tailieunhanh - Gastroenterology an illustrated colour text - part 2

Một bên xem nội soi được sử dụng (Hình 3) để cho phép một cái nhìn của các nhú, cannulated với một ống chứa đầy trung bình tương phản X-ray. Điều này cho phép nội địa hoá và chẩn đoán chính xác. | STANDARD INVESTIGATIONS I 7 Fig. 2 Control head of colonoscope showing wheels for steering and buttons for air water and suction. Colonoscopy Indications Colonoscopy is indicated for investigation of ữon deficiency anaemia follow-up of abnormal barium enema investigation of change in bowel habit colorectal cancer screening staging and surveillance in ulcerative colitis. It also allows procedures such as polypectomy or stent insertion. Technique The bowel is prepared by cleansing with a strong stimulant laxative such as picolax or an osmotic laxative such as polyethylene glycol solution which is taken the day prior to the investigation. Iron is discontinued several days earlier and warfarin replaced with heparin if polypectomy is to be carried out. The patient is asked to give consent and receives sedation and analgesia. Colonoscopy follows digital examination of the anorectal canal and a complete colonoscopy is one that reaches the caecum or better still the terminal ileum small bowel biopsies confirm complete colonic examination . Poor bowel preparation looping of the colonoscope and patient discomfort may be reasons for an incomplete examination. It is essential that the colonoscopist recognises when an incomplete examination has been performed so that further imaging may be undertaken such as a barium enema. A major potential hazard is an unrecognised incomplete examination which has the potential of missing proximal lesions. After the procedure patients have some gaseous abdominal distension which soon passes. Potential computations These are the same as for flexible sigmoidoscopy but the risk of perforation is higher particularly if right-sided colonic polyps are removed. Endoscopic retrograde cholangiopancreatography ERCP Indications Diagnostic ERCP is becoming less common as better imaging techniques such as ultrasound and CT allow the endoscopist to know what to expect during the procedure. Investigation and treatment of obstructive jaundice cholangitis and

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