DIGESTIVE SYSTEM Medical terms By Loredana T. Lungu
1. Liver BiopsyA liver biopsy is a procedure to remove a smallpiece of the liver so it can be examined with amicroscope for signs of damage or disease. Thethree main types of liver biopsy are percutaneous,transvenous, and laparoscopic.
What is the liver? The liver is a vital organ with many important functions.The liver• removes harmful chemicals from the blood• fights infection• helps digest food• stores nutrients and vitamins• stores energy
When is a liver biopsy performed? A liver biopsy is performed when a liver problem is difficult to diagnose with blood tests or imaging techniques, such as ultrasound and x ray. More often, a liver biopsy is performed to estimate the degree of liver damage—a process called staging. Staging helps guide treatment.
Restricted medication nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and naproxen• blood thinners• high blood pressure medication• diabetes medications• antidepressants• antibiotics• asthma medications• dietary supplements
How to prepare for the procedure? Prior to liver biopsy, blood will be drawn to determine its ability to clot. People with severe liver disease often have blood clotting problems that can increase the risk of bleeding after the procedure. A medicine given just before a liver biopsy, called clotting factor concentrates, reduces the risk of bleeding in patients with blood clotting abnormalities. Patients who will be sedated should not eat or drink for 8 hours before the liver biopsy and should arrange a ride home, as driving is prohibited for 12 hours after the procedure. Mild sedation is sometimes used during liver biopsy to help patients stay relaxed. Unlike general anesthesia where patients are unconscious, patients can communicate while sedated but then often have no memory of the procedure. Sedatives are often given through an intravenous (IV) tube placed in a vein. The IV can also be used to give pain medication, if necessary, after the procedure.
How is the procedure performed? All three main types of liver biopsy remove liver tissue with a needle; however, each takes a different approach to needle insertion. A liver biopsy may be performed at a hospital or outpatient center.
Results of the liver biopsyResults from a liver biopsy take a few days to comeback. The liver sample goes to a pathologylaboratory where the tissue is stained. Staininghighlights important details within the liver tissueand helps the pathologist—a doctor whospecializes in diagnosing disease—identify signs ofliver disease. The pathologist looks at the tissuewith a microscope and sends a report to thepatient’s doctor.
Recovery time after the biopsyMost patients fully recover from a liver biopsy in 1to 2 days. Patients should avoid intense activity,exercise, or heavy lifting during this time. Sorenessaround the incision site may persist for about aweek. Acetaminophen (Tylenol) or other painmedications that do not interfere with blood clottingmay help. Patients should check with their doctorbefore taking any pain medications.
What are the risks?Pain at the biopsy site is the most frequent risk of percutaneous liver biopsy,occurring in about 20 percent of patientsThe risk of excessive bleeding, called hemorrhageRisk of death is about 1 in 10,000Other risks include puncture of other internal organs, infection, and spread ofcancer cells, called cancer seedingTransvenous liver biopsy carries an additional risk of adverse reaction to thecontrast material.
2. ColectomyColectomy is a surgical procedure to remove all orpart of your colon. Your colon, also called yourlarge intestine, is a long tube-like organ at the endof your digestive system. Colectomy may benecessary to treat or prevent diseases andconditions that affect your colon.
Types of colectomy operationsColectomy that involves removing the entire colon is called total colectomyColectomy to remove part of the colon may be called subtotal colectomy orpartial colectomyRemoving the right or left portion of the colon is called hemicolectomy.Surgery to remove both the colon and rectum is called proctocolectomy.Colectomy surgery usually requires other procedures to reattach theremaining portions of your digestive system and permit waste to leave yourbody.
Why is the colectomy done? Bowel obstruction. A blocked colon is an emergency that may require total or partial colectomy, depending on the situation.1 Bleeding that cant be controlled. Severe bleeding from the colon may require surgery to remove the affected portion of the colon. For instance, in rare cases, pockets in the colon (diverticula) can cause bleeding that may require surgery.2 Bowel perforation. A torn colon is also an emergency that may require colectomy.3 Colon cancer. Early-stage cancers may require only a small section of the colon to be removed during colectomy. Cancers at a later stage may require more of the colon to be removed.4 Crohns disease. If medications arent helping you, removing the affected part of your colon may offer temporary relief from signs and symptoms.5 Ulcerative colitis. Your doctor may recommend total colectomy if medications arent helping to control your signs and symptoms.6 Preventive surgery. If you have a very high risk of colon cancer due to the formation of multiple precancerous colon polyps, you may choose to undergo total colectomy to prevent cancer in the future. Colectomy may be an option for people with inherited genetic conditions that increase colon cancer risk,
Risks of Colectomy Bleeding1 Blood clots in the legs (deep vein thrombosis) and the lungs (pulmonary embolism)2 Infection3 Injury to organs near your colon, such as the bladder and small intestines4 Tears in the sutures that reconnect the remaining parts of your digestive system
How to Prepare for colectomyStop taking certain medicationsFast before your surgeryDrink a solution that clears your bowels. Yourdoctor may prescribe a laxative solution that youmix with water at home.Take antibiotics; if prescribed by your DoctorTake a shower. Shower before going to the
What to expect during colectomy? Youll be given a general anesthesia medication to put you in a sleep-like state so that you wont be aware during your operation. Colon surgery may be performed in two ways: 1. Open colectomy. Open surgery involves making a large incision in your abdomen to access your colon. 2. Laparoscopic colectomy. Laparoscopic colectomy, also called minimally invasive colectomy, involves several small incisions in your abdomen. Your surgeon passes a tiny video camera through one incision and special surgical tools through the other incisions. Once the colon has been repaired or removed, your surgeon will reconnect
What to expect after colectomy? After surgery youll be taken to a recovery room to be monitored as the anesthesia wears off. Then your health care team will take you to your hospital room to continue your recovery. Youll stay in the hospital until you regain bowel function. This may take acouple of days to a week. You may not be able to eat solid foods at first. You mightreceive liquid nutrition through a vein in your arm and then transition to drinkingclear liquids. As your intestines recover, you can eventually add solid foods.
