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Procedures EGD (upper GI Endoscopy) What is an EGD? EGD is a procedure that enables Dr. Alvarez to examine the lining of the upper part of your gastrointestinal tract. He will examine your esophagus, stomach, and duodenum (the first portion of the small intestine). The test is performed using a thin flexible tube with its own lens and light source. A variety of instruments can be passed through the tube to allow the doctor to treat many abnormalities directly with little or no discomfort. For example, if you have been experiencing difficulty swallowing foods or liquids and a narrowed or strictured area is found in your esophagus, Dr. Alvarez will stretch this area. If polyps (usually benign growths) are found, these can be removed during your procedure. If areas of bleeding are noted, these can safely and effectively be controlled. Swallowed objects can also be removed during an EGD. Why is an EGD done? Upper endoscopy is usually performed to evaluate symptoms of persistent abdominal pain, nausea, vomiting, or difficulty swallowing. It is also the best test for finding the cause of bleeding from the upper gastrointestinal tract. Upper endoscopy is more accurate than x-rays for detecting inflammation, ulcers, polyps, or tumors of the esophagus, stomach, and duodenum. Upper endoscopy with biopsy can detect early cancer and distinguish between benign and malignant conditions. Biopsies are taken for many reasons including diagnosing Helicobacter pylori (the bacteria that causes peptic ulcer disease and malignancy). What preparation is needed? For the best possible examination, the stomach must be completely empty, so you should have nothing to eat or drink, including water, for at least 4 hours before you are scheduled to arrive for your test. If you take blood pressure or heart medications, you can take those when you wake up the morning of the test with a small sip of water. Someone must come with you to drive you home, because you will be given medication to help you relax. It will make you drowsy, so you will not be allowed to drive after the test. Even though you may not feel tired, your judgment and reflexes may not be normal. What should you expect during the procedure? You will be given medication through a vein to make you relaxed and sleepy. While you are in a comfortable position on your side, the scope will be passed through the mouth and then through the esophagus into the stomach and duodenum. The scope will not interfere with your breathing during the test. What are the possible complications? Endoscopy is safe and is associated with very low risk when performed by a doctor who has been specially trained and is experienced in the procedure. Complications can occur but are rare. One possible complication is perforation in which a tear through the wall of the esophagus or stomach may allow leakage of digestive fluids. This complication may be managed simply by aspirating the fluids until the opening seals or may require surgery. Bleeding may occur from the site of the biopsy or polyp removal. It is usually minimal but rarely may require transfusions or surgery. Other risks include drug reactions and complications from unrelated diseases such as heart attack or stroke. Death is extremely rare but remains a remote possibility. Esophageal Dilation What is esophageal dilation? Esophageal dilation is a procedure that allows your doctor to dilate, or stretch, a narrowed area of your esophagus [swallowing tube]. Doctors can use various techniques for this procedure. Your doctor might perform the procedure as part of a sedated endoscopy. Alternatively, your doctor might apply a local anesthetic spray to the back of your throat and then pass a weighted dilator through your mouth and into your esophagus. Why is esophageal dilation done? The most common cause of narrowing of the esophagus, or stricture, is scarring of the esophagus from reflux of stomach acid occurring in patients with heartburn. Patients with a narrowed portion of the esophagus often have trouble swallowing; food feels like it is “stuck” in the chest region, causing discomfort or pain. Less common causes of esophageal narrowing are webs or rings (which are thin layers of excess tissue), cancer of the esophagus, scarring after radiation treatment, or a disorder of the way the esophagus moves [motility disorder]. How should I prepare for the procedure? An empty stomach allows for the best and safest examination, so you should have nothing to eat after midnight the night before your test and nothing to drink, including water, for at least four hours before the examination. What can I expect during esophageal dilation? Esophageal