Category Archives: Diagnonistic Test

Lipid profile or Lipid panel

Definition:
A complete cholesterol test — also called a lipid panel or lipid profile: — It is a blood test that can measure the amount of cholesterol and triglycerides in your blood. A cholesterol test can help determine your risk of atherosclerosis, the buildup of plaques in your arteries that can lead to narrowed or blocked arteries throughout your body. High cholesterol levels usually don’t cause and signs or symptoms, so a cholesterol test is an important tool. High cholesterol levels are a significant risk factor for heart disease.

An extended lipid profile may include very low-density lipoprotein. This is used to identify hyperlipidemia (various disturbances of cholesterol and triglyceride levels), many forms of which are recognized risk factors for cardiovascular disease and sometimes pancreatitis.

It is recommended that healthy adults with no other risk factors for heart disease be tested with a fasting lipid profile once every five years. Individuals may also be screened using only a cholesterol test and not a full lipid profile. However, if the cholesterol test result is high, there may be the need to have follow-up testing with a lipid profile.

 

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If there are other risk factors or the individual has had a high cholesterol level in the past, regular testing is needed and the individual should have a full lipid profile.

For children and adolescents at low risk, lipid testing is usually not ordered routinely. However, screening with a lipid profile is recommended for children and youths who are at an increased risk of developing heart disease as adults. Some of the risk factors are similar to those in adults and include a family history of heart disease or health problems such as diabetes, high blood pressure (hypertension), or being overweight. High-risk children should have their first lipid profile between 2 and 10 years old, according to the American Academy of Pediatrics. Children younger than 2 years old are too young to be tested.

A total cholesterol reading can be used to assess an individual’s risk for heart disease, however, it should not be relied upon as the only indicator. The individual components that make up total cholesterol reading –- LDL, HDL, and VLDL –- are also important in measuring risk.

For instance, one’s total cholesterol may be high, but this may be due to very high good (HDL) cholesterol levels –- which can actually help prevent heart disease. So, while a high total cholesterol level may help give an indication that that there is a problem with cholesterol levels, the components that make up total cholesterol should also be measured.

The “lipid profile” is a popular component of master health check ups.There is no ideal age for the first evaluation. Elevated levels have been found in children as young as two if there is a history of adults in the family having elevated lipids or early heart attacks. Genetic studies have consistently shown changes in the Apolipoprotein E (APOE) locus in affected families. But for this gene to express itself, environmental factors like diet, obesity and inactivity also play a part.

If there is no such family history, lipids should be evaluated for the first time at the age of 20. If the results are “desirable”, the next reading can be taken after five years. In an older person (over 45 in men and 55 in women) the values need to be checked every year.

The blood should be taken after a nine-hour fast (water can be consumed). There should be no fever, infection, inflammation or pregnancy as these can alter the values.

Everyone has fat deposits under the skin, where it serves as insulation against heat and cold. Cholesterol is a fat that is produced by the liver and is essential for normal metabolism. It is not soluble in blood, it is transported through the body by LDL (low density lipoproteins), HDL (high density lipoproteins) and VLDL (very low density lipoproteins). Of these HDL is a “good” lipid as it transports excess cholesterol to the liver for excretion. VLDL and LDL transport cholesterol from the liver back into the blood.

As long as blood cholesterol remains in the normal range, the blood circulates freely. When levels are elevated, it precipitates in the blood vessels, forming obstructive deposits called plaques. This eventually leads to high blood pressure, heart attacks and strokes.

TGL or triglycerides are different from cholesterol. They are derived from food when the calorie intake is greater than the requirement. It combines with cholesterol and gets deposited in the blood vessels.

A person with elevated lipids may develop a yellow deposit of cholesterol under the skin, usually around the eyelids. They may also have a crease on the earlobes.

A fat deposit (lipoma) can appear as a painless mobile lump just under the skin anywhere in the body. When multiple, it is a hereditary condition called multiple lipomatosis. These are not markers for elevated lipids. The lumps are not cancerous but may be cosmetically unacceptable. They do not respond to the lipid lowering medications and need to be surgically removed.

An elevated lipid profile can often be reversed by changes in lifestyle. Quit smoking immediately and drink in moderation only — two drinks a day for men and one for women. The much publicised cardio protective actions of alcohol are outweighed by the other problems of regular drinking.

Try to achieve ideal body weight and bring down the BMI (body mass index, which is found by dividing the weight by the height in metre squared) to 23. This can only be achieved with a combination of diet and exercise. Try to stop snacking, especially on fried items and “ready to eat” snacks. Increase the consumption of fruits and vegetables to 4-6 helpings a day. Walnuts, almonds and fish are rich in protective omega -3 fatty acids and Pufa (poly unsaturated fatty acids). Oats contains dietary fibre. Lower oil consumption to 300ml per month per family member. Try to use olive oil. If that is not practical or feasible, use a mixture of equal quantities of rice bran oil, sesame oil, mustard oil and groundnut oil.

Exercise aerobically (walking, running, jogging or swimming) for 60 minutes a day. This need not be done at one stretch but can be split into as many as six 10-minute sessions.

If lipids are still elevated after 3-6 months despite these interventions, speak to your physician about regular medication.

