This week I was at Victoria Hospital. During my time this week I was assisting in Endoscopic retrograde cholangiopancreatography (ERCP). There was a full morning list and we were using a new room. I had previously screened ERCP patients in this hospital, however this was new equipment that I was being instructed on.
ERCPs are performed on patients who suffering from gallstones or experiencing problems such as jaundice. Ducts in the biliary system drain bile from the liver and pancreas. The biliary ducts and the pancreatic ducts join just before they drain into the upper bowel. This drainage opening is called the papilla and is surrounded by a circular muscle, called the sphincter of Oddi.
One patient due to have her gallstones removed had to have a biliary sphincterotomy. This is where the surgeon has to cut the muscle which surrounds the opening of the duct. This cut is made using a specialised catheter which has an electric current running through it. The surgeon was able to see stones in the gall bladder but was unable to remove them without performing the sphincterotomy. Once the sphincterotomy had been performed to enlarge the opening of the bile duct, the stones were able to be pulled from the duct into the bowel using a balloon attached to the catheter. Once the stones were removed the patient was experiencing a little bleeding. The surgeon then explained to me he was going to inject adrenaline around the site of the cut to try and minimise the bleeding. Epinephrine commonly referred to as adrenaline is a naturally produced hormone within the body, secreted by the medulla of the adrenal glands. Epinephrine, is used to contract the blood vessels around the site of the cut. Epinephrine is a hormone and a neurotransmitter. It can be used to increase the heart rate, contract blood vessels, and dilate air passages and participates in the fight or flight response of the sympathetic nervous system. Epinephrine is added to injectable forms of local anesthetics such as lidocaine as a vasoconstrictor.
Another procedure which I performed was the screening of patients who had undergone a procedure called adiana. This procedure is a minimally invasive procedure that permanently prevents pregnancy. It works by stimulating your body’s own tissue to grow in and around tiny soft inserts that are placed inside your fallopian tubes. This is a simple procedure with a quick recovery and leaves nothing in the uterus that might limit future gynecologic procedures. It is performed by inserting a catheter into the cervix and into the uterus. This catheter delivers a low level radiofrequency (energy that generates heat to create a superficial lesion) to a small section of each fallopian tube. A tiny soft insert the size of a grain of rice is placed in each of your fallopian tubes where the radiofrequency is applied. This allows for new tissue to grow in and around the adiana inserts, eventually blocking your fallopian tubes. Patients are then sent for a hysterosalpingogram (HSG) to confirm that the tubes have been fully blocked. This test is performed to ensure that the procedure has been successful.
Attached to this piece of writing are images of both procedures.

Endoscopic Treatment for Bleeding Peptic Ulcers. 2010. Available at: http://sunzi.lib.hku.hk/hkjo/view/23/2300709.pdf [Accessed October 30 2010].
ERCP. 2010. Available at:http://emedicine.medscape.com/article/365698-imaging [Acessed October 30 2010].
Sphinterotome. 2010. Avaliable at; http://www.top5plus5.com/Procedures_files/THERAPEUTIC%20ENDOSCOPY.htm [Acessed October 30 2010].
Colonoscopy. 2011. Available at:http://www.colonoscopy-exam.info/coe/Portals/0/proc_images/procedure_images/photo14.jpg [Accessed October 30 2010].
ERCP. 2011. [online image] Avaiable at: http://www.google.co.uk/imgres?imgurl=http://www.pregnantagain.com/img [Accessed October 30 2011].
ERCP. 2011. [online image] Avaiable at:http://www.google.co.uk/imgres?imgurl=http://journals.prous.com/journals/ [Accessed October 30 2011].

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adrenaline used in surgery

 

 

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