dilation is performed with sedation along with an upper endoscopy. An endoscope is passed through your mouth and into the esophagus, stomach, and duodenum. The endoscope does not interfere with your breathing. At this point, your doctor will determine whether to use a dilating balloon or plastic dilators over a guiding wire to stretch your esophagus. You might experience mild pressure in the back of your throat or in your chest during the procedure. Your doctor will then pass a tapered dilating instrument through your mouth and guide it into the esophagus. What can I expect after esophageal dilation? Most patients experience no symptoms after this procedure and can resume eating the next day, but you might experience a mild sore throat for the remainder of the day. What are the potential complications of esophageal dilation? Although complications can occur even when the procedure is performed correctly, they are rare when performed by doctors who are specially trained. A perforation, or hole, of the esophagus lining occurs in a small percentage of cases and may require surgery. A tear of the esophagus lining may occur and bleeding may result. There are also possible risks of side effects from sedatives. It is important to recognize early signs of possible complications. If you have chest pain, fever, trouble breathing, difficulty swallowing, bleeding, or black bowel movements after the test, tell your doctor immediately. Will repeat dilations be necessary? Depending on the degree and cause of narrowing of your esophagus, you may require repeat dilations. This allows the dilation to be performed gradually and decreases the risk of complications. Once the stricture, or narrowed esophagus, is completely dilated, repeat dilations may not be required. If the stricture was due to acid reflux, acid-suppressing medicines can decrease the risk of stricture recurrence. Colonoscopy What is colonoscopy? Colonoscopy is a procedure that enables Dr. Alvarez to examine the lining of the colon (large bowel) by inserting a tube about the thickness of your finger into the anus and advancing it slowly into the rectum and colon. What preparation is required? The colon must be completely empty of waste material for the procedure to be accurate and complete. Follow the prep instructions you are given carefully. If you do not, the procedure may have to be cancelled and repeated later. You may have some nausea and/or vomiting with the prep. If you are not passing clear (or clear yellow) liquid with your last bowel movement, please call our office the morning of your procedure for further instructions. What about my medications? Most medications can be continued as usual; however, drugs such as aspirin or blood thinners are examples of medications which you may need to stop before the date of your test. You will be given instructions on which medications we will need you to stop. It is also essential you alert us if you require antibiotics prior to undergoing dental procedures since you may need antibiotics prior to colonoscopy as well. What can be expected during colonoscopy? Colonoscopy is usually well tolerated and rarely causes much pain. You will be given a medication through a vein to help you relax. You will be lying on your side while the colonoscope is advanced through the large intestine. As the instrument is withdrawn, the lining of the intestine is carefully examined. What if the exam shows something abnormal? If Dr. Alvarez sees an area that needs evaluation, a biopsy (sample of the colon lining) may be obtained and submitted to a laboratory for analysis. If areas of bleeding are noted, these areas may be controlled through the colonoscope by injecting certain medications or by sealing off the bleeding with heat treatment (coagulation). If polyps are found, they are generally removed. If you have been experiencing rectal bleeding and internal hemorrhoids are found, laser treatment may be performed on these areas. What happens after colonoscopy? After the procedure, you may have some mild cramping or a bloating sensation because of the air that has been passed into the colon during the examination. This will disappear with the passage of gas. You should be able to eat after having the procedure, but your diet and activities may be restricted for a few days, especially if polyps are removed. What are the possible complications? Colonoscopy and polypectomy are generally safe when performed by physicians who have been specially trained and are experienced in these endoscopic procedures. Possible complications include a perforation (tear through the bowel wall) and bleeding from the site of the biopsy or polypectomy. Although complications