The “statin” group of drugs are very effective. They lower cholesterol, prevent its deposition and stabilise the plaques in the blood vessels. They can be combined with other drugs like ezetimibe (which limit the absorption of cholesterol), or bile acid binding resins, or niacin or fibrates. Natural supplements of fish oil or pure omega-3 fatty acid capsules also help. Lipid lowering medications are usually well tolerated and very effective.

Resources:

http://www.mayoclinic.com/health/cholesterol-test/MY00500

http://en.wikipedia.org/wiki/Lipid_profile

http://www.telegraphindia.com/1120730/jsp/knowhow/story_15788559.jsp

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Transrectal Ultrasound and Biopsy of the Prostate

What is the test?
Your doctor is likely to recommend this test if you’ve had a rectal exam or blood tests that suggest that you might have prostate cancer. For this test, a urologist takes tissue samples from several places in your prostate, to be examined for cancer. A transrectal ultrasound helps the urologist see the prostate during the procedure.

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How do you prepare for the test?
Some doctors recommend that you have an enema before the test. Tell your doctor if you have any allergies, especially to antibiotics.

What happens when the test is performed?
In most cases, you lie on your side with your knees bent up to your chest. An ultrasound machine’s sensor-a short rod about the width around of two fingers-is covered with a condom and clear jelly and gently inserted into your rectum. You may feel some pressure similar to the sensation before a bowel movement. Once the sensor is in place, an image of your prostate appears on a video screen.

The ultrasound sensor surveys the whole prostate gland and pinpoints specific areas for biopsy. Then the doctor removes this ultrasound sensor and replaces it with a slightly smaller one. In addition to generating an ultrasound image, the smaller sensor has a small tube on its side called a needle guide. Your doctor points the needle guide at specific parts of your prostate. The guide releases a spring-loaded needle to take biopsies from different parts of the prostate. The spring-loading allows this needle to move into and out of the prostate very quickly. You are likely to feel some discomfort from each biopsy, but because the needle moves so quickly, any pain lasts only for a second at a time. Doctors usually collect multiple samples.Your doctor will probably give you antibiotics at the end of this procedure to prevent infection.

What risks are there from the test?
Many people have some blood in their urine or stool for a day or two after the biopsy. The only significant risk is the possibility of an infection in the prostate, but antibiotics can help prevent this.

Must you do anything special after the test is over?
Call your doctor if you develop a fever.

How long is it before the result of the test is known?
A pathologist will examine the biopsies under a microscope for cancer. This process usually requires several days.

For more knowledge & information you may click :-http://emedicine.medscape.com/article/457757-overview

Source:https://www.health.harvard.edu/fhg/diagnostics/transrectal-ultrasound-and-biopsy-of-the-prostate.shtml

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Testing for Vaginitis (Yeast Infections, Trichomonas, and Gardnerella)

Posterior half of uterus and upper part of vag...
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What is the test?
Vaginitis is inflammation or an infection of the vagina; symptoms usually include itchiness or irritation, abnormal discharge, and an unpleasant odor. Diagnosing the cause of vaginitis involves a simple examination of the vaginal fluid under a microscope or sending the sample to a laboratory for a culture.

How do you prepare for the test?
Because douches or vaginal creams can make it hard for the doctor to interpret test results, don’t use these products before the test. No other preparation is necessary.


What happens when the test is performed?

You’ll have a pelvic examination. The doctor uses a cotton swab to collect a sample of the fluid that moistens the lining of the vagina. This swab is rubbed against two glass slides, and a small drop of fluid is placed on each slide to mix with the vaginal fluid. If your doctor is testing for infection with gonorrhea or chlamydia, he or she might use a second cotton swab to take a sample of mucus from the middle of the cervix.

Your doctor or a technician examines the slides under a microscope for signs of infection with yeast, a tiny parasite called Trichomonas, or a bacterium called Gardnerella (which causes an infection called bacterial vaginosis). If a second cotton swab was used, the doctor sends it to a laboratory for gonorrhea or chlamydia testing.

A pelvic examination assesses the health of your vagina, uterus, fallopian tubes, and ovaries. This exam may be done in conjunction with a diagnostic or screening test. You lie on your back on an examining table with your knees bent and your feet in footrests. The doctor or the doctor’s assistant asks you to spread your knees apart. The exam has two parts: a speculum examination and a bimanual examination. The speculum examination allows the doctor to see inside you, and the bimanual examination allows him or her to feel inside you.

During the first part of the examination, the doctor inserts a speculum, a device used to separate the walls of your vagina (normally the walls are touching each other) so that he or she can see inside. You will feel some pressure when the doctor inserts the speculum. As it is inserted, the doctor also shines a light inside you, and can see the walls of your vagina as well as the cervix-the outermost part of your uterus. If you have a vaginal infection, an abnormal discharge may be visible in the vagina. The doctor can take a sample of that discharge and study it under a microscope to diagnose what kind of infection you have.

In the center of the cervix is a channel called the cervical os that leads to the interior of your uterus. If there is bleeding in the uterus, bloody material may be seen coming out through the cervical os. If there is an infection in the uterus, pus can be seen coming out through the os. With certain infections, the outer surface of the cervix can appear irritated, or may have tiny areas of bleeding.

Even if everything looks normal, the doctor may do a routine screening test such as a Pap smear or a diagnostic test such as an endometrial biopsy or colposcopy. These techniques identify various diseases or conditions that cannot be seen with the naked eye.

