ColonoscopColonoscopyy

HematocheHematocheziazia

CachexiaCachexia

AnastomosAnastomosisis

By Hana By Hana JakubickovaJakubickova

ColonoscopyColonoscopyIntroductionIntroduction

Endoscopic examination of the Endoscopic examination of the whole colon with a camera on a whole colon with a camera on a flexible tube passed through the flexible tube passed through the anusanus

Allows the doctor to look at the Allows the doctor to look at the inner lining of large intestine (colon inner lining of large intestine (colon and rectum)and rectum)

Could be used to look at the lower Could be used to look at the lower part of the small intestinepart of the small intestine

Colonoscopy Colonoscopy Introduction (Cont.)Introduction (Cont.)

Helps find ulcers, colon polyps, Helps find ulcers, colon polyps, tumors, and areas of inflammationtumors, and areas of inflammation

During a colonoscopy, tissues During a colonoscopy, tissues samples could be collected samples could be collected

Abnormal growths can be taken outAbnormal growths can be taken out Colonoscopy could be used as screening test to Colonoscopy could be used as screening test to

check for cancer or precancerous growths in the check for cancer or precancerous growths in the colon or rectum.colon or rectum.

Anatomy of the ColonAnatomy of the Colon

Colonoscopy vs. Colonoscopy vs. SigmoidoscopySigmoidoscopy

Indications for Indications for ColonoscopyColonoscopy

Blood in the stool or rectal bleedingBlood in the stool or rectal bleeding Dark or black stoolsDark or black stools Unexplained changes in bowel Unexplained changes in bowel

habits, chronic diarrheahabits, chronic diarrhea Iron deficiency anemiaIron deficiency anemia Sudden, unexplained weight lossSudden, unexplained weight loss Abnormal results from a stool test or Abnormal results from a stool test or

a barium enema testa barium enema test

Indications for Colonoscopy Indications for Colonoscopy (Cont.)(Cont.)

Inflammatory bowel disease (IBD)Inflammatory bowel disease (IBD) Crohn diseaseCrohn disease Ulcerative colitisUlcerative colitis Long-term, unexplained belly painLong-term, unexplained belly pain Screening for colorectal cancer Screening for colorectal cancer

- people with no risk factors at age 50- people with no risk factors at age 50

- people with a family history of colon - people with a family history of colon cancer cancer

at age 40, or 10 years before the age at age 40, or 10 years before the age that the that the

relative got cancerrelative got cancer

Preparation for Preparation for ColonoscopyColonoscopy

One to three days prior :One to three days prior :

- a low fiber or clear-fluid liquid only diet - a low fiber or clear-fluid liquid only diet

- don’t drink orange juice, prune juice, and- don’t drink orange juice, prune juice, and

milk (contain fiber)milk (contain fiber)

- don’t consume liquids and foods the are - don’t consume liquids and foods the are

dyed red, orange, purple, or brown (no dyed red, orange, purple, or brown (no grape grape

juice, fruit punch, cherry Jell-O, or grapejuice, fruit punch, cherry Jell-O, or grape

popsicles)popsicles)

- cola and black coffee are usually allowed- cola and black coffee are usually allowed

Preparation for Preparation for Colonoscopy (Cont.)Colonoscopy (Cont.)

The day before the colonoscopy: The day before the colonoscopy:

-- laxative tablet, laxative solution laxative tablet, laxative solution (Nulytely,(Nulytely,

Golytely)Golytely)

- if indicated stop taking aspirin, aspirin-- if indicated stop taking aspirin, aspirin-likelike

products, and blood thinnersproducts, and blood thinners

stop drinking clear liquids 6 to 8 hours stop drinking clear liquids 6 to 8 hours priorprior

30 to 60 minutes before the test:30 to 60 minutes before the test:

- you may be given enema- you may be given enema

ColonoscopyColonoscopyProcedureProcedure

ColonoscopyColonoscopyProcedureProcedure

Patient is undress and changed into Patient is undress and changed into an examination gownan examination gown

Vital signs are check and monitoredVital signs are check and monitored Intravenous line is put in place Intravenous line is put in place

(sedation and pain medication is (sedation and pain medication is given through IV line)given through IV line)

Patient is positioned on his/her left Patient is positioned on his/her left side with the knees up to the bellyside with the knees up to the belly

ColonoscopyColonoscopyProcedure (Cont.)Procedure (Cont.)

The doctorThe doctor

- checks the anus for potential - checks the anus for potential blockage (with a lubricated gloved blockage (with a lubricated gloved finger)finger)

- gently puts lubricated colonoscope - gently puts lubricated colonoscope into the anus and moves it slowly into the anus and moves it slowly through the rectum and colonthrough the rectum and colon

- inflates the large intestine with - inflates the large intestine with carbon dioxide gas for a better view carbon dioxide gas for a better view

ColonoscopyColonoscopyProcedure (Cont.)Procedure (Cont.)