after colonoscopy are rare, it is important for you to recognize early signs of any possible complication. Contact our office if you notice any of the following symptoms: severe abdominal pain, fever and chills, or rectal bleeding of more than one-half cup. It is important to note that rectal bleeding can occur even several days after the removal of a polyp. Infrared Coagulation (IRC) What is Infrared Coagulation? Infrared Coagulation (IRC) is the most widely used treatment for hemorrhoids and is preferred over other methods because it is fast, well-tolerated by patients, and virtually problem-free. A small probe is used to contact the area above the hemorrhoid, exposing the tissue to a burst of infrared light for about one second. This coagulates the vein above the hemorrhoid causing it to shrink and recede. What preparation is needed? Usually IRC is performed during a colonoscopy, so the prep for the colonoscopy is all that is needed. If you are coming just for an IRC, you will need to take 2 Bisacodyl pills the night before your test and use one Fleet’s enema the morning of your test. What should you expect during the procedure? You may feel a sensation of heat very briefly, but the procedure is generally not painful. Are there any after affects? Generally not. Most patients return to a normal lifestyle the same day. There may be slight spot bleeding a few days later. Heavy straining or lifting should be avoided and aspirin should not be taken for a few days. Infusion Therapy What exactly is Infusion Therapy? Infusion Therapy is a medical term to describe the process by which medications are delivered through an IV. For those suffering from Inflammatory Bowel Disease (IBD) and related health conditions, and for whom conventional treatments are ineffective, Infusion Therapy is the next best option. Even though it may seem inconvenient, intense, or even a little scary, it can potentially make you feel a whole lot better. Our highly trained nurses administer biological anti-inflammatory treatments in a relaxed, comfortable setting. What are the benefits of Infusion Therapy? The benefits of Infusion Therapy can include: - Significant reduction of IBD symptoms - Reduced inflammation - Prevention of complications, which can lead to hospitalization or surgery Is Infusion Therapy safe? Infusion Therapy and biologics are extremely safe, and can be very effective. Because the injections are administered by professionals in a medical environment, patients should feel confident about their safety.
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Gastroenteroloska ambulanta Gastroenterologija je disciplina Interne medicine. Naziv joj potiče od grčkih riječi gastros (stomak), enteron (crijeva) il ogos (nauka). Bavi se proučavanjem bolesti probavnog sistema i to kako bolesti Jednjaka, želuca, tankog crijeva,debelog crijeva, tako i bolesti bilijarnog sistema, pankreasa i peritoneuma. Najvažniji simptomi su disfagija, odinofagija, melena, haematomesis, bol u abdomenu, nagon na povraćanje te septični sindromi izazvani različitim bakterijskim infekcijama. Gastroenteroloske usluge u našoj ambulanti: Gastroenteroloski pregled Pregled gastroenterologa podrazumijeva razgovor doktora s bolesnika u cilju dobivanja detaljnih anamnestičkih podataka o sadašnjim tegobama, ranijim bolestima, operacijama, njihovom liječenju te bolestima u porodici. Također, doktor će se detaljno informirati o vašem apetitu, stolici, mokrenju, ostalim funkcijama i navikama, kao i lijekovima koje uzimate (trajno ili povremeno). Nakon toga doktor će Vas detaljno pregledati s posebnim osvrtom na trbuh i trbušne organe. U nekim slučajevima biti će potreban i digitorektalni pregled, tokom kojega doktor svojim kažiprstom pregledava unutrašnjost završnog dijela debelog crijeva u svrhu pronalaska mogućeg uzroka tegoba (npr. hemoroidi, fisure, polipi i slično). Anus se prethodno namaže posebnom kremom kako bi pregled bio manje neugodan. Nakon pregleda doktor Vam daje svoje mišljenje u kojem predlaže daljnje pretrage, ukoliko su one potrebne radi postavljanja točne dijagnoze, ili Vam propisuje terapiju u cilju rješavanja Vaših tegoba. Rektoskopija To je endoskopski pregled zadnjeg dijela debelog crijeva u dubinu do 20–25 cm. Ako znamo da se oko 80% tumoroznih tvorevina nalazi u zadnjih 20 cm debelog crijeva, to ćemo bolje shvatiti važnost ovog pregleda. Za rektoskopiju je važno reći sljedeće: - Priprema debelog crijeva za pregled nije potrebna, odnosno ne preporuča se „čišćenje“, i to iz dva razloga: prvo zato što možemo dobiti lažno pozitivni nalaz radi iritiranja sluznice, a zatim i zbog toga što se „isperu“ eventualni tragovi krvi iz gornjih partija debelog crijeva, pa nam taj važan