The course of a colonoscopy
synonym
Colonoscopy, intestinal examination
English: colonoscopy
definition
A colonoscopy is a diagnostic measure in which the inside of the large intestine can be inspected and diagnosed with a flexible endoscope.
The colonoscopy procedure
Before the colonoscopy is performed, the patient's colon must be cleaned in order to create optimal visibility for the examiner during the procedure. For this reason, the patient must undergo medication laxative measures before a colonoscopy. The day before the examination, the patient usually needs water with dissolved in it Movicol or drink similar preparations that have a laxative effect.
Furthermore, he should not eat any more before the end of the examination. The colonoscopy is seldom done on the hospital ward, but mostly in dedicated endoscopic departments that almost every hospital has. The patient is lying on his side shortly before the procedure. He is also given a venous access (Braunüle) through which a short anesthetic or, if complications arise, life-saving medication can be applied directly into the vein.
Propofol is usually used as a sleep aid in low doses during a colonoscopy. The patient then falls asleep. With the help of a pulse oximeter attached to the finger, the heart rate and oxygen saturation of the patient can be monitored during the procedure.
The examiner, usually also wearing a plastic apron, inserts the flexible colonoscope into the patient's anus after a thorough examination.
With buttons attached to the handle, the tip of the colonoscope can be rotated in all directions like a snake's head. Shortly after inserting the colonoscope, air is passed into the intestine during a colonoscopy.
The reason for this is that the intestine has the property of folding up when emptied and thus making visibility very poor. With the help of the air, the intestine is unfolded. Some patients who do not want to have a short anesthetic before the procedure describe the breathing in as uncomfortable to painful.
The examiner now pushes the colonoscope forward bit by bit. The focus here is not initially on the assessment of the intestine, but on the careful maneuvering of the endoscope through the intestine. It is important that the intestinal wall is not injured during a colonoscopy. Narrowed areas are opened by increasing the air intake. With the help of the camera and the very powerful lamp, the current image is projected onto a monitor next to the examiner.
The mobility at the tip of the colonoscope only helps to change the camera setting accordingly, the skill of the examiner is required to move the colonoscope. From the outside, he can maneuver the examination device by moving left and right so that it is advanced to the transition from the small intestine to the large intestine.
It has to cover a distance of approx. 1.50 m. At the so-called Baumann flap (Transition from small intestine to large intestine) in most cases the push maneuver is ended. From now on, the colonoscope is slowly withdrawn and the actual colonoscopy begins. The intestinal walls are inspected, redness, swellings and evidence are assessed. In conspicuous places, a wire can be pushed from the outside to the tip of the colonoscope.
There are small pliers at the tip of the wire. With these forceps the examiner can grasp suspicious areas of the intestinal wall, pull them from the outside and move them outside.
The tissue samples, also known as biopsy, are then sent to the pathology department for pathological assessment. Next to the Live image it is also possible to take photos with the camera. Every suspicious area must be documented with a photographic technique during a colonoscopy in order to be able to understand the examination process later.
In addition to the insertable forceps, loops can also be inserted into the intestine via the endoscope, with which e.g. Polyps, which are often found on the intestinal walls, can be entwined and removed. When the examiner reaches the anus again, the device is pulled out and disinfected. The patient usually remains in a sleeping or twilight state for a short time and is brought back to the ward.
Read more about the topic here: This is how colon polyps are removed
preparation
The extensive preparation for a colonoscopy includes examining the blood. Here it can be seen whether there is an inflammation and whether the coagulation is OK, or whether medication may have to be discontinued.
Since the intestinal mucosa must be assessed during the colonoscopy, it is necessary to have a clear view of it. To do this, the bowel must be completely emptied in advance, which is achieved by adjusting the food and by taking a laxative.
About three days before the colonoscopy, care should be taken to avoid foods that contain grains, such as muesli, whole grain bread, grapes or kiwi fruit.