3. Fecal occult blood testFecal occult blood test is used to test the presence ofmicroscopic or invisible blood in the stool, or feces. Fecaloccult blood can be a sign of a problem in your digestivesystem, such as a growth, or polyp, or cancer in the colonor rectum. If microscopic blood is detected, it isimportant for your doctor to determine the source ofbleeding to properly diagnose and treat the problem.
Causes for blood in the stool Benign (non-cancerous) or malignant (cancerous) growths or polyps of the colon1. Hemorrhoids (swollen blood vessels near the anus and lower rectum that can rupture causing bleeding)2. Anal ﬁssures (splits or cracks in the lining of the anal opening)3. Intestinal infections that cause inﬂammation4. Ulcers5. Ulcerative colitis6. Crohns disease7. Diverticular disease, caused by outpouchings of the colon wall8. Abnormalities of the blood vessels in the large intestine
How to take the test? The fecal occult blood test requires the collection of three stool samples. The stool samples should be taken one day apart, because colon cancers may bleed from time to time, rather than consistently.You can purchase fecal occult blood test kits at the pharmacy to perform the test at home, oryour doctor may give you the home test during one of your appointments. These testsprovide speciﬁc instructions, and most offer a toll-free number to call if you have questions.The stool samples are collected in a clean container and evaluated by detecting colorchanges on a test card, or by sending the samples, in a special container and envelope,directly to the doctors ofﬁce for analysis. Your doctor may examine the samples with amicroscope or with chemical tests.
How to prepare for the test? Don’t perform the test is you have:1.Diarrhea2.Colitis3.Constipation4.Diverticulitis5.Ulcers6.Hemorrhoid ﬂare-ups7.Your period
How to prepare for the test? Do not eat:• Beets• Broccoli• Cantaloupe• Carrots• Cauliﬂower• Cucumbers• Grapefruit• Horseradish• Mushrooms• Radishes• Red meat (especially meat that is cooked rare)• Turnips• Vitamin C-enriched foods or beverages
Results of the testBecause small amounts of blood normally appear in thestool, tests for occult blood are designed to detect largerquantities of blood.A positive fecal occult blood test means that blood hasbeen found in the stoolA negative test result means that no blood was found inthe stool sample during the testing period. You shouldcontinue to follow your doctors recommendations forregular cancer screening.
4. Barium swallowA barium swallow, or upper GI series, is an x-ray test used to examine theupper digestive tract (the esophagus, stomach, and small intestine). Becausethese organs are normally not visible on x-rays, you need to swallow barium,a liquid that does show up on x-rays. The barium temporarily coats the liningof the esophagus, stomach, and intestine, making the outline of these organsvisible on the xray pictures. This test is useful for diagnosing cancers, ulcers,problems that cause narrowing of the esophagus, some causes ofinflammation in the intestine, and some swallowing problems.
How to prepare for the test?Tell your doctor and the x-ray technicians if there is any chance you could bepregnant. If you have diabetes and take insulin, discuss this with your doctorbefore the test.Stop eating and drinking the night before your test. This is important becausefood in your stomach or intestine could prevent the doctors from seeing aclear outline of these structures on the x-rays. Usually it isnt a problem foryou to take your regular pills, but you should check with your doctor.
How is the test performed?At the start of the test, you drink barium, a liquid that looks like a milkshakebut does not taste nearly as good (most patients say it tastes like chalk). Youmight also be asked to swallow some tablets that "fizz," causing air-bubblesto be released in your stomach. This might make you feel like burping, but trynot to. You will get better pictures if you can keep yourself from burping.Atthe start of the test, you drink barium, a liquid that looks like a milkshake butdoes not taste nearly as good (most patients say it tastes like chalk). Youmight also be asked to swallow some tablets that "fizz," causing air-bubblesto be released in your stomach. This might make you feel like burping, but trynot to. You will get better pictures if you can keep yourself from burping
What happens during the test?The x-ray technician may ask you to stand or lie in different positions over thenext few minutes, to help spread around the liquid you have swallowed. Mostoften, the x-ray pictures are taken while you lie on your back on a table. Thex-ray machine or the table is moved a few times so it can take pictures of allof the internal structures. You are asked to hold your breath for each pictureso that your breathing movement does not blur the image.
RisksThere are no significant risks.You are exposed to a small amount of radiation during the test, but theamount of radiation is too small to be likely to cause any health problems.After the test, you can eat normally and do your normal activities. You shoulddrink more water than usual to help clear out the barium and to preventconstipation, which might be a side effect of the test. Your stool may appearlight in color for a couple of days.
ResultsIt takes the x-ray department 30 minutes to an hour to develop the picturesfrom your barium swallow, and it will take additional time for a doctor toexamine the x-rays and to decide how they look. Typically you can get theresults within a day or two.