Nursing, Medical, Health, Diagnostic procedure for small intestine

1. PRESENTATION ON PILL
CAMERA
PREPARED BY
PROF. MRS VIJAYALAXMI. A. H
PROFESSOR
HOD, DEPT. OF MEDICAL
SURGICAL NURSING
ALKAREEM COLLEGE OF NURSING
KALABURGI

2. ANATOMY AND PHYSIOLOGY
• Gastrointestinal (Gl) tract
– Tube within a tube
– Direct link/path between organs
– Structures
• Mouth
• Pharynx
• Esophagus
• Stomach
• Small intestine
• Large Intestine
• Rectum

3. MOUTH
• Hard Palate
– Anterior roof
• Soft Palate
– Posterior Roof
• Uvula
– Projection of soft palate
• Lingiuinal Frenulum
– Attaches tongue to mouth floor

4. PHARYNX
• Passageway for food and air

5. • Approximately 20 cm long.
• Functions include:
1. Secrete mucus
2. Moves food from the throat to the stomach using muscle
movement called peristalsis
• If acid from the stomach gets in here that’s heartburn.
ESOPHAGUS

6. • J-shaped muscular bag that stores the food you
eat, breaks it down into tiny pieces.
• Mixes food with Digestive Juices that contain
enzymes to break down Proteins and Lipids.
• Acid (HCl) in the stomach Kills Bacteria.
• Food found in the stomach is called Chyme.
• The pyloric sphincter is a muscular valve that
opens to allow food to pass from the stomach to
the small intestine.
STOMACH

7. SMALL INTESTINE
• Small intestines are roughly 7 meters long
• Lining of intestine walls has finger-like projections
called villi, to increase surface area.
• The villi are covered in microvilli which further
increases surface area for absorption.

9. Histology

10. Functions

11. DIGESTION
• The small intestine is where most chemical digestion takes
place. Many of the digestive enzymes that act in the small
intestine are secreted by the pancreas and liver and enter the
small intestine via the pancreatic duct.
• Pancreatic enzymes and bile from the gallbladder enter the
small intestine in response to the hormone cholecystokinin,
which is produced in the small intestine in response to the
presence of nutrients.

12. CONTINUE….
The three major classes of nutrients that undergo digestion are
proteins, lipids (fats) and carbohydrates:
• Proteins are degraded into small peptides and amino acids
before absorption.
• Lipids (fats) are degraded into fatty acids and glycerol.
Pancreatic lipase breaks down triglycerides into free fatty acids
and monoglycerides.

13. • Some carbohydrates are degraded into simple sugars, or
monosaccharide's (e.g., glucose). Pancreatic amylase breaks
down some carbohydrates (notably starch) into
oligosaccharides. Other carbohydrates pass undigested into the
large intestine and further handling by intestinal bacteria.
CONTINUE….

14. ABSORPTION
• Digested food is now able to pass into the blood vessels in the
wall of the intestine through either diffusion or active transport.
The small intestine is the site where most of the nutrients from
ingested food are absorbed.
• The absorbed substances are transported via the blood
vessels to different organs of the body where they are used to
build complex substances such as the proteins required by our
body. The material that remains undigested and unabsorbed
passes into the large intestine.

15. Blood supply
• The small intestine receives a blood supply from the
coeliac trunk and the superior mesenteric artery.
These are both branches of the aorta.
• The duodenum receives blood from the coeliac trunk
via the superior pancreatic duodenal artery and from
the superior mesenteric artery via the inferior
pancreatic duodenal artery
• The jejunum and ileum receive blood from the
superior mesenteric artery.

16. LARGE INTESTINE
• About 1.5 meters long
• Accepts what small intestines don’t absorb
• Rectum (short term storage which holds
feces before it is expelled).
• Functions
– Bacterial digestion
• Ferment carbohydrates
–Absorbs more water
– Concentrate wastes

17. Mucus Secretion.
• The mucosa of the large intestine has many crypts of
Lieberkühn.
• Absence of villi.
• The epithelial cells contain almost no enzymes.
• Presence of goblet cells that secrete mucus (provides
an adherent medium for holding fecal matter together).
Secretions of the Large Intestine

18. • Stimulation of the pelvic nerves from the spinal cord
can cause marked increase in mucus secretion.
This occurs along with increase in peristaltic motility
of the colon.
• During extreme parasympathetic stimulation, so
much mucus can be secreted into the large intestine
that the person has a bowel movement of ropy
mucus as often as every 30 minutes; this mucus
often contains little or no fecal material.
CONTINUE…..

19. ACCESSORY ORGANS
• Not part of the path of food, but play a
critical role.
• Include: Pancreas, Liver and gall bladder.