Around 24 hours before the colonoscopy, fiber should not be consumed, i.e. no foods that are difficult to digest or gas. After lunch you should not eat any more.
Only tea, water, meat or vegetable broth may be drunk. Eating must also be avoided in the evening. Instead, you must start taking the laxative solution. For this purpose, two to three liters of a special solution must be drunk in about 90 minutes, which takes effect about one to two hours after drinking.
On the morning of the colonoscopy, a comparably large amount of this solution must be drunk again and food must be avoided. The attending doctor will decide which laxative is used here and how much of the solution must be drunk.
In preparation for a colonoscopy, it is also necessary to decide together with the doctor whether calming down, a light anesthetic, is desirable during the examination. This depends on the patient's condition, as it is usually not medically necessary. If reassurance is desired, the patient should arrange for an escort in advance to accompany him home after the examination and arrange for his transport. Even after a light anesthetic, it is not allowed to drive a vehicle for the following 24 hours.
In addition, it is part of the preparation to insert an indwelling venous cannula, i.e. access to the patient's blood system in order to inject any sedatives or other medication that may be required here.
Read more on the topic: Colonoscopy - Preparation
Can you drink beforehand?
In general, drinking directly before a colonoscopy is not allowed. In order to prepare the bowel perfectly for the colonoscopy, a few things must be observed from around 24 hours before it is performed. Only clear liquids may be consumed. These include, for example, water and tea.
This also includes the laxative. If you feel hungry or have hypoglycaemia, lemonade can also be drunk. Milk, cream and juices should be avoided. If necessary, fruit juices without pulp are allowed. You can drink as much as you like the day before. On the day of the colonoscopy, the doctor in charge should pay attention to the instructions. As a rule, drinking is allowed.
laxative
When it comes to laxatives for a colonoscopy, you can choose between numerous preparations with numerous active ingredients. They have different mechanisms of action depending on the active ingredient and are used in technical jargon Laxatives called. They also come in many different forms. There are laxatives in tablets, as powder, as granules, as drops and as suppositories.
Except for the suppositories, all laxatives are absorbed into the intestine through the mouth. These are drunk along with a large amount of water. The intestines are flushed to a certain extent by the water alone. Some laxatives stimulate the intestines to move more. This leads to faster emptying.
Other active ingredients such as the sugars mannitol or sorbitol bind the water in the intestine. As a result, it cannot be absorbed into the body through the mucous membrane and it is excreted in liquid form. Furthermore, some laxatives can stimulate the intestines to secrete water and electrolytes.Therefore, with these substances, care should be taken to ensure that you drink enough fluids.
These include, for example, oils or various plant substances contained in aloe or buckthorn. The very salty active ingredients such as sodium sulphate or magnesium sulphate only lead to the secretion of water. Other laxatives such as lactulose also soften the stool, making it easier to pass through.
Read more on the subject below: Laxatives
Pain
The colonoscopy is definitely not one of the pleasant examinations.
The advancement of the approx. 1 cm thick examination tube leads to the Pull on various structures in the abdomen on which the intestine is suspended and the advancement itself is felt.
This is not pleasant for the person being examined and can also cause pain.
However, the pain usually does not come through the intestine itself because there is none on the inside sensitive fibers can cause pain.
The pain only lasts when the examination tube is pushed forward Bowel loop happened and straightened.
The guided air allows light Abdominal pain even after a colonoscopy occur.
In addition to the mechanical releases mentioned above, the large ones can also be used Air or CO2 quantities which are pumped into the intestines during the examination cause pain.
These arise from the strain and pressure on other organs in the abdomen and feel similar to the most extreme Flatulence.
However, these should disappear again within 1-2 days after the colonoscopy when the air or CO2 is absorbed by the intestinal wall and the stretching of the intestine subsides.
Due to the now very soft and bendable materials of the hoses and the ever smaller cameras, pulling on the straps and pushing them forward can be made more comfortable for the patient and is only painful in individual cases.
