INSTRUCTIONS FOR COLONOSCOPY
DAY BEFORE TEST
Have a light breakfast(but do not have any grain bread or anything with seeds in it)
12:00 Noon
Have a light lunch – (eg soup, sandwich). YOU MUST NOT EAT AFTER THIS
3:00 pm
Start taking the COLOCAPS BALANCE
Swallow down 5 capsules with a glass of clear fluids(eg water, black tea or coffee without mild, cordials, strained fruit juices without pulps, jelly, clear soup)
If morning procedure,
Continue taking 5 capsules every 15min until all 65 capsules have been taken
If afternoon procedure,
Continue doing these until there are 20 capsules left.
Leave 20 capsules to take on the morning of the test – every 15 minutely from 7am until 8am. You can continue to have clear non-alcoholic fluids up to 4 hours prior to the procedure
INSTRUCTIONS FOR COLONOSCOPY
DAY BEFORE TEST
Have a light breakfast(but do not have any grain bread or anything with seeds in it)
Dissolve GLYCOPREP in ONE litre of water and place in fridge
12:00 Noon
Have a light lunch – (eg soup, sandwich). YOU MUST NOT EAT AFTER THIS
3:00 pm
Start drinking the GLYCOPREP solution – drink 1 glass every 15 minutes. (Slow down if nauseaous)
5:00 pm
Mix 1 sachet PICOPREP with water and drink. Drink at least 1 litre of clear fluids(eg water, black tea or coffee without mild, cordials, strained fruit juices without pulps, jelly, clear soup) over the next 2 hours
7:00pm
Mix 1 sachet PICOPREP with water and drink. Drink at least 1 litre of clear fluids over the next 2 hours
DAY OF TEST
Morning examination – Do not eat or drink anything. Take usual medication with sip of wter.
Afternoon examination – Drink lots of clear fluids up to 4 hours before procedure.
One of the interesting things working in Australia is the English we use – even today after nearly 20 years here, I am still learning the language.
Just the other day, my theatre nurse was saying “this whipper snapper is having a double banger this arvo”. I could see that my registrar(who is an international medical graduate) had no idea what she was talking about. I sort of had to guess what a whipper snapper is…
Anyway, a double banger(also called a top & tail or top & bottom) is a gastroscopy and colonoscopy.
Whipper snapper – I am told that this is a term we refer to someone who is younger. But in this case, we were referring to a “young” elderly man!
To all the medical students and doctors taking the AMC exams who may be reading this, don’t worry – this will should not come out in your exams! Imagine getting a question like this in “layman’s terms” – “Please discuss with this whipper snapper who has family history of bowel cancer the pros and cons of doing a double banger”
Oh.. and by the way, “arvo” means afternoon – learnt that years ago, when my colleague told me he was taking the “arvo” off and handing over the pager to me.
An elderly patient was referred with rectal bleeding thought to be from haemorrhoids(The patient has just had colonoscopy <2 years ago by a gastroenterologist which showed only haemorrhoids and was otherwise reported as normal) The patient’s bleeding had not really settled at all since the previous colonoscopy and the patient’s bleeding was attributed to the haemorrhoids reported in the colonoscopy. The patient was referred recently for the haemorrhoidal bleeding and a colonoscopy was performed. A low rectal cancer measuring about 5cm was found(the cancer was arising from a tubulovillous adenoma, located just above the anal canal, the tumour can be felt on rectal examination – mobile, T2 on MRI). Fortunately, this could be treated with a transanal excision of the rectal cancer and the patient recovered quickly from the surgery.
The points to learn from here is that :
1. One should not always assume any rectal bleeding is due to haemorrhoids- especially if this persist despite treatment of the haemorrhoids. (If haemorrhoids have been bleeding up to the colonoscopy, it would be a good idea to band them at the end of the colonoscopy) If symptoms persist, reinvestigate or refer on.
2. A rectal examination is still useful even in the 21st century- As Norman Browse’s book on Symptoms and Signs of Surgical Diseases says “”Every patient with a rectal complaint should have a rectal examination”". This still holds true today. Be thankful that there are gloves these days – I have heard in the past in places where gloves were not easily available, doctors used to put soap into their fingernails before doing the rectal examination. ( A good tip is to double glove the hand doing the rectal examination – that way you can throw away the top glove after the rectal exam before doing anything else)
3. On colonoscopy, care must be taken to look carefully at the anal canal and what is just above. Sometimes faeculent fluid can obscure the view – this should be sucked out. A J manouvre at the end in the rectum is also useful. In fact during my training, I remembered one of my mentors telling me how he heard about a case of a low rectal cancer being missed during a colonoscopydue to too rapid an insertion.
The waiting times in public hospitals can be months especially in Melbourne – for Category 2 and 3 patients. A colleague who works in a public hospital in the western suburds says he hardly sees any Category 2 or 3 patients getting onto his endoscopy list.
In smaller country public hospitals, the waiting list is thankfully shorter. This is only fair as country patients do not usually have access to a local private endoscopy centre(where one can pay a small centre fee to have the endoscopy with the endoscopist fees’ bulk billed to Medicare)
It is terribly important to follow the instructions for the bowel preparation. If not properly followed, there may still be faeculent fluid or worse still, thick faeces covering some of the lining of the large intestine. This could hide a small polyp. Also the procedure becomes longer as the endoscopist has to spend time trying to wash and suck out the faeculent fluid as much as possible. (This wouldalso mean the anaesthetist giving the patient more sedation)
Also it is important to avoid food with seeds in the few days preceeding the colonoscopy. Small seeds are a nightmare to the endoscopist as they become stuck in the suction channel of the scope when the faeculent fluid is sucked out!
Other things that have been seen during a colonoscopy include: pill granules, vegetable material …and even a fruit sticker stuck on the wall of the bowel!
Also the bowel preparation work best when one drinks plenty of fluids in order to “wash” out all the faeces in the colon. So remember to take lots of drinks when taking the bowel prep! (But avoid alcohol or coffee !)