic effects especially to exceed this number should not be. The maximum allowed here dose - 0,09 g, i.e. 3 ml 3% solution [Mashkovsky, Menshikov Palace, 1978]. Anesthesia occurs within 5-7 minutes After that, his stack on a table with a slightly higher leading position on the left side. The left leg should be stretched and bent right in the hip and knee joints so that the knee right leg patient rested on the table surface. This creates a stable position on the side. Dentures patient must remove.
The study is necessarily a doctor-endoscopist, assisted by specially trained nurse. This rule must be carried out strictly. Study of the sick one physician, without the presence sisters, should be prohibited. Sister helps in preparing the patient for research and biopsy: accepts the material is taken, and so on, it is Desirable that a study be made on a specially designated for gastroduodenoscopy the table that allows to change the position of the patient to the best overview of the different sections of the stomach. Needless to say that gastroscopy must be performed in a specially designated for this purpose the endoscopy room, appropriately equipped.
The unit is attached safety ring (mouthpiece), the distal end of the device is bent in such a situation the gastroscope on the back of the throat is inserted into the esophagus, and the mouthpiece patient captures teeth. Sometimes a minor issue notes in passing the entrance into the esophagus. In this case, the patient should be asked to make a gulp and then gastroscope freely "fail" in the esophagus. In any case you should not use violence with the introduction of the device, the more that is known when the experience of the doctor is not needed and can lead to injury of the esophagus. The gastroscope must enter the esophagus quite easily, without efforts. After the introduction of the head of the apparatus of the stomach it is inflated with air through a special device. Introduction of air patient needs to stop immediately, as soon abdominal pain. Then as needed air to frighten small portions, fractional, in the research process.
Examination of the stomach should be performed in a certain sequence. It is advisable to start with a tour of the mouth of the pyloric canal, pyloric stomach, small curvature, rear wall, the big curvature of the front wall, corner of a stomach, bottom and so on, i.e. in the direction from the janitor to the cardia, consistently examining all the walls of the stomach and all of its departments. Especially carefully it is necessary to examine the scope of the cardia and the lesser curvature of the pyloric, as these areas are the most difficult for inspection. For best viewing of the various sections of the stomach is sometimes necessary to change the position of the patient on the table, inspection on the left side to be combined with the examination on the right side, on the back, complement it with palpation of the abdominal wall. All this requires a lot of patience from the patient and doctor. However, the study should not be tedious for the patient and not to cause him pain.