GI Investigation

Blood tests
Endoscopy
Contrast studies
U/S
CT
MRI
Laparoscopy
Special tests
Colonoscopy & Gastroscopy
Colonoscopy

This is a test used
to visualise the
whole colon and
terminal ileum.


The Colonoscope consists of a long flexible fibteoptic tube
with a light and video camera at its tip

Colonoscopy
The tip can be guided
using controls, and
samples can be taken
through a channel which
passes the full length of
the Colonoscope. In this
way lesions may be
biopsied or removed.

Indications
1. Rectal bleeding
2. Altered bowel habit
3. Chronic diarrhoea
(especially with blood or
mucus)
4. Melaena with normal
gastroscopy
5. Unexplained iron
deficiency anaemia

6. Screening family
members eg familial
polyposis FAP
7. Assessment of
inflammatory bowel
disease(IBD)
8. Surveillance of IBD,cancer
and polyposis patients


HNPCC
Procedure
1. Explain procedure to
patient (patient info
leaflets)

2. Obtain written
consent

Procedure Bowel Prep
3. Laxatives are given on
the day prior to the
procedure to
completely empty the
colon. A good prep gives
good visibility and a bad
prep obscures visibility.

Procedure cont.
4. IV sedation is given, and
most patients sleep,
remembering little of
the test.
5. O2 saturation is
monitored.
6. The patient is placed in
lateral decubitus
position. The scope is
inserted through the
anus and manoeuvred
around the colon to the
terminal ileum.

Procedure cont
7. Air is inflated into
the colon to allow
full circumference of
colon to be seen.
8. Biopsies may be
taken or polyps
removed.

Procedure cont

9. Minimal discomfort
is associated with
the test.
10. The patient then
rests for about 30
minutes.

Following the Procedure
Following discharge the patient must be picked up
by family/friend.
They should not drive or work until following day.
Explain that air insufflation may cause gas pains
or flatulence
At home should observe for increasing abdominal
pain, abdominal swelling or blood in bowel
motion

Complications
Complications are
more frequent when
bowel is diseased or
when interventions
are performed.
Bleeding
Perforation
Mortality

Gastroscopy (OGD)

This is a test used to visualise the upper
gastrointestinal tract - oesophagus, stomach
and duodenum.
A long, flexible tube with a light and video
camera at its tip is again used

Gastroscope
One for thumb and another one
index and middle finger
Oesophoagogastroduodenoscopy
Indications
1. Diagnostic
Haematemesis and/or
melaena
Dyspepsia
Dysphagia
Persistent or severe
nausea and/or vomiting
Unexplained weight loss
Unexplained anaemia

Indications cont.

2. Therapeutic
Sclerosis of varices
Dilation of stricture
Removal of foreign
body
Insertion of PEG tube

Percutaneous endoscopic gastrostomy
Contraindications

Clinically unstable
Coagulopathy
Oropharyngeal abnormality
Massive bleeding
Suspected perforation
Recent surgery

Procedure
1. The patient is fasted
for at least 6 hours.
2. The procedure is
explained to patient
and written consent
obtained.

Procedure cont.
3. The throat is sprayed
with lignocaine.
4. Oxygen saturation is
monitored.
5. Intravenous sedation is
given if patient very
anxious or for
additional procedures.

Can cause aspiration
It is not painful but unpleasant
Procedure cont.
6. A supportive
mouthpiece is placed in
the patients mouth and
the instrument is
passed into the pharynx
then down the
oesophagus and into
stomach and
duodenum. (Patient
should feel no pain nor
is breathing affected)

Procedure cont.

7. A biopsy may be
taken, this is again
painless.
8. The procedure takes
about 10-15 minutes
Procedure cont.
Biopsies can be Obtained
Following the Procedure

The patient is nil by
mouth for one and a
half hours after
procedure and should
be collected from the
hospital by
family/friend.


Side Effects & Complications
Side Effects
Sore throat
Bloating or cramps
(should both settle within 24 hours)

Complications
Local perforation
Bleeding
Aspiration pneumonia