Anatomy Review Indications Should consider colonoscopy

Anatomy Review

Indications • Should consider colonoscopy if: • previous polyps • family history of colon cancer • rectal bleeding • hemoccult positive stools • change in bowel habits • protracted diarrhea • anemia • unexplained wt. Loss/fevers • abdominal pain.

CONTRAINDICATIONS • ABSOLUTE • Acute, severe cardiopulmonary disease. • Inadequate bowel prep. • Active diverticulitis • Acute abdomen. • History of SBE or prosthetic valves with no prophylaxis. • Marked bleeding dyscrasia. RELATIVE • Recent abdominal surgery (bowel or pelvic). • Active infection • Pregnancy.

Clear Liquid Diet • Beverages: carbonated, coffee, kool-aid (avoid red), tea. • Desserts: Jello, clear popsicles • Fruit: Apple juice, cranberry juice, grape juice • Soups: Beef bouillon, clear broth • Sweets: hard candy, sugar.

Equipment

Additional Equipment • Light source • Suction apparatus • Biopsy forceps • 4 X 4 inch gauze pads • sterile gloves • Water container (for suction)

Techniques FIGURE 1. Hooking and straightening technique used to pass through a tortuous sigmoid colon. (A) The scope is inserted to the angled sigmoid. (B) The scope tip is turned to a sharp angle, and the sigmoid is hooked as the scope is withdrawn. (C) The sigmoid is straightened as the scope is withdrawn. The scope can then be inserted through to the descending colon.

Complications • Bowel perforation (1 -2/1000) • Complications from sedation • Bleeding (increased risk with biopsy) • Abdominal distention and pain • Infection (SBE, infection from another pt. ) • Vasovagal symptoms • Missed disease