FAQ AND TOPICS

How , when and why?? Answer to all your queries

Endoscopy is a nonsurgical procedure used to examine a person’s digestive tract. Using an endoscope, a flexible tube with a light and camera attached to it, your doctor can view pictures of your digestive tract on a color TV monitor.


During an upper endoscopy, an endoscope is easily passed through the mouth and throat and into the esophagus allowing the doctor to view the esophagus, stomach, and upper part of the small intestine.


Overall, endoscopy is safe; the procedure does have a few potential complications.


A special form of endoscopy called endoscopic retrograde cholangiopancreatography or ERCP, allows pictures of the pancreas, gallbladder, and related structures to be taken.


Endoscopic ultrasound or EUS combines upper endoscopy and ultrasound examination to obtain images and information about various parts of the digestive tract.


Procedure identifies the causes of:



  • Abdominal or chest pain

  • Nausea and vomiting

  • Heartburn

  • Stomach pain

  • Ulcers, gastritis, or difficulty swallowing

  • Digestive tract bleeding


In addition, it help to take a biopsy (removal of tissue) to look for the presence of disease.


Endoscopy may also be used to treat a digestive tract problem. For example, the endoscope might not only detect active bleeding from an ulcer, but devices can be passed through the endoscope that can stop the bleeding. Also, using ERCP, gallstones that have passed outside the gallbladder and into the bile duct can be removed.


Preparation for Endoscopy?


General Preparation. Examining the upper digestive tract (upper endoscopy or ERCP) requires nothing more than fasting for 6-8 hours prior to the procedure


Sedation. For most examinations with an endoscope, a sedative is provided. This increases the comfort of the individual undergoing the examination. The sedative, which is administered via an injection into the vein, produces relaxation and light sleep. There are usually few if any recollections of the procedure. Patients wake up within an hour, but the effects of the medicines are more prolonged, so it is not safe to drive until the next day.


General anesthesia (puts you totally asleep for a period of time) is given in only very special circumstances (in young children, and when very complex procedures are planned).


Do visit for endoscopy test with our super-specialist at Pace Hospitals, Begumpet.


Colonoscopy is a test that allows your doctor to look at the inner lining of your large intestine (rectum and colon). He or she uses a thin, flexible tube called a colonoscope to look at the colon. A colonoscopy helps find ulcers, colon polyps, tumors, and areas of inflammation or bleeding. During a colonoscopy, tissue samples can be collected (biopsy) and abnormal growths can be taken out. Colonoscopy can also be used as a screening test to check for cancer or precancerous growths in the colon or rectum (polyps).


Why is colonoscopy done?


Colonoscopy is done to:



  • Check for colorectal cancer or polyps.

  • Check for the cause of blood in the stool or rectal bleeding.

  • Check for the cause of dark or black stools.

  • Check for the cause of chronic diarrhoea.

  • Check for the cause of iron deficiency anemia.

  • Check for the cause of sudden, unexplained weight loss.

  • Check the colon after abnormal results from a CT scan, MRI, virtual colonoscopy, stool test, or barium enema.

  • Watch or treat inflammatory bowel disease (IBD).

  • Check for the cause of long-term, unexplained belly pain.

  • Certain individuals with a family history of some types of non-colonic cancers or colonic problems that may be associated with colon cancer (such as ulcerative colitis and colonic polyps)


How often should one undergo colonoscopy depends on the degree of the risk and the abnormalities found at previous colonoscopies. One widely accepted recommendation has been that even healthy people at normal risk for colon cancer should undergo colonoscopy at age 50 and every 10 years thereafter, for the purpose of removing colonic polyps before they become cancerous


How to prepare for colonoscopy?


One to two days before a colonoscopy, you have to stop eating solid foods and drink only clear fluids, such as water, tea, coffee, clear juices, clear broths, flavoured ice pops, and gelatine (such as Jell-O). Do not drink anything red or purple, such as grape juice or fruit punch. And do not eat red or purple foods, such as grape ice pops or cherry gelatine.


The colon must be completely cleaned, and there are several colonoscopy preparations. Patients are given detailed instructions about the cleansing preparation.