20. PANCREAS
• Produces enzymes that break food down
• Empties into small intestine
• Neutralizes gastric acid
• Produces insulin and glucagon

21. LIVER AND GALL BLADDER
• Produces bile
• Bile enters small intestine
• Helps breakdown lipids
• Gall bladder stores bile

22. ENDOSCOPY

23. ENDOSCOPY
o Endoscopy, is the
examination of internal body
cavities using a specialized
medical instrument called an
endoscope.
o Physicians use endoscopy
to diagnose, monitor, and
surgically treat various
medical problems.

24. • An endoscope is a slender,
flexible tube equipped with
lenses and a light source.
Illumination is done by the
help of a number of optical
fibers.
• Reflected light rays are
collected by CCD( Charge
coupled device) and electrical
signals are produced, which
are fed to the video monitor to
get image.
CONTINUE……

25. • Thorough one channel of endoscope water
and air is conducted to wash and dry the
surgical site.

26.  The endoscope also has a
channel through which surgeons
can manipulate tiny instruments,
such as forceps, surgical
scissors, and suction devices.
 A variety of instruments can be
fitted to the endoscope for
different purposes.
CONTINUE….

27.  A surgeon introduces the endoscope into the
body either through a body opening, such as the
mouth or the anus, or through a small incision in
the skin.
CONTINUE….

28. CONTINUE……
• The endoscope gives
visual evidence of the
problem, such as
ulceration or
inflammation
• It can be used to collect a
sample of tissue; remove
problematic tissue, such
as polyps
• It is used to take
photograph of the hollow
internal organs

29. TYPES
• Depending on the body part, each type of endoscopy has its
own special term, such as
laparoscopy (abdomen, uterus, fallopian tube),
laryngoscopy (vocal cords),
bronchoscopy (lungs),
colonoscopy (colon),
arthroscopy (joint) and
Gastroscopy (Stomach).

30. Pill Camera

31. Contents…
 History of development
 Introduction to Capsule Camera…
 Meaning and definition
 Conventional Method…
 Description…
 Inside a Capsule Capsule Camera…
 Applications
 Contraindications
 Procedure…
 Advantages…
 Drawbacks & Overcomes…
 Complications
 Conclusion…

32. HISTORY OF DEVELOPEMENT
• The diagnostic pill was invented in the 1990s by Israeli inventor
Gabriel Iddan.
• Gabriel Iddan was an electrical engineer who previously
worked at Israeli military manufacturer Rafael Israel's
Armament Development Authority, developing guided-missile
technology.
• Gabriel Iddan's first capsule endoscopy products was named
M2A capsule and was cleared by the FDA for small intestine
visualization in August 2011.

33. • Pill Cam has had tremendous success after its release in 2001
because of its improved safety and accuracy.
• It is more healthy than X-rays and radioactive tracing of stomach
tumors.
• Currently, the Pill Cam video capsule has been used
approximately 1.5 million times by more than 5,000 medical
facilities in more than 75 countries.

34. CONTINUE….
• The new wireless capsule endoscopy has been established as the
global standard for digestive diagnosis.
• Given Imaging, the Pill Cam company, has sold 221,300 capsules and
reached an annual revenue of $157.8 million. The cost of the pill
camera is Rs.35,000.

35. Introduction to Capsule Camera
Imagine a vitamin pill-sized camera that could travel through your body
taking pictures, helping diagnose a problem which doctor previously would
have found only through surgery.

36. Continue….
• Capsule endoscopy is a procedure used to record internal
images of the gastrointestinal tract for use in medical diagnosis.
• The capsule is similar in shape to a standard pharmaceutical
capsule, although a little larger, and contains a tiny camera and
an array of LED’s powered by a battery.

37. CONTINUE….
• After a patient swallows the capsule, it passes along the
gastrointestinal tract taking a no. of images per second which
are transmitted wirelessly to an array of receivers connected to
a portable recording device carried by the patient.

38. MEANING AND DEFINATION
• Capsule endoscopy is a procedure that uses a tiny wireless
camera to take pictures of your digestive tract.
• A capsule endoscopy camera sits inside a vitamin-size capsule
swallow.

39. CONTINUE…..
• As the capsule travels through digestive tract, the camera takes
thousands of pictures that are transmitted to a recorder wear on a
belt around waist.

40. Conventional Method
 The conventional method that Doctors would have preferred
earlier was Endoscopy Procedure .By which Doctor able to see
the inside lining of digestive tract.
 This Examination is performed using an Endoscope-a flexible
fiber optic tube with a tiny TV camera at the end.

41. Continue…
 The camera is connected to either an eyepiece for direct viewing
or Video screen that displays the images on a color TV. This
Procedure used for Gastro Intestinal(GI) disease and treatment
as well.

42. Description…
The device, called the Diagnostic Imaging System, comes in capsule form
and contains a camera, lights, transmitter and batteries.
The latest pill camera is sized at 11.6×31.5 mm and is capable of transmitting
50,000 color images during its traversal through the digestive system of
patient.

