We feel urged, in first considering this sore and very common ...
Foreign Bodies In The Stomach
Gastroscopy is indicated in cases of a foreign body that ref...
Children's Healthy Growth
Often either the whole system or some part fails to grow prope...
Site Of Lodgment
The majority of foreign bodies in the air passages occur in ...
This frequent and severe trouble results most usually from chi...
Pulse Counting The
Most valuable information as to the nature and progress of dis...
Suppression Of The Menses Amenorrhoea
For sudden suppression from taking cold, as by wetting the ...
The following are the antidotes and remedies for some of the m...
Leucorrhoea And Prolapsus Uteri - Whites Female Weakness
The disease depends in all cases upon _inflammation_ of the u...
These are often piled on the front of the body, while the far ...
Diet For A Long, Long Life
Some people not only want to be healthy, but they want to liv...
Rupture And Trauma Of The Esophagus
These may be spontaneous or may ensue from the passage of an ...
Of Fungous Ulcer Of The Navel In Infants
It sometimes occurs that a little fungous sore exists upon th...
See Children's Sleep. ...
This should always be managed so as to soothe and not excite t...
Water For Drinking
Every care should be taken to have drinking water absolutely p...
Take B D current. Place N. P., long cord, upon the lumbar ver...
The Dissection Of The Oblique Or External And The Direct Or Internal Inguinal Herniae
The order in which the herniary bowel takes its investments f...
Clothes should be Loose and Comfortable. Man is the only anim...
This frequent and distressing trouble is to be traced to a sta...
Category: ACQUIRING SKILL
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
The first step is to get rid of the
gastric secretions. There is always fluid in the stomach, and this
keeps pouring out of the tube in a steady stream. Fold after fold is
emptied of fluid. Once the stomach is empty, the search begins for the
cardial opening. The best landmark is a mark with a dermal pencil on
the skin at a point corresponding to the level of the hiatus
esophageus. When it is desired to do a retrograde esophagoscopy and
the gastrostomy is done for this special purpose, it is wise to have
it very high. Once the cardia is located and the esophagus entered,
the remainder of the work is very easy. Bouginage can be carried out
from below the same as from above and may be of advantage in some
cases. Strictural lumina are much more apt to be concentric as
approached from below because there has been no distortion by pressure
dilatation due to stagnation of the food operating through a long
period of time. At retrograde esophagoscopy there seems to be no
abdominal esophagus and no cardia. The esophagoscope encounters only
the diaphragmatic pinchcock which seems to be at the top of the
stomach like the puckering string at the top of a bag.
Retrograde esophagoscopy is sometimes useful for stringing the
esophagus in cases in which the patient is unable to swallow a string
because he is too young or because of an epithelial scaling over of
the upper entrance of the stricture. In such cases the smallest size
of the author's filiform bougies (Fig. 40) is inserted through the
retrograde esophagoscope (Fig. 43) and insinuated upward through the
stricture. When the tip reaches the pharynx coughing, choking and
gagging are noticed. The filiform end is brought out the mouth
sufficiently far to attach a silk braided cord which is then pulled
down and out of the gastrostomic opening. The braided silk string
must be long enough so that the oral and the abdominal ends can be
tied together to make it endless; but before doing so the oral end
should be drawn through nose where it will be less annoying than in
the mouth. The purpose of the string is to pull up the retrograde
bougies (Fig. 35)
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