podatak izostane. - Ovaj pregled potpuno je bolno neosjetljiv, ali su nažalost iskustva drugačija, prvenstveno zbog toga što se ne poštuje specifičnost građe ove regije. Rektoskopijom pregledava sluznicu zadnjeg crijeva, rektuma, tako da uvodi šuplju, metalnu, rigidnu cijev nešto deblju od prsta u rektum. Pretraga se još naziva proktoskopija, a instrument rektoskop ili proktoskop, obično je dužine od oko 30 cm. U položaju koljena-laktovi Vaš doktor će nakon podmazivanja analnog otvora anestetskim gelom i nakon učinjenog digitorektalnog pregleda (pregled zadnjeg crijeva prstom) uvesti polako instrument u rektum, izvaditi nastavak koji se naziva obdurator koji štiti rektoskop od ulaza stolice, staviti optički prsten, te pregledati perianalnu regiju, analni kanal i rektum, a ako je crijevo dovoljno čisto i dio sigmoidnog debelog crijeva, sve skupa najviše do 25 cm. Tom pretragom moguće je otkriti polipe u analnom kanalu, rektumu i dijelu sigmoidnog debelog crijeva, hemoroide i fisure, te promjene sluznice završnog debelog crijeva. Rektoskopija je zahvat koji koji je siguran, pa su komplikacije poput perforacije crijeva, mehaničke ozljede sluznice ili krvarenja iznimno rijetke. Gastroskopija Gastroskopija, poznata još kao gornja endoskopija ili ezofagogastroduodenoskopija je postupak koji omogućuje doktoru da detaljno pregleda vaš jednjak, želudac i dvanaesnik. Savitljiva glatka cijev sa rasvjetom na vrhu, debljine vašeg malog prsta, uvodi se kroz usta do jednjaka, želuca i dvanaesnika. Pregled se izvodi u pacijenata sa simptomima nelagode ili boli u gornjem dijelu trbuha, mučnine, nagona na povraćanje, žgaravice ili teškoća u gutanju. Metoda je vrlo pouzdana u otkrivanju uzroka krvarenja, upale ili tumora jednjaka, želuca i dvanaesnika. Pri endoskopij je moguće učiniti bezbolnu biopsiju specijalnim instrumentom, a uzeto se tkivo kasnije posebno analizira. Želudac mora biti potpuno prazan i stoga ne smijete ništa jesti ili piti osam sati prije pregleda. Ako trajno uzimate neke lijekove posavjetujte se prije toga sa doktorom možete li ih uzeti prije pregleda ili ne. Isto tako, ako bolujete od srčanih ili plućnih bolesti, porazgovarajte o njima sa doktorom i ponesite raniju medicinsku dokumentaciju. Pregled želuca iznutra putem sonde koja se kroz usta i jednjak plasira u želudac. Na ovaj načina otkriva se čir na želucu ili dvanaestopalačnom crevu, upala sluzokože kod infekcije sa Helicobacter pylori, dobroćudni i zloćudni tumori, želudačna kila, kao i efekat lečenja. Pregled traje nekoliko minuta. Kolonoskopija To je sigurna, učinkovita metoda za vizualno ispitivanje sluznice crijeva pomoću dugog, fleksibilnog, cjevastog instrumenta (kolonoskopa) koji na vrhu ima malu kameru. Koristi se za dijagnosticiranje problema debelog crijeva i rektuma, te za obavljanje biopsija i uklanjanje polipa debelog crijeva. Većina kolonoskopija se izvodi ambulantno uz minimalne neugodnosti i nelagodu. Kolonoskopija se može raditi i u analgosedaciji tj. bez bola i neprijatnosti. Prije kolonoskopije crijeva prvo moraju biti temeljito očišćena. To se učini po uputstvu za čišćenje koje ćete dobiti od sestre. Pacijent leži na lijevom boku a kolonoskop se pažljivo uvodi u debelo crijevo kroz anus i ukoliko je moguće prolazi sve do spoja sa tankim crijevom. Tokom pretrage gastroenterolog će ukloniti polipe ili uzeti biopsiju ako je potrebno. Cijeli postupak obično traje manje od pola sata. Da bi se stijenka crijeva mogla dobro analizirati, tijekom pregleda u crijevo se upuhuje manja količina zraka zbog čega tijekom i nakon kolonoskopije možete imati nelagodu i osjećaj napuhnutosti koja popušta nakon puštanja plina (flatulencije). Većina pacijenata može nastaviti svoju redovitu prehranu kasnije taj dan.Kolonoskopijom je sada moguće otkriti i ukloniti većinu polipa bez abdominalne operacije. Kolonoskopija je točnija od irigografije debelog crijeva za otkrivanje polipa ili ranog karcinoma debelog crijeva. Često se pronađeni polipi mogu odmah i ukloniti, što je veliki korak ka prevenciji raka debelog crijeva Ezofagoskopija Ezofagoskopija, osmatranje unutrašnjeg lumena i zida jednjaka uz upotrebu osvjetljenog dugačkog spekuluma u obliku ovalne cijevi (ezofagoskopa), koji se uvlači u jednjak pri anesteziji (lokalnoj ili opštoj) bolesnika. Ovaj metod primjenjuje se i za vađenje stranih tijela iz jednjaka. Ezofagoskopija je dijagnostička metoda kojom se dugi fleksibilni instrument uvodi kroz usta te uz izvor svjetla omogudava prikaz anatomskih struktura jednjaka zajedno sa svim patološkim promjenama na sluznici jednjaka. Znatna korist je i od endoskopske ultrasonografije(ultrazvuka) što nam daje informaciju i o dubini invazije bolesti i širenju na regionalne limfne čvorove.