During the bimanual examination, the doctor determines the size and shape of your uterus. He or she presses inside your vagina with one or two fingers while pressing on your lower abdomen with the other hand. In this way, the uterus is lifted up toward your abdominal wall, making it easier to feel between the two hands. The doctor can feel if the uterus is enlarged, or whether it is lumpy from fibroids (very common but benign growths on or in the wall of the uterus). The doctor also sometimes can feel the ovaries and any masses in the fallopian tubes (the tubes that carry eggs from the ovaries into the uterus). Sometimes he or she will insert another finger into your rectum, to better feel the area between the uterus and rectum. That finger can also feel for any lumps in the wall of the rectum, and can obtain a sample of stool to be tested for any sign of bleeding.

What risks are there from the test?
There are no risks from this test.

Must   you do anything special after the test is over?
No.

How long is it before the result of the test is known?
Your doctor can tell you what he or she saw under the microscope right away. Testing for gonorrhea and chlamydia usually requires a few days. Yeast infections are the most common type of vaginal infection, affecting three out of four women at one point or another in their lives.Although a number of over-the-counter medications are available to treat yeast infections, it is best to consult a doctor before treating yourself-especially if you have never had a yeast infection before.

Source: https://www.health.harvard.edu/fhg/diagnostics/testing-for-vaginitis.shtml

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Pelvic Ultrasound and Transvaginal Ultrasound

 

Alternative  Names:Endovaginal ultrasound; Ultrasound – transvaginal; Sonohysterography; Hysterosonography; Saline infusion sonography; SIS
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Definition:
Ultrasound uses sound waves instead of radiation to generate snapshots or moving pictures of structures inside the body. This imaging technique works in a manner similar to radar and sonar, developed in World War II to detect airplanes, missiles, and submarines that were otherwise invisible. After coating your skin with a lubricant to reduce friction, a radiologist or ultrasound technician places an ultrasound transducer, which looks like a microphone, on your skin and may rub it back and forth to get the right view. The transducer sends sound waves into your body and picks up the echoes of the sound waves as they bounce off internal organs and tissue. A computer transforms these echoes into an image that is displayed on a monitor.

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Pelvic organ ultrasound is used to monitor pregnancy, find cysts on your ovaries, examine the lining of your uterus, look for causes of infertility, and find cancers or benign tumors in the pelvic region. Depending on the view needed, the ultrasound sensor is placed either on your abdomen (pelvic ultrasound) or in your vagina (transvaginal ultrasound).

Pelvic ultrasound, primarily performed on females is most frequently used for evaluation of pelvic pain, abnormal vaginal bleeding, inflammatory disease, or detection of a mass. Pelvic ultrasound may help explain findings from a manual examination and provide additional information. Pelvic ultrasound examination will generally result in good depiction of the bladder, uterus, and ovaries.

In some patients, transvaginal ultrasound, which involves the insertion of a small transducer (probe) into the vagina, may be necessary to provide a complete analysis of the ovaries and uterine endometrial lining. Early pregnancy or body habitus (obesity) can obscure adequate evaluation of some structures. The decision to use transvaginal ultrasound is determined by the radiologist following pelvic ultrasound.

Pelvic ultrasound generally requires a full bladder and is performed with the patient lying flat on a padded table. Transvaginal ultrasound testing requires the patient to empty their bladder in the restroom and return to the scanning room for a transvaginal examination. Patients are asked disrobe from the waist down with hips elevated by folded towels or a foam pad. Patients usually insert the probe themselves, but can be assisted.

How to prepare for the test.
You will be asked to undress, usually from the waist down.
Your doctor might ask you to drink a few glasses of water before the test because a full bladder lifts your intestines out of the way and provides a clearer view of your pelvic organs. If you’re having a transvaginal ultrasound and have a tampon in place, you’ll need to remove it before the test.

A full bladder is essential for adequate visualization of the pelvic region.

* Finish drinking 4 glasses (32 ounces total) of water one hour prior to your appointment. It is important to drink water only. Do not substitute other beverages.

* Do not empty your bladder prior to the exam.

* Eat as you normally would before and after the examination and return to your usual or recommended activities after the exam.

To avoid delay or rescheduling of your pelvic / transvaginal ultrasound examination, follow preparation instructions carefully.

* Arrive 15 minutes prior to your scheduled appointment time to register for your test.

* The length of time needed to complete this examination will vary depending on the information needed. Plan for up to 45 minutes to complete your exam.

How the Test is Performed
You will lie down on a table with your knees bent and feet in holders called stirrups. The health care provider will place a probe, called a transducer, into the vagina. The probe is covered with a condom and a gel. The probe sends out sound waves, which reflect off body structures. A computer receives these waves and uses them to create a picture. The doctor can immediately see the picture on a nearby TV monitor.

The health care provider will move the probe within the area to see the pelvic organs. This test can be used during pregnancy.

In some cases, a special transvaginal ultrasound method called saline infusion sonography (SIS), also called sonohysterography or hysterosonography, may be needed to more clearly view the uterus.

This test requires saline (sterile salt water) to be placed into the uterus before the ultrasound. The saline helps outline any abnormal masses, so the doctor can get a better idea of their size.

SIS is not done on pregnant women.

What happens when the test is performed.