The doctorThe doctor

- may ask the patient to move periodically so - may ask the patient to move periodically so

the scope can be adjusted for better the scope can be adjusted for better viewingviewing

- slowly withdraws the scope once it reaches - slowly withdraws the scope once it reaches

the opening to the small intestinethe opening to the small intestine

- again examines the lining of the large - again examines the lining of the large intestineintestine

- removes polyps or performs biopsy if - removes polyps or performs biopsy if

necessarynecessary

Polyp RemovalPolyp Removal

Polyp is A sterile solution A portion of Polyp is A sterile solution A portion of The polyp The polyp

identified is injected under the polyp is identified is injected under the polyp is is fully is fully

the polyp to lift it now removed the polyp to lift it now removed removed removed

away from deeperaway from deeper

tissuestissues

Colonoscopy Colonoscopy RecoveryRecovery

The test usually takes 30 to 60 minutes.The test usually takes 30 to 60 minutes. After testAfter test::

- patient is watched for 1 to 2 hours- patient is watched for 1 to 2 hours

- could go home when fully awake- could go home when fully awake

- may not drive or operate machinery - may not drive or operate machinery for 12 hoursfor 12 hours

- should drink a lot of fluid - should drink a lot of fluid

- may have bloating or cramps - may have bloating or cramps

HematocheziaHematochezia Is the passage of bright red (or maroon) Is the passage of bright red (or maroon)

bloody stools from the rectumbloody stools from the rectum Is also called Is also called bright red blood per bright red blood per

rectum rectum (BRBPR)(BRBPR) Is usually from the lower Is usually from the lower

gastrointestinal tract (the colon or gastrointestinal tract (the colon or rectum) or from hemorrhoidsrectum) or from hemorrhoids

It is distinguished from melena, which is stool with It is distinguished from melena, which is stool with blood that has been altered by the gut flora and blood that has been altered by the gut flora and appears black, smelly, and tarry (sticky). Melena appears black, smelly, and tarry (sticky). Melena usually signifies bleeding from the upper usually signifies bleeding from the upper gastrointestinal tract)gastrointestinal tract)

HematocheziaHematochezia

HematocheziaHematocheziaCausesCauses

Adults Adults

- hemorrhoids - enlarged, painful veins - hemorrhoids - enlarged, painful veins in the in the

rectumrectum

- diverticulosis - condition where - diverticulosis - condition where pockets (pouches) form in the colonpockets (pouches) form in the colon

- colorectal cancer - colorectal cancer

- large polyp- large polyp

HematocheziaHematocheziaCauses (Cont.)Causes (Cont.)

Adolescents and young adultsAdolescents and young adults

- ulcerative colitis – a type of - ulcerative colitis – a type of inflammatory bowel disease that inflammatory bowel disease that causes inflammation and sores causes inflammation and sores (ulcers) in the lining of the large (ulcers) in the lining of the large intestine;intestine;

usually affects the lower section usually affects the lower section (sigmoid colon) and the rectum (sigmoid colon) and the rectum

HematocheziaHematocheziaCauses (Cont.)Causes (Cont.)

NewbornsNewborns

- result of swallowed maternal blood - result of swallowed maternal blood at the time of deliveryat the time of delivery

- initial symptom of necrotizing - initial symptom of necrotizing enterocolitis - acquired disease, enterocolitis - acquired disease, primarily of preterm or sick primarily of preterm or sick neonates, characterized by mucosal neonates, characterized by mucosal or even deeper intestinal necrosisor even deeper intestinal necrosis

CachexiaCachexia Is physical wasting with loss of Is physical wasting with loss of

weight, fat, and muscle mass caused weight, fat, and muscle mass caused by diseaseby disease

Occurs in people who are eating Occurs in people who are eating enough, but cannot absorb nutrientsenough, but cannot absorb nutrients

Is not the same as anorexia (lack of Is not the same as anorexia (lack of appetite) or starvation (a healthy appetite) or starvation (a healthy person’s body can adjust starvation by person’s body can adjust starvation by slowing down its use of nutrients, but slowing down its use of nutrients, but in a cachectic patient, the body does in a cachectic patient, the body does not make this adjustment) not make this adjustment)

CachexiaCachexiaCachexia involves increased tissue Cachexia involves increased tissue

metabolism.metabolism.

Protein synthesis is decreased and Protein synthesis is decreased and degradation isdegradation is

increased.increased.

CachexiaCachexiaCausesCauses

Cancer (end-stage cancer – cancer Cancer (end-stage cancer – cancer cachexia)cachexia)

AIDS (acquired immunodeficiency AIDS (acquired immunodeficiency syndrome)syndrome)

COPD (chronic obstructive pulmonary COPD (chronic obstructive pulmonary disease)disease)

CHF (congestive heart failure)CHF (congestive heart failure) TuberculosisTuberculosis Drug addictionDrug addiction Some severe cases of schizophrenia Some severe cases of schizophrenia

(vesanic cachexia)(vesanic cachexia)

CachexiaCachexiaTreatmentTreatment

Additional caloric supplementation Additional caloric supplementation does not relieve cachexia.does not relieve cachexia.