In general, this consists of drinking a large volume of a special cleansing solution or several days of a clear liquid diet and laxatives or enemas prior to the examination. These instructions should be followed exactly as prescribed or the procedure may be unsatisfactory (visualization of the lining of the colon may be obscured by residual stool), and it may have to be repeated, or a less accurate alternative test may be performed in its place.



  • You will want to stay home while doing the colon prep, because the colon prep will make you use the bathroom often.

  • Drink plenty of clear fluids during the prep so you will not get dehydrated. This will also help clean out your colon completely after you finish the colon prep.

  • Do not eat any solid foods after doing the colon prep.

  • Stop drinking clear liquids 6 to 8 hours before the colonoscopy.


What should I expect during colonoscopy?


You may lie on your left side with your knees pulled up to your belly. Because you will be given medicine during the colonoscopy, you probably won’t remember much, if anything, until you wake up after the procedure.


Next, the doctor will insert a thin, flexible colonoscope in your anus and move it slowly through the rectum and into your colon. Air will be used to inflate your colon so the doctor can look at the lining of the colon through the scope or on a computer screen hooked to the scope.


You may feel the need to have a bowel movement while the scope is in your colon. You may also feel some cramping. Breathe deeply and slowly through your mouth to relax your belly muscles. This should help the cramping. You will likely feel and hear some air escape around the scope. There is no need to be embarrassed about it. The passing of air is expected. You may be asked to change your position during the test.


Your doctor will look at the whole length of your colon as the scope is gently moved in and then out of your colon.


The doctor may also use tiny tools, such as forceps, loops, or swabs, through the scope to collect tissue samples (biopsy) or take out growths. Usually, people do not feel anything if a biopsy is done or if polyps are taken out.


What if there are abnormalities detected during colonoscopy?


If an abnormal area needs to be better evaluated, a biopsy forceps can be passed through a channel in the colonoscope and a biopsy (a sample of the tissue) can be obtained. The biopsy is submitted to the pathology laboratory for examination under a microscope by a pathologist. If infection is suspected, a biopsy may be obtained for culturing of bacteria (and occasionally viruses or fungus) or examination under the microscope for parasites. If colonoscopy is performed because of bleeding, the site of bleeding can be identified, samples of tissue obtained (if necessary), and the bleeding controlled by several means. Should there be polyps, (benign growths that can become cancerous) they almost always can be removed through the colonoscope. Removal of these polyps is an important method of preventing colorectal cancer, although the great majority of polyps are benign and do not become cancerous. None of these additional procedures typically produce pain. Biopsies are taken for many reasons and do not necessarily mean that cancer is suspected.


Do visit for colonoscopy test with our super-specialist at Pace Hospitals, Begumpet.


Endoscopic retrograde cholangiopancreatography is a procedure that combines upper gastrointestinal (GI) endoscopy and x rays to treat problems of the bile and pancreatic ducts. ERCP is also used to diagnose problems, but the availability of non-invasive tests such as magnetic resonance cholangiography has allowed ERCP to be used primarily for cases in which it is expected that treatment will be delivered during the procedure.


What is upper gastrointestinal (GI) endoscopy?


Upper GI endoscopy is a procedure that uses a lighted, flexible endoscope to see and perform procedures inside the upper GI tract. The upper GI tract includes the esophagus, stomach, and duodenum—the first part of the small intestine.


Drawing of the gastrointestinal tract inside the outline of a man’s torso with the esophagus, stomach, liver, common bile duct, gallbladder, pancreas, main pancreatic duct, duodenum, small intestine, and large intestine labeled.


What are the bile and pancreatic ducts?


Ducts are tube like structures in the body that carry fluids. The bile ducts carry bile, a liquid the liver makes to help break down food. A group of small bile ducts—called the biliary tree—in the liver empties bile into the larger common bile duct. Between meals, the common bile duct closes and bile collects in the gallbladder—a pear-shaped sac next to the liver.


The pancreatic ducts carry pancreatic juice, a liquid the pancreas makes to help break down food. A group of small pancreatic ducts in the pancreas empties into the main pancreatic duct.


The common bile duct and the main pancreatic duct join before emptying their contents into the duodenum through the papillary orifice at the end of the duodenal papilla—a small, nipplelike structure that extends into the duodenum.


Drawing of the biliary system with the liver, biliary tree (bile ducts), common bile duct, gallbladder, pancreas, duodenal papilla, main pancreatic duct, and duodenum labeled. Inset of an enlarged biliary system with the duodenal papilla and papillary orifice labeled.