You lie on your back on a table for the test. For a pelvic ultrasound, after squirting some clear jelly onto your lower abdomen to help the ultrasound sensor slide around easily, a doctor or technician places the sensor against your skin. For a transvaginal ultrasound, the doctor or technician covers a sensor with a condom and some jelly before inserting it into your vagina.When the sensor is in place, a picture will appear on a video screen. The technician or doctor moves the sensor on your abdomen or in your vagina to see the uterus and ovaries from many different views.

How the Test Will Feel
The test is usually painless, although some women may have mild discomfort from the pressure of the probe. Only a small part of the probe is placed into the vagina.

Risk Factors:
There are no known harmful effects of transvaginal ultrasound on humans.

Unlike traditional x-rays, there is no radiation exposure with this test.

How long is it before the result of the test is known.

If a doctor does the test, you might be able to get preliminary results immediately; this will not be possible if a technician performs the test.Whether a doctor or technician performs the test, he or she records it on a videotape so that it can be formally reviewed by a radiologist. Your doctor should receive the radiologist’s report in a day or two.

Results:
Normal Results

The pelvic structures or fetus are normal.

What Abnormal Results Mean

An abnormal result may be due to many conditions. Some problems that may be seen include:

* Cancers of the uterus, ovaries, vagina, and other pelvic structures
* Non-cancerous growths of the uterus and ovaries (such as cysts or fibroids)
* Twisting of the ovaries
* Infection, including pelvic inflammatory disease
* Birth defects

Some problems that may be found specifically in pregnant women include:

* Ectopic pregnancy
* More than one fetus (twins, triplets, etc.)
* Miscarriage
* Placenta previa
* Placental abruption
* Tumors of pregnancy including gestational trophoblastic disease

Resources:

https://www.health.harvard.edu/fhg/diagnostics/pelvic-ultrasound-and-transvaginal-ultrasound.shtml

http://www.tacomarad.com/exams/ultrasound/pelvic.html

http://www.nlm.nih.gov/medlineplus/ency/article/003779.htm

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Enhanced Alpha Fetoprotein Test (“Triple Screen”)

Definition:This is a  blood test that measures the levels of alpha-fetoprotein (AFP), a protein released by the fetal liver and found in the mother’s blood. AFP is sometimes called MSAFP (maternal serum AFP )  This blood test for pregnant women, also called a “triple screen,” checks the levels of protein and hormones being produced by the fetus. The levels of three different substances together can enable doctors to identify pregnancies that are at a higher risk for birth defects such as Down syndrome or neural tube defects (brain and spinal cord problems). If the blood test suggests problems, your doctor might recommend additional tests, such as amniocentesis or fetal ultrasound, to confirm the findings.
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The alpha-fetoprotein (AFP) test is available to women between their 15th and 20th week of pregnancy to screen for fetal abnormalities. This simple blood test measures the level of a protein called alpha-fetoprotein which is secreted by the liver of the fetus and enters the mother’s blood stream. Elevated levels of AFP may indicate an increased risk of neural tube defects such as spina bifida or anencephaly, while low levels suggest Down Syndrome or other chromosomal defects.

The AFP test does not determine the existence of these genetic disorders; it only predicts their likelihood. And while the AFP test is most often used to screen for these defects, it can also be used to identify abdominal wall defects, some renal and urinary tract abnormalities, Turner syndrome, low birth weight, and placental complications. An incorrectly-calculated gestational age and multiple fetuses can also cause abnormal AFP levels.


How do you prepare for the test?

* Before having this test done, you need to think carefully about what you would do with the results once you have them. The results of this blood test cannot show for sure whether you have either a healthy fetus or one with a problem; it can only suggest which patients might want to go ahead with further testing. Because amniocentesis (the test that is usually recommended after an abnormal triple screen) has a small risk of miscarriage, and because most people with an abnormal triple screen decide to go ahead with amniocentesis, this is an important decision. You should have this test done only if you think the information it offers would help you to make decisions about your pregnancy.

What happens when the test is performed?

* Your blood is drawn for this test sometime between your 15th and 20th weeks of pregnancy. The blood is tested for three protein and hormone levels: maternal serum alpha fetoprotein (MSAFP), unconjugated estriol (uE3), and human chorionic gonadotropin (hCG). Your doctor needs to weigh you on the day you have your blood drawn and ask when your last period began or what your expected due date is. The analysis of the results will take into account your weight and stage of pregnancy to determine whether the levels are normal.

What risks are there from the test?

* There are no risks from this test itself, but there are some risks from tests that might be recommended if the test result comes back abnormal (see-> “Amniocentesis,” ). This test can be stressful for expectant parents. Several things can cause the test to come back as abnormal even when there are no real health problems. Confusing results can happen, for example, in twin pregnancies and when mistakes have been made in estimating the age of the pregnancy.

How long is it before the result of the test is known?
The test results are available to your doctor within two or three days.