Corticosteroids Corticosteroids CannabinoidsCannabinoids ProgestogensProgestogens

AnastomosisAnastomosis

A surgical connection between two A surgical connection between two structures (usually tubular structures (usually tubular structures), such as blood vesselsstructures), such as blood vessels

or loopsor loops

of intestineof intestine

Anastomotic TechniquesAnastomotic Techniques

Conventional methodsConventional methods

- hand-sewn- hand-sewn

- stapled- stapled Novel techniquesNovel techniques

- compression rings- compression rings

- tissue glues- tissue glues

A A

compression ringcompression ring

Anastomosis Anastomosis

Anastomoses can be Anastomoses can be fashioned in these ways:fashioned in these ways: End-to-endEnd-to-end End-to-sideEnd-to-side Side-to-sideSide-to-side

End-to-end anastomosisEnd-to-end anastomosis End-to-side End-to-side

anastomosisanastomosis

Small Intestine Small Intestine AnastomosisAnastomosis

AnastomosisAnastomosis

Phases of healingPhases of healing:: Lag phase (day 0-4) Lag phase (day 0-4)

- Acute inflammatory responses - Acute inflammatory responses occuroccur

- Anastomosis has no intrinsic - Anastomosis has no intrinsic strengthstrength

Fibroplasia phase (day 3-14)Fibroplasia phase (day 3-14)

- Fibroblasts proliferate- Fibroblasts proliferate

- Immature collagen is laid down- Immature collagen is laid down

AnastomosisAnastomosis(Cont.)(Cont.)

Phases of healing:Phases of healing: Maturation phase (beyond 10 days)Maturation phase (beyond 10 days)

- Collagen is remodeled- Collagen is remodeled

- Strength of anastomosis is - Strength of anastomosis is increased increased

Sources:Sources:

Wikipedia, the free encyclopedia (Last modified June 25, 2009). Wikipedia, the free encyclopedia (Last modified June 25, 2009). Colonoscopy. Colonoscopy. Retrieved July 4, 2009, from Retrieved July 4, 2009, from http://en.wikipedia.org/wiki/Colonoscopyhttp://en.wikipedia.org/wiki/Colonoscopy

WebMD. Monica Rhodes (August 11, 2008). WebMD. Monica Rhodes (August 11, 2008). Colorectal Cancer Colorectal Cancer Health Center Colonoscopy. Health Center Colonoscopy. Retrieved July 4, 2009, from Retrieved July 4, 2009, from http://www.webmd.com/colorectal-cancer/colonoscopy-16695http://www.webmd.com/colorectal-cancer/colonoscopy-16695

Wikipedia, the free encyclopedia (Last modified June 15, 2009).Wikipedia, the free encyclopedia (Last modified June 15, 2009). Hematochezia. Hematochezia. Retrieved July 4, 2009, from Retrieved July 4, 2009, from http://en.wikipedia.org/wiki/Hematocheziahttp://en.wikipedia.org/wiki/Hematochezia

Wikipedia, the free encyclopedia (Last modified July 3, 2009). Wikipedia, the free encyclopedia (Last modified July 3, 2009). CachexiaCachexia. Retrieved July 4, 2009, from . Retrieved July 4, 2009, from http://en.wikipedia.org/wiki/Cachexiahttp://en.wikipedia.org/wiki/Cachexia

Sources (Cont.):Sources (Cont.):

MedicineNet.com (Last editorial review November 10, 2004). MedicineNet.com (Last editorial review November 10, 2004). Definition of Cachexia. Definition of Cachexia. Retrieved July 4, 2009, from Retrieved July 4, 2009, from http://www.medterms.com/script/main/art.asp?articlekey=http://www.medterms.com/script/main/art.asp?articlekey=1106511065

Surgical-tutor.org.uk, a free on-line resource (Last updated Surgical-tutor.org.uk, a free on-line resource (Last updated April 21, 2009).April 21, 2009). Intestinal and Vascular Anastomoses. Intestinal and Vascular Anastomoses. Retrieved July 4, 2009, from Retrieved July 4, 2009, from http://www.surgical-tutor.org.uk/default-home.htm?core/prhttp://www.surgical-tutor.org.uk/default-home.htm?core/preop1/anastomoses.htm~righeop1/anastomoses.htm~righ

MedinePlus (Updated July 25, 2007). MedinePlus (Updated July 25, 2007). Medical Encyclopedia: Medical Encyclopedia: Anastomosis. Anastomosis. Retrieved July 4, 2009, from Retrieved July 4, 2009, from http://www.nlm.nih.gov/medlineplus/print/ency/article/002http://www.nlm.nih.gov/medlineplus/print/ency/article/002231.htm231.htm