Gastroenterology ob 4

EGD
we don't normally do H.Pylori biopsy with endoscopy. For patient has never test for H.Pylori, can use serology test, if patient has complete eradication treatment, use stool antigen test, which has high sensitive, and is cheapest.

Wireless video capsule endoscopy
after take capsule, 2hr clear liquid, 4hr eat light meal.

Indications — The indications for VCE of the small bowel are evolving. The primary indications are for diagnosis of the site of obscure gastrointestinal bleeding in adults (including iron deficiency anemia), suspected Crohn's disease, and small bowel tumors. In addition, VCE is being used to detect small bowel injury associated with the use of nonsteroidal antiinflammatory drugs (NSAIDs), evaluate abdominal pain of unclear etiology, to screen for polyps in patients with familial polyposis syndromes such as Peutz-Jeghers syndrome and familial adenomatous polyposis, and possibly in the assessment of celiac disease. There is also growing experience in children over the age of 10 for the above indications [17] and these indications are now approved for children as young as two years of age. 

preparation--a 12-hour fast without preparation

Both the PillCam SB2 (in SVH) and the EndoCapsule are 11 x 26 mm in size and acquire images from one end of the device at a rate of two frames per second for approximately eight hours.



Capsule ingestion — The video capsule is swallowed with water. Following capsule ingestion, clear liquids may be taken after two hours, and food and medications may be taken after four hours. The sensor arrays are removed after eight hours and the recorded images are downloaded and processed on workstations.No need to collect the capsule.

The overall yield of VCE for obscure gastrointestinal bleeding has been reported to be in the range of 30 to 70 percent.

• Small bowel angiectasia – 22 percent
• Small bowel ulcerations – 10 percent
• Small bowel tumors – 7 percent
• Small bowel varices – 3 percent
• Blood in the small bowel with no lesion identified – 8 percent
• Esophagogastric lesions (eg, esophagitis, gastritis) – 11 percent
• Colonic angiectasia – 2 percent

VCE should not be used in patients with known or suspected strictures, Capsule retention has been described in up to 5 percent of patients who underwent a capsule study for Crohn's disease, even after performing an initial small bowel study.

Magnetic resonance imaging — Patients should not undergo magnetic resonance imaging (MRI) until passage of the capsule has been confirmed due to concern that it could result in damage to the gastrointestinal tract. Perforation!!!!

Contraindications — The procedure may be contraindicated in patients with the following conditions, albeit these contraindications may not be absolute:

• Dementia (in patients who cannot cooperate with swallowing of the capsule or who may inadvertently damage the equipment)
• Gastroparesis (the capsule can be placed in the duodenum by endoscopy to avoid this problem)
• An esophageal stricture, swallowing disorders that could prevent passage of the capsule (eg, Zenker's diverticulum) (the capsule can be placed in the duodenum by endoscopy to avoid this problem)
• Partial or intermittent small bowel obstruction (unless a surgeon is involved, the patient understands the risks, and the patient has been cleared for surgery)
• Those who are inoperable or refuse surgery
• Patients who have defibrillators or pacemakers (this is a recommendation in the package insert, but does not appear to be a significant clinical problem)
• Women who are pregnant

diabetes patient preparation for colonoscopy
if patient is taking insulin, stop short act insulin in the morning and only take half dose long act insulin the night before.
actually prefer higher glucose than low glucose.

EGD
snakeskin pattern in gastric mucosa indicate mild portal hypertension
http://www.gastrointestinalatlas.com/English/Stomach/Portal_Hypertensive_Gastropath/portal_hypertensive_gastropath.html

Endoscopic appearance of portal hypertensive gastropathy
 in a 65-year-old man with cirrhosis. Note the characteristic
 snakeskin appearance of the gastric mucosa.