For more information You may click to see:->

Health informations for pregnant women:
Pregnancy & Childbirth :
Integrated test during pregnancy:
Common Tests During Pregnancy:
Glossary:  From “abdomen” to “zygote,” here’s your guide to pregnancy terminology.
:
High-Risk Pregnancy :
Healthy & Safe Pregnancy
:

Resources:

https://www.health.harvard.edu/fhg/diagnostics/AFP/AFP.shtml?Submit=Know+More+About+This+Test%3F

http://www.parentingweekly.com/pregnancy/pregnancy_information/afp_test.htm

Chorionic Villus Sampling

Definition
Chorionic villi are small structures in the placenta that act like blood vessels. These structures contain cells from the developing fetus. A test that removes a sample of these cells through a needle is called chorionic villus sampling (CVS).Chorionic villus sampling (CVS) is the removal of a small piece of placenta tissue (chorionic villi) from the uterus during early pregnancy to screen the baby for genetic defects

CVS answers many of the same questions as amniocentesis about diseases that the baby might have. Diseases that can be diagnosed with CVS include Tay-Sachs, sickle cell anemia, cystic fibrosis, thalassemia, and Down syndrome. (Rh incompatibility and neural tube defects, however, can be diagnosed only through amniocentesis.) CVS can be done earlier in pregnancy than amniocentesis and can be done when there is not enough amniotic fluid to allow amniocentesis. However, it has some extra risks when compared with amniocentesis.

Why the Test is Performed
The test is a way of detecting genetic disorders. The sample is used to study the DNA, chromosomes, and enzymes of the fetus. It can be done sooner than amniocentesis, about 10 to 12 weeks after your last menstrual period. Test results take about 1 to 2 weeks, whereas amniocentesis results may take longer.

Chorionic villus sampling does not detect neural tube defects. If neural tube defects or Rh incompatibility are a concern, an amniocentesis will be performed.

This test can usually not diagnose problems in the way the body forms.

How the Test is Performed
CVS can be done through the cervix (transcervical) or through the abdomen (transabdominal). The techniques are equally safe when done by a provider with experience, although miscarriage rates are slightly higher when done through the cervix. The health care provider will use ultrasound to pick the safest approach and as a guide during sampling.

An abdominal ultrasound is performed to determine the position of the uterus, the size of the gestational sac, and the position of the placenta within the uterus. Your vulva, vagina, cervix, and abdomen are cleaned with an antiseptic such as Betadine.

The transcervical procedure is performed by inserting a thin plastic tube through the vagina and cervix to reach the placenta. The provider uses ultrasound images to help guide the tube into the appropriate area and then removes a small sample of chorionic villus tissue.

The transabdominal procedure is performed by inserting a needle through the abdomen and uterus and into the placenta. Ultrasound is used to help guide the needle, and a small amount of tissue is drawn into the syringe.

The sample is placed in a dish and evaluated in a laboratory.

What happens when the test is performed.
There are two ways that your doctor can perform CVS. Some patients have the sampling done through the vagina and cervix. Most patients have the sampling done through the abdominal wall. For both types of sampling, you lie on your back on an examination table and the doctor uses ultrasound to locate the fetus and the placenta.

If the sampling is to be done through the vagina and cervix, you place your feet in footrests and bend your knees up, as you would for a pelvic examination. A speculum (a device that looks like a duck-bill that can be opened and closed) is used to open the vagina so that your doctor can see inside. A long tube, much narrower than a straw, is inserted through the cervix and moved forward while your doctor watches on the ultrasound until it is next to the fetal side of the placenta. A small sample of the lining around the fetus is then pulled into the tube for testing.

If the sampling is to be done through the abdominal wall, your lower abdomen is cleaned with an antibacterial soap. In some cases, the doctor uses a small needle to inject a numbing medicine just under the skin, so that you do not feel the sampling needle. (Because the sampling needle does not cause much more stinging than the numbing medicine itself, not every doctor includes this step.) A hollow needle several inches long is inserted through the skin and muscle of the abdomen and through the wall of the uterus, to the edge of the placenta. This needle is held in place as a guide needle. A narrower needle is then inserted through the first needle and is rotated and moved inward and outward a number of times while a sample is collected into an attached syringe.

The fetal heart tones and the mother’s blood pressure and heart rate are checked at the beginning and end of the procedure. The whole procedure takes close to 30 minutes.

How to Prepare for the Test.
CVS can be done between the 10th and 13th weeks of pregnancy. Tell your doctor ahead of time if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office.

Your health care provider will explain the procedure, its risks, and alternative procedures such as amniocentesis. Genetic counseling is recommended prior to the procedure. This will allow you to make an unhurried, informed decision regarding options for prenatal diagnosis.

You will be asked to sign a consent form before this procedure, and you may be asked to wear a hospital gown.

The morning of the procedure you may be asked to drink fluids and refrain from urinating to fill your bladder, which allows adequate visualization so the sample may be taken.

How the Test Will Feel
The ultrasound doesn’t hurt. A clear, water-based conducting gel is applied to the skin to help with the transmission of the sound waves. A handheld probe called a transducer is then moved over the area. In addition, your health care provider may apply pressure on your abdomen to find the position of your uterus.

The antiseptic cleansing solution will feel cold at first nd may irritate your skin if not washed off after the procedure. Some people are allergic to Betadine. Notify your health care provider if you are allergic to Betadine or if you have any other allergies.

Some women say the vaginal approach feels like a Pap smear with some discomfort and a feeling of pressure. There may be a small amount of vaginal bleeding following the procedure.

An obstetrician can perform this procedure in about 5 minutes, after the preparation

Risk Factors:

The risks of CVS are only slightly higher than those of an amniocentesis.

Possible complications include:

* Bleeding
* Infection
* Miscarriage
* Rh incompatibility in the mother
* Rupture of membranes

Signs of complications include:

* Excessive bleeding
* Excessive vaginal discharge
* Fever

The risk of miscarriage and other complications from CVS is slightly higher than the risk from amniocentesis, although some parents feel that it is worth the extra risk to be able to makedecisions earlier in the pregnancy if the results show the baby has a health problem. There have also been some reports that suggest there is a very small risk of birth defects (abnormal limbs) in the fetus.