When is ERCP used?


ERCP is used when it is suspected a person’s bile or pancreatic ducts may be narrowed or blocked due to



  • Tumors

  • Gallstones that form in the gallbladder and become stuck in the ducts

  • Inflammation due to trauma or illness, such as pancreatitis—inflammation of the pancreas

  • Infection

  • Valves in the ducts, called sphincters, that won’t open properly

  • Scarring of the ducts, called sclerosis

  • Pseudocysts—accumulations of fluid and tissue debris


How does a person prepare for ERCP?


The upper GI tract must be empty. Generally, no eating or drinking is allowed 8 hours before ERCP. Smoking and chewing gum are also prohibited during this time.
Patients should tell about all health conditions they have, especially heart and lung problems, diabetes, and allergies. Patients should also tell their health care provider about all medications they take. Patients may be asked to temporarily stop taking medications that affect blood clotting or interact with sedatives, which are usually given during ERCP to help patients relax and stay comfortable.


Medications and vitamins that may be restricted before and after ERCP include:-



  • Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen (Advil), and naproxen (Aleve)

  • Blood thinners

  • High blood pressure medication

  • Diabetes medications

  • Antidepressants

  • Dietary supplements


Driving is not permitted for 12 to 24 hours after ERCP to allow the sedatives time to completely wear off. Before the appointment, patients should make plans for a ride home.


How is ERCP performed?


ERCP is conducted at a hospital or outpatient center by a doctor and assistants who have specialized training in this procedure. Patients receive a local anesthetic that is gargled or sprayed on the back of the throat. The anesthetic numbs the throat and calms the gag reflex.


An intravenous needle is inserted into a vein in the arm if sedatives will be given. Doctors and other medical staff monitor vital signs while patients are sedated.


During ERCP, patients lie on their back or side on an x-ray table. The doctor inserts an endoscope down the esophagus, through the stomach, and into the duodenum. Video is transmitted from a small camera attached to the endoscope to a computer screen within the doctor’s view. Air is pumped through the endoscope to inflate the stomach and duodenum, making them easier for the doctor to examine.


When the doctor locates the duodenal papilla, a blunt tube called a catheter is slid through the endoscope and guided through the papillary opening. Once the catheter is inside the papilla, the doctor injects a dye into the ducts. The dye, also called contrast medium, allows the ducts to be seen on x rays. X rays are then taken to see the ducts and to look for narrowed areas or blockages.


Procedures to treat narrowed areas or blockages can be performed during ERCP. To see the ducts during treatment procedures, the doctor uses x-ray video, also called fluoroscopy. Special tools guided through the endoscope and into the ducts allow the doctor to open blocked ducts, break up or remove gallstones, remove tumors in the ducts, or insert stents. Stents are plastic or expandable metal tubes that are left in narrowed ducts to restore the flow of bile or pancreatic juice. A kind of biopsy called brush cytology allows the doctor to remove cells from inside the ducts using a brush that fits through the endoscope. The collected cells are later examined with a microscope for signs of infection or cancer.


Occasionally, ERCP is done after gallbladder surgery, if a surgical bile leak is suspected, to find and stop the leak with a temporary stent.


What does recovery from ERCP involve?


After ERCP, patients are moved to a recovery room where they wait for about an hour for the sedatives to wear off. Patients may not remember conversations with health care staff, as the sedatives reduce memory of events during and after the procedure. During this time, patients may feel bloated or nauseous. Patients may also have a sore throat, which can last a day or two.


Patients can go home after the sedatives wear off. Patients will likely feel tired and should plan to rest for the remainder of the day.


Some ERCP results are available immediately after the procedure. Biopsy results are usually ready in a few days.


Eating, Diet, and Nutrition


Unless otherwise directed, patients may immediately resume their normal diet and medications after having an ERCP. The health care provider can answer any specific questions about eating, diet, and nutrition.


What are the risks associated with ERCP?