Patients, however, in advance Operations in the abdomen are more often plagued by these side effects and pain, as they mostly relieve themselves after abdominal surgery Adhesions train which can then be easily pulled and which then cause more pain than the rather loose hanging straps.
Depending on whether you have already signed up for one in advance anesthesia anesthesia can be started even now if the patient only feels the procedure is too uncomfortable during the examination.
The pain relievers described under anesthesia as part of anesthesia always relieve the pain sufficiently so that the examination is not unnecessarily uncomfortable.
Nevertheless, there are also many patients who describe the treatment as unpleasant but tolerable even without medication. Much more uncomfortable than pain for most patients is uncomfortable laxative in remembrance.
Duration of the process
As a rule, purging with a colonoscopy is started in the afternoon of the day before. Eating should be stopped about 24 hours before the start of the procedure. The duration of the pure colonoscopy depends on the length of the intestine being examined and the anesthetic.
An examination of the colon should take 30 minutes. If you are anesthetized, the process will take a little longer. When taking a tissue sample, only short delays are to be expected.
When can you eat again afterwards?
After the end of a colonoscopy, you can eat straight away. Drinking immediately after the end is also unproblematic. It is not necessary to pay attention to a special diet afterwards. However, sometimes you may experience nausea or other similar symptoms after a long time without food. It is therefore advisable to start with a light diet.
Anesthesia or rather no anesthesia?
Since the feeling of a tube in the body is not one of the pleasant feelings, it is possible to have the examinations carried out under anesthesia.
In contrast to major surgery, a colonoscopy is Not in a general anesthetic carried out, so no Ventilation be necessary, but you continue to breathe independently all the time.
There is only one for implementation IV cannula necessary, a small plastic tube that is placed in the crook of the elbow or on the back of the hand in a vein of the arm and through which the medication can then be administered directly into the blood.
This requires a small prick through the skin, comparable to that of the Vaccinating.
Depending on the wishes of the patient or depending on the standard of the clinic or practice, in addition to one Painkiller either a strong one Sedatives administered or a strong Sleeping pillswhich, unlike the sedative, completely shields you from the action and puts the patient into a twilight or sleep state within 30 seconds.
With both types of anesthesia, you are constantly monitored by the doctors and nurses Pulse and Oxygen saturation be measured.
For patients who already have problems with their heart or circulation, e.g. already one Heart attack are usually also accompanied by a EKG- and Blood pressure monitoring fitted.
A positive aspect of the Sedatives is that it causes forgetfulness and, after the examination, ideally one cannot remember the examination.
One should inquire about the conditions of a cost assumption from the health insurance companies beforehand. Some practices that perform colonoscopies work together with anesthesia practices for such cases, who then perform the anesthesia during the examination.
The internist who performs the colonoscopy usually only performs the more superficial anesthesia described above.
After the anesthesia, you should stay in the practice's relaxation or recovery rooms until the doctor releases you into the care of an accompanying person.
Anyone who opts for anesthesia, however, should be aware that 50% of the complications associated with the examination are related to the anesthesia.
Above all, this includes problems with the Cycle and the breathing up to allergic Reactions to the anesthetics.
Anesthesia should be carefully considered, especially for those with previous illnesses to be examined.
It is also possible to start the examination without anesthesia and, if symptoms or discomfort arise, to initiate the anesthesia during the examination in order to make it as pleasant as possible for the patient.
Also, anesthesia does not prevent the pain caused by flatulence after the procedure.
It should be noted that the patient should and should rest as much as possible after an anesthetic for this day no vehicles and the like can control more, so the way home should be secured.
Furthermore, one is not able to operate machines or to do larger deals.
Depending on the occupation, an absence from the workplace is also necessary on the day after the examination, e.g. Bus driver.
This time is regulated by law and cannot be shortened by taking a lower dose of medication.
Read everything about this topic at: Anesthesia for a colonoscopy