One particular difficulty with this test is that due to variability in the cells of the placenta (called mosaicism), occasionally you can have an abnormal test result even if the baby is normal and healthy. This might lead you to make decisions about pregnancy termination that you would not have made if you had better information.

Some women have vaginal bleeding after the procedure. Infection is uncommon.

Report any signs of complications to your health care provider.

CVS may also cause limb problems in the fetus. This risk appears to be very low (1 in 3,000) when CVS is performed after 10 weeks gestational ag

Time to know the  result of the test
Chromosome analysis of the sample takes two weeks or more. The results of some tests may be available sooner.

RESULTS:-

Normal Results
A normal result means there are no signs of any genetic defects. However the test could miss some genetic defects.

Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

An abnormal result may be a sign of more than 200 disorders, including:

* Down syndrome
* Hemoglobinopathies
* Tay-Sachs disease

Considerations
If your blood is Rh negative, you may receive RhoGAM to prevent Rh incompatibility.
You will receive a follow-up ultrasound 2 to 4 days after the procedure to make sure the pregnancy is proceeding normally.

Resources:

https://www.health.harvard.edu/fhg/diagnostics/chorionic-villus-sampling.shtml

http://www.nlm.nih.gov/medlineplus/ency/article/003406.htm

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Amniocentesis

Definition:
Amniocentesis (also referred to as amniotic fluid test or AFT), is a medical procedure used in prenatal diagnosis of chromosomal abnormalities and fetal infections, in which a small amount of amniotic fluid, which contains fetal tissues, is extracted from the amnion or amniotic sac surrounding a developing fetus, and the fetal DNA is examined for genetic abnormalities
Tests of fetal cells found in this fluid can reveal the presence of Down syndrome or other chromosome problems in the baby. Amniocentesis can also show whether the lungs of the baby are mature enough to allow it to survive if it were elivered right away.

Amniocentesis is often recommended for pregnant women over age 35, women who have an abnormal “triple screen” blood test during pregnancy, or women who have (or whose husbands have) a family history of certain diseases or birth defects.

How do you prepare for the test?

You should have a serious discussion with your obstetrician regarding whether to have amniocentesis. Amniocentesis may be done anytime between the 14th and 20th weeks of pregnancy to test for fetal abnormalities. To check on fetal lung development, the test may be done late in the third trimester.

Tell your doctor ahead of time if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office.

Just before the test, you should empty your bladder.

How the test is performed ?


Before the actual procedure, a local anesthetic is sometimes given to relieve the pain when inserting the needle used to withdraw the fluid. A needle is usually inserted through the mother’s abdominal wall through the wall of the uterus into the amniotic sac. With the aid of ultrasound-guidance, a physician aims towards an area of the sac that is away from the fetus and extracts approximately 20ml of amniotic fluid for testing. The puncture heals, and the amniotic sac replenishes the liquid over a day or so. After the amniotic fluid is extracted, the fetal cells are separated from it. The cells are grown in a culture medium, then fixed and stained. Under a microscope the chromosomes are examined for abnormalities. The most common abnormalities detected are Down syndrome, Edward syndrome [Trisomy 18] and Turner syndrome [Monosomy X]. Amniocentesis is most safely performed after the 14th-16th week of pregnancy, does not need to be done before then due to risk it can to to the babys limbs. Usually genetic counseling is offered prior to amniocentesis.

What happens when the test is performed?
You wear a hospital gown and lie on your back on a table. An ultrasound is done to show the location of the fetus and placenta. Your lower abdomen is cleaned with an antibacterial soap. In some cases, the doctor uses a small needle to inject a numbing medicine just under the skin, so you do not feel the amniocentesis sampling needle later. (Because the sampling needle does not cause much more stinging than the numbing medicine itself, not every doctor includes this step.)

The hollow sampling needle is several inches long and is inserted through the skin and abdominal muscle and then through the wall of the uterus. A syringe attached to the needle is used to collect a sample of fluid.

The baby’s heart tones and the mother’s blood pressure and heart rate are checked at the beginning and end of the procedure. The whole procedure takes close to 30 minutes.

Risk Factors:
Although the procedure is routine, possible complications include infection of the amniotic sac from the needle, and failure of the puncture to heal properly, which can result in leakage or infection. Serious complications can result in miscarriage. Other possible complications include preterm labor and delivery, respiratory distress, postural deformities, fetal trauma and alloimmunisation (rhesus disease). Studies from the 1970s originally estimated the risk of amniocentesis-related miscarriage at around 1 in 200 (0.5%). A more recent study (2006) has indicated this may actually be much lower, perhaps as low as 1 in 1,600 (0.06%). In contrast, the risk of miscarriage from chorionic villus sampling (CVS) is believed to be approximately 1 in 100, although CVS may be done up to four weeks earlier, and may be preferable if the possibility of genetic defects is thought to be higher

Most women experience a few hours of mild pelvic cramping, and a few will have slight vaginal bleeding. About 1 in 100 women will have a temporary leak of amniotic fluid through the vagina; this usually causes no problem.

There is a small risk of miscarriage associated with amniocentesis; this occurs in about 1 in every 200 to 400 cases, depending in part on the timing of the test and the experience level of the physician performing it. Other risks (such as infection or injury to the fetus that does not cause miscarriage) are extremely rare.