43. OPTICAL DOME
LENS HOLDER
LENS
ILLUMINATING LED’S CMOS IMAGE SENSOR
BATTERY
ASIC
TRANSMITTER
ANTENNA
5 7
Inside a Capsule Camera

44. 1.Optical Dome
 This shape results in easy orientation of the capsule axis along
the central axis of small intestine and so helps propel the capsule
forward easily.
 The Optical Dome contains the Light Receiving Window .
2.Lens Holder
 The Lens Holder is that part of the capsule which accommodates the
lens. The lens is tightly fixed to the holder so that it doesn’t get
dislocated anytime.
Components…

45. 3.Lens
 The Lens is an integral component of the capsule.
 It is arranged behind the Light Receiving Window.
4.Illuminating LED’S
 Around the Lens & CMOS Image Sensor, four LED’s (Light
Emitting Diodes) are present. These plural lighting devices are
arranged in donut shape.
Components…

46. 5.CMOS Image Sensor
Components…
CMOS (Complementary Metal Oxide Semiconductor) Image Sensor
is the most important part of the capsule. It is highly sensitive and
produces very high quality images.
It has 140º field of view and can detect objects as small as possible

47. Continue….
6.Battery
 Battery used in the capsule is button shaped and are two in
number as shown. The batteries are arranged together just
behind the CMOS Image Sensor.
 Silver Oxide primary batteries are used (Zinc/Alkaline
Electrolyte/Silver Oxide). Such a battery has a even discharge
voltage, disposable and doesn’t cause harm to the body.

48. 7.ASIC Transmitter
8.Antennae
As shown, the Antennae is arranged at the end of the capsule. It is
enclosed in a dome shaped chamber.
Components…
 The ASIC (Application Specific Integrated Circuit) Transmitter is
arranged behind the Batteries as shown. Two Transmitting
Electrodes are connected to the outlines of the ASIC Transmitter.
These Electrode are electrically isolated from each other.

49.  Crohn's Disease.
 Mal-absorption Disorders.
 Tumors of the small intestine & Vascular Disorders.
 Ulcerative Colitis
 Medication Related To Small Bowel Injury.
Applications…

50. CONTRAINDICATIONS
• Patient with known or suspected GI obstructions, strictures or
fistulas based on the clinical picture or pre procedure testing and
profile.
• Patient with cardiac pace maker or other implanted electro medical
device.
• Patient with swallowing disorders.

51. Procedure Of Capsule Cam
 Capsule is swallowed by the patient like a conventional pill.
 It takes images as it is propelled forward by peristalsis.
 A wireless recorder, worn on a belt, receives the images
transmitted by the pill.
 A computer workstation processes the data and produces a continuous
still images.
 You should pass the capsule naturally after 24-48 hours, but it can
sometimes take up to two weeks.

52. DATA
RECORDER
COMPUTER
Movement Of Capsule Through The
Digestive System
Data Acquisition & Storage Of Data On
Computer
Produces two images per
second, approximately 2,600
high quality images.

53. Images obtained by capsule camera

54. Advantages …
 Painless, no side affects or complications.
 Small size, so can move easily through digestive system.
 Accurate, precise and effective.
 Images taken are of very high quality which are sent almost
instantaneously to the data recorder for storage.
 Made of bio-compatible material, doesn’t cause any harm to the
body.

55. Drawbacks & Overcomes …
1.Patients with gastrointestinal structures or narrowing are not
good candidates for this procedure due to the risk of obstruction.
2.The Pill will get stucked if there is a partial obstruction in
the small intestine.
3.Impossible to control Camera behavior.
The first drawback is overcome using another product
manufactured with the help of nanotechnology which is the rice-
grain sized motor.
Other two drawbacks can be overcome using a bi-directional
telemetry Camera..

56. COMPLICATIONS
• Perforation of organ.
• Excessive bleeding
• Infection
• Bowel obstruction

57. PERFORATION OF ORAGAN
• Gastrointestinal perforation is a hole in the wall of the
gastrointestinal tract.
• Other names for the condition includes ruptured bowel,
intestinal perforation.
• Signs and symptoms include abdominal pain and tenderness,
nausea, vomiting.

58. EXCESSIVE BLEEDING
• If an obstruction or stricture prevents passage of the capsule,
surgery may be required for removal, with the associated risks
of bleeding and infection, prolonged hospitalization and even
death.

59. BOWEL OBSTRUCTION
• Bowel obstruction also known as intestinal obstruction, is a
mechanical or functional obstruction of the intestines which
prevents the normal movement of the products of digestion.
• Either the small bowel or large bowel may be affected.
• Sign and symptoms include abdominal pain, vomiting, bloating
and not passing gas.

60. Conclusion
The Capsule Endoscopy is a pioneering concept for Medical
Technology of the 21st century.
The endoscopy system is the first of its kind to be able to
provide non-invasive imaging of the entire small intestine.
It has revolutionized the field of diagnostic imaging to a
great extent and has proved to be of great help to
physicians all over the world.