Colonoscopy.net.au

I have had a lot of request to do scopes on a Saturday morning. I will be doing a list at John Fawkner hospital this coming Saturday on August 27th.

I normally like to see all my patients beforehand so that full informed consent can be obtained. I can see my patients before hand at:

The Clinic Footscray (Wednesday) – Aug 17th and 24th
1st Floor, 91 Paisley Street, Footscray 3011 Tel: 9687 2271 Fax: 9689 6008

John Fawkner Private Hospital Consulting Rooms(Monday – Aug 22nd)
267 Moreland Road, Coburg 3058 Tel: 9385 2285

Caroline Springs Specialist Centre Suite 3-5, 224-226 Caroline Springs Blvd, Caroline Springs 3023 Tel: 8361 7655

Please bring along a referral from the general practitioner. (If you have seen me before, you would need a new referral if the last referral letter from your GP was more than 12 months old)

If it is not possible to come for a consult before hand or it is an urgent referral(ie acute bleeding from haemorrhoids) – please contact me directly through the rooms.

For more information about the procedures and the bowel preparation please see www.melbournesurgery.com

Many condition can cause rectal bleeding. It is important that you exclude a serious cause first by speaking to your doctor!  Risks symptoms for a more serious cause include having clots, blood being mixed with the stools, having lots of bleeding, bleeding frank blood, passage of mucus, increasing age(the older you are the higher your risk of bowel cancer), presence of anaemia and loss of weight

Causes include:

1. Bowel cancer – in particular a rectal cancer or cancer in the sigmoid colon

2. Polyps in the bowel – especially large ones in the rectum

3. Haemorroids – this is quite common but it is important to speak to your doctor about it and be examined throughly to exclude more serious cause

4. Inflammatory bowel disease eg proctitis, ulcerative colitis, Crohn’s disease

5. Anal fissure – usually there is a lot of pain when or after opening the bowels(but be warned : rectal cancer invading into the anal canal can also be painful)

6. Trauma to the perianal tissue

Lifetime risk of developing bowel cancer in Australia by the age of 85 years old:

1 in 10 men

1 in 14 women

Medial age at diagnosis: 70 years old

Risks in next 5 years:

30 year old person – 1 in 7000(less than the risks from a colonoscopy of perforation and serious bleeding)

40 year old person – 1 in 1200

50 year old person – 1 in 300

60 year old person – 1 in 100

70 year old person – 1in 65

80 year old person – 1 in 50

The risk is also greater for people with a family history of bowel cancer

Recently another patient in his early 40s went to see his GP for a skin lesion.  The GP suggested he has a FOBT too during the consultation. The FOBT turned out to be positive.  He subsequently had  a colonoscopy which showed a small caecal cancer. He went on to have a right hemicolectomy. Further scans have not shown any evidence of spread.

Were it not for his GP ordering the FOBT, this patient’s cancer would probably not have been detected until a few years later(usually the patient would either present with anaemia; occasionally one can get a right sided abdominal pain  from this that could be the same as an appendicitis type pain). This raises the dilemma for the all doctors  – how aggressively does one screen the patient and from what age? Also is there enough resources to do this especially in the public system?

A most interesting case out of the textbook.

Patient in the 20s walked into the clinic. Has been referred to me for a colonoscopy.

First thing I noticed was the reddish nodules on the shins of both the legs. The patient says that these has been quite painful. The pain had thougth this was due to mosquito bites or some sort of reaction to insect bites. (Clinically on examination, this was consistent with erythema nodosum)

Further history taking reveals the patient has been having diarrhoea. The patient had also been feeling tired.

Colonoscopy was performed and it showed proctitis as well as distal colitis. Biospsies were taken – histology was initially reported as normal but when I queired it with the pathologist, a second opinion was sought and the consensus opinion was that is was consistent with ulcerative colitis.

This is a difficult question to answer for the individual.

Just last month a man in his 40s was seeing his GP for a skin problem when the GP suggested that he take the test. The faecal occult blood test came back positive – in fact, positive on all specimen. He was then referred for a colonoscopy.

On colonoscopy, a bowel cancer in the caecum was found.

He subsequently underwent a bowel resection.  The pathology showed that is was a fairly advanced cancer – with lymph glands involved. Further scans suggest the possibility of spread to the liver already..

The main difference is actually the Medicare fees – say you are referred to a specialist because you have been screened for faecal occult blood and the test has been positive. For the initial consult, the Medicare benefits(100%) for the gastroenterologist is $139.45 while for surgeons it is $79.05.  This difference is because different specialities are allowed to claim different rates for the consults and in the past, not many physicians do procedures such as endoscopy.

Also in general, surgeons tend to treat the haemorrhoids at the same time while most gastroenterologist would refer the haemorrhoids to a surgeon for treatment(eg banding of haemorrhoids)

Not all general surgeons do colonoscopies as they concentrate on their specialized fields.  But there are general surgeons too who specializes in colonoscopy.

The most important thing is to check if the endoscopist is allocating enough time to do the scope in order to have a good thorough gentle look for polyps. One can easily miss a polyp in a mucosal fold or under a pool of faeculent fluid if one does a colonoscope too quickly(eg if there are time or economic pressures)

You should always speak to the endoscopist about this. It is best for the endoscopist to allocate on average about 30minutes to do a colonoscopy.

In the last month, I have found two low rectal cancers on colonoscopy – both were palpable on rectal digital examination and had symptoms that the patients have brushed off as being nothing too serious for months.

Lesson from this to all my readers:

If you have any rectal bleeding, passage of mucus, change in your bowel action, feeling of not being able to completely empty your bowels – please see your general practitioner as soon as possible!