What must you do after the test is over?
If the test confirms that you are Rh incompatible with the fetus, you will need to receive an injection of a medicine called Rh immune globulin (Rhogam) to protect the baby from complications.

Let your doctor know immediately if you are having any vaginal bleeding, fluid leakage, or strong abdominal pain.

Time to know the result:
Chromosome analysis of the fluid sample takes two weeks or more. The results of some tests may be available sooner.

Amniocentesis and stem cells:
Recent studies discovered that in amniotic fluid there are a lot of multipotent stem cell, mesenchymal, hematopoietic, neural,epithelial and endothelial stem cell[1][2][3]. Amniotic stem cells don’t have ethical problem. In fact, in harvesting embryonic stem cells, a human embryo is destroyed, and so it’s considered it immoral. Another potential benefit of using amniotic stem cells over those obtained from embryos is that they side-step ethical concerns among pro-life activists by obtaining pluripotent lines of undifferentiated cells without harm to a fetus or destruction of an embryo.

Artificial heart valves, working tracheas, as well as muscle, fat, bone, heart, neural and liver cells have all been engineered through use of amniotic stem cells [4]. Tissues obtained from amniotic cell lines show enormous promise for patients suffering from congenital diseases/malformations of the heart, liver, lungs, kidneys, and cerebral tissue

You may click to see:->HOW TO – Isolate amniotic stem cells from a placenta, at home

Resources:

https://www.health.harvard.edu/fhg/diagnostics/amniosentesis.shtml

http://en.wikipedia.org/wiki/Amniocentesis

http://healthlibrary.epnet.com/GetContent.aspx?token=7e9094f4-c284-4b3a-8f7c-867fd12b36ee&chunkiid=14762

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Laparoscopic Surgery

Definition:
Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery, keyhole surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5-1.5cm) as compared to larger incisions needed in traditional surgical procedures. Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.

...Click to  see ..

The key element in laparoscopic surgery is the use of a laparoscope. There are two types: a telescopic rod lens system, that is usually connected to a video camera (single chip or three chip) or a digital laparoscope where the charge-coupled device is placed at the end of the laparoscope, eliminating the rod lens system.  Also attached is a fiber optic cable system connected to a ‘cold’ light source (halogen or xenon), to illuminate the operative field, inserted through a 5 mm or 10 mm cannula or trocar to view the operative field. The abdomen is usually insufflated with carbon dioxide gas to create a working and viewing space. The abdomen is essentially blown up like a balloon (insufflated), elevating the abdominal wall above the internal organs like a dome. The gas used is CO2, which is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic procedures.

Laparoscopy is a surgery that allows your doctor to see and operate on the organs inside your pelvis and abdomen through very small incisions in the abdominal wall. Many types of abdominal surgery can be done with laparoscopy, including diagnosis and treatment of infertility or pelvic pain, gallbladder or appendix removal, and tubal ligation for preventing pregnancies.

How do you prepare for the test?
Discuss the specific procedures planned during your laparoscopy ahead of time with your doctor. Laparoscopy is done by either a surgeon or a gynecologist-obstetrician. You will need to sign a consent form giving your doctor permission to perform this test.

If you take aspirin, nonsteroidal anti-inflammatory drugs, or other medicines that affect blood clotting, talk with your doctor. It may be necessary to stop or adjust the dose of these medicines before your test.

You will be told not to eat anything for at least eight hours before the surgery. An empty stomach will help prevent the nausea that can be a side effect of anesthesia medicines. You should arrange for a ride home from the hospital if your doctor plans on sending you home on the same day.

Before the surgery (sometimes on the same day), you will meet with an anesthesiologist to go over your medical history (including medicines and allergies) and to discuss the anesthesia.

History
It is difficult to credit one individual with the pioneering of laparoscopic approach. In 1902 Georg Kelling, of Dresden, Saxony, performed the first laparoscopic procedure in dogs and in 1910 Hans Christian Jacobaeus of Sweden reported the first laparoscopic operation in humans. In the ensuing several decades, numerous individuals refined and popularized the approach further for laparoscopy. The introduction of computer chip television camera was a seminal event in the field of laparoscopy. This innovation in technology provided the means to project a magnified view of the operative field onto a monitor, and at the same time freed both the operating surgeon’s hands, thereby facilitating performance of complex laparoscopic procedures. Prior to its conception, laparoscopy was a surgical approach with very limited application and used mainly for purposes of diagnosis and performance of simple procedures in gynecologic applications.

The introduction in 1990 of a laparoscopic clip applier with twenty automatically advancing clips (rather than a single load clip applier that would have to be taken out, reloaded and reintroduced for each clip application) made surgeons more comfortable with making the leap to laparoscopic cholecystectomies (gall bladder removal). On the other hand, some surgeons continue to use the single clip appliers as they save as much as $200 per case for the patient, detract nothing from the quality of the clip ligation, and add only seconds to case lengths.