Significant risks associated with ERCP include



  • Infection

  • Pancreatitis

  • Allergic reaction to sedatives

  • Excessive bleeding, called hemorrhage

  • Puncture of the GI tract or ducts

  • Tissue damage from radiation exposure

  • Death, in rare circumstances


When ERCP is performed by an experienced doctor, complications occur in about 6 to 10 percent of patients and these often require hospitalization.1 Patients who experience any of the following symptoms after ERCP should contact their health care provider immediately:



  • Swallowing difficulties

  • Throat, chest, or abdominal pain that worsens

  • Vomiting

  • Bloody or dark stool

  • Fever


Points to Remember -



  • ERCP is a procedure that combines upper gastrointestinal (GI) endoscopy and x rays to treat problems of the bile and pancreatic ducts.

  • Upper GI endoscopy is a procedure that uses a lighted, flexible endoscope to see and perform procedures inside the upper GI tract.

  • Ducts are tubelike structures in the body that carry fluids. The bile ducts carry bile, a liquid the liver makes to help break down food. The pancreatic ducts carry pancreatic juice, a liquid the pancreas makes to help break down food.

  • The common bile duct and the main pancreatic duct join before emptying their contents into the duodenum, the first part of the small intestine.

  • The health care provider usually provides written instructions about how to prepare for ERCP.

  • Driving is not permitted for 12 to 24 hours after ERCP to allow the sedatives time to completely wear off. Before the appointment, patients should make plans for a ride home.

  • During ERCP, the doctor inserts an endoscope down the esophagus, through the stomach, and into the duodenum.

  • The doctor injects contrast medium into the ducts and x rays are taken to see the ducts.

  • Special tools that slide through the endoscope allow the doctor to open blocked ducts, break up or remove gallstones, remove tumors in the ducts, or insert stents.

Whether it’s a mild stomach ache, sharp pain, or stomach cramps, abdominal pain can have numerous causes. Some of the more common causes include:



  • Indigestion

  • Constipation

  • Stomach virus

  • Menstrual cramps

  • Food poisoning

  • Food allergies

  • Gas

  • Lactose intolerance

  • Ulcers

  • Pelvic inflammatory disease

  • Hernia

  • Gallstones

  • Kidney stones

  • Endometriosis

  • Crohn’s disease

  • Urinary tract infection

  • Gastroesophageal reflux disease (GERD)

  • Appendicitis


What Symptoms of Abdominal Pain Are Cause for Concern?


If your abdominal pain is severe or if it is accompanied by any of the following symptoms, contact your health care provider as soon as possible:



  • Fever

  • Inability to keep food down for several days

  • Inability to pass stool, especially if you are also vomiting

  • Painful or unusually frequent urination

  • The abdomen is tender to the touch

  • The pain is the result of an injury to the abdomen

  • The pain lasts for several days


These symptoms can be an indication of an internal problem that requires treatment as soon as possible.


Seek immediate medical care for abdominal pain if you:



  • Vomit blood

  • Have bloody stools

  • Have difficulty breathing

  • Have pain occurring during pregnancy


How Is the Cause of Abdominal Pain Determined?


Because there are so many potential causes of abdominal pain, your health care provider will perform a thorough physical exam, discuss with you the type of symptoms you are experiencing, and ask you several questions about the pain you are feeling. These questions may include:



  • What type of pain are you experiencing? Is the pain throughout your abdomen or is it confined to a particular area?

  • Where in your abdomen does the pain seem to be located?

  • What type of pain are you experiencing? Is it stabbing and severe? -Is it a dull ache?

  • When does the pain occur? Always? More often in the morning or at night? If the pain comes and goes, about how long does it last each time? Does it occur after eating certain types of foods or after drinking alcohol? During menstruation?


How long have you had this pain?



  • Does the pain also radiate into your lower back, shoulder, groin, or buttocks?

  • Are you currently taking any medications or herbal supplements?

  • Are you pregnant?

  • Does any activity such as eating or lying on one side relieve the pain?

  • Have you been injured recently?

  • Once an initial evaluation has been completed, your health care -provider may have you undergo some tests to help find the cause of your pain. These may include stool or urine tests, blood tests, barium swallows or enemas, an endoscopy, X-ray, ultrasound, or CT scan.


 


How Is Abdominal Pain Treated?


Treating abdominal pain depends on its cause. Treatments can range from medications for inflammation, GERD, or ulcers, to antibiotics for infections, to changes in personal behavior for abdominal pain caused by certain foods or beverages. In some cases, such as appendicitis and a hernia, surgery is necessary.

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