Gastrointestinal  - gastroscopy, colorectal

Gastroscopy

Gastroscopy is a commonly performed investigation typically for gastroesophageal reflux / heartburn but there are other indications as well. Although no bowel preparation is required, the patient needs to fast as a sedation is used. It is often combined with colonoscopy.

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Colonoscopy

Colonoscopy is also frequently performed for a variety of indications that include a positive faecal occult blood test, bleeding, change of bowel habit and a family history of bowel cancer. The bowel must be prepped, a process that takes three days. Faecal occult blood testing kits can be obtained from the chemist and also, the government’s National Bowel Screening project sends the kit for those turning 50..

View colonoscopy document

Bowel cancer

Approximately 1 in 22 Australians will be treated for bowel cancer. In a small percentage of cases it is associated with certain gene defects (there will often be a pre-existing strong family history of bowel cancers) but for the most part it happens spontaneously. When the diagnosis of a large polyp or definite cancer is made at colonoscopy, then further workup in the form of blood tests and usually a CT scan is necessary. Further management will depend on the circumstances.

Chronic abdominal pain

Unfortunately it is an all too common phenomenon for people to suffer from chronic abdominal pain, often associated with a cluster of other symptoms most notably irregular bowel habit and bloating. My approach to this frustrating problem is to first rule out significant pathology by means of gastroscopy and colonoscopy. If these are unhelpful, an ultrasound checking for gall stones is usually performed and sometimes a CT scan is also ordered. If nothing can be found on these measures, another avenue that is sometimes helpful is to check for food intolerance. It is now possible to test for intolerance to lactose (a sugar in dairy products), fructose (a sugar in a lot of fruit), sucrose (table sugar) and mannitol and sorbitol - both common food additives.

Hepatobiliary

Gall stones

A common problem in the Western World, gall stones usually form due to an imbalance of cholesterol in the bile. The supersaturated cholesterol precipitates out of the bile mostly in the gall bladder forming stones. While the stones may be asymptomatic, they can cause problems if they temporarily block the outlet of the gall bladder (biliary colic), or actual inflammation and infection of the gall bladder which often requires hospitalization. The stones may also leave the gall bladder and enter the common bile duct, sometimes blocking it (in which case the individual becomes jaundiced) or stirring up pancreatitis. Sometimes the presence of gall stones is noted incidentally on an ultrasound performed on the abdomen but not for gall bladder symptoms. These "asymptomatic" stones as a rough guide have a 7% chance of causing serious problems over a ten year period.

 

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