Procedures

Laparoscopic cholecystectomy is the most common laparoscopic procedure performed. In this procedure, 5-10mm diameter instruments (graspers, scissors, clip applier) can be introduced by the surgeon into the abdomen through trocars (hollow tubes with a seal to keep the CO2 from leaking). Rather than a minimum 20cm incision as in traditional cholecystectomy, four incisions of 0.5-1.0cm will be sufficient to perform a laparoscopic removal of a gallbladder. Since the gall bladder is similar to a small balloon that stores and releases bile, it can usually be removed from the abdomen by suctioning out the bile and then removing the deflated gallbladder through the 1cm incision at the patient’s navel. The length of postoperative stay in the hospital is minimal, and same-day discharges are possible in cases of early morning procedures.

In certain advanced laparoscopic procedures where the size of the specimen being removed would be too large to pull out through a trocar site, as would be done with a gallbladder, an incision larger than 10mm must be made. The most common of these procedures are removal of all or part of the colon (colectomy), or removal of the kidney (nephrectomy). Some surgeons perform these procedures completely laparoscopically, making the larger incision toward the end of the procedure for specimen removal, or, in the case of a colectomy, to also prepare the remaining healthy bowel to be reconnected (create an anastomosis). Many other surgeons feel that since they will have to make a larger incision for specimen removal anyway, they might as well use this incision to have their hand in the operative field during the procedure to aid as a retractor, dissector, and to be able to feel differing tissue densities (palpate), as they would in open surgery. This technique is called hand-assist laparoscopy. Since they will still be working with scopes and other laparoscopic instruments, CO2 will have to be maintained in the patient’s abdomen, so a device known as a hand access port (a sleeve with a seal that allows passage of the hand) must be used. Surgeons that choose this hand-assist technique feel it reduces operative time significantly vs. the straight laparoscopic approach, as well as providing them more options in dealing with unexpected adverse events (i.e. uncontrolled bleeding) that may otherwise require creating a much larger incision and converting to a fully open surgical procedure.

Conceptually, the laparoscopic approach is intended to minimise post-operative pain and speed up recovery times, while maintaining an enhanced visual field for surgeons. Due to improved patient outcomes, in the last two decades, laparoscopic surgery has been adopted by various surgical sub-specialties including gastrointestinal surgery (including bariatric procedures for morbid obesity), gynecologic surgery and urology. Based on numerous prospective randomized controlled trials, the approach has proven to be beneficial in reducing post-operative morbidities such as wound infections and incisional hernias (especially in morbidly obese patients), and is now deemed safe when applied to surgery for cancers such as cancer of colon.

The restricted vision, the difficulty in handling of the instruments (new hand-eye coordination skills are needed), the lack of tactile perception and the limited working area are factors which add to the technical complexity of this surgical approach. For these reasons, minimally invasive surgery has emerged as a highly competitive new sub-specialty within various fields of surgery. Surgical residents who wish to focus on this area of surgery gain additional training during one or two years of fellowship after completing their basic surgical residency.

The first transatlantic surgery (Lindbergh Operation) ever performed was a laparoscopic gallbladder removal.

Laparoscopic techniques have also been developed in the field of veterinary medicine. Due to the relative high cost of the equiment required, however, it has not become commonplace in most traditional practices today but rather limited to specialty-type practices. Many of the same surgeries performed in humans can be applied to animal cases – everything from an egg-bound tortoise to a German Shepherd can benefit from MIS. A paper published in JAVMA (Journal of the American Veterinary Medical Association) in 2005 showed that dogs spayed laparoscopically experienced significantly less pain (65%)than those that were spayed with traditional ‘open’ methods. Arthroscopy, thoracoscopy, cystoscopy are all performed in veterinary medicine today. The University of Georgia School of Veterinary Medicine and Colorado State University’s School of Veterinary Medicine are two of the main centers where veterinary laparoscopy got started and have excellent training programs for veterinarians interested in getting started in MIS.

What happens when the test is performed?
Laparoscopy is done in an operating room. You wear a hospital gown. You have an IV (intravenous) line placed in your arm so that you can receive medicines through it.

You have general anesthesia for this test, which puts you to sleep so you are unconscious during the procedure. For general anesthesia, you breathe a mixture of gases through a mask. After the anesthetic takes effect, a tube may be put down your throat to help you breathe.

During laparoscopy, a tiny camera is inserted through a very small incision (less than an inch long), usually in or just below your navel. A gas such as carbon dioxide or nitrous oxide is pumped into your abdomen to help lift your abdominal wall off of your pelvic and abdominal organs so that the camera can view them clearly. If you are having any procedure more complicated than inspection of the pelvis or abdomen, your doctor makes one or more additional incisions to allow other instruments to reach into your abdomen. For pelvic surgeries, it is common for the additional incision to be just below the pubic hair line. You should ask your surgeon where you might expect to have incisions as part of your laparoscopy.

A wide variety of instruments are useful in laparoscopy. These include instruments that can cut and place clips onto internal structures, burn away scar tissue or painful areas in the pelvis, or remove small biopsy samples or even whole internal organs (often in pieces so that larger incisions are not necessary). Your doctor can see the work he or she is doing by watching a television screen.

At the end of the surgery, the instruments are withdrawn, the gas is removed, and the incisions are stitched closed. Your anesthesia is stopped so that you can wake up within a few minutes after your laparoscopy is finished.

Advantages:
There are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include:

*reduced haemorrhaging , which reduces the chance of needing a blood transfusion.
*smaller incision, which reduces pain and shortens recovery time.
*less pain, leading to less pain medication needed.

*Although procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which leads to a faster return to everyday living.
*reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.
*can be used in Gamete intrafallopian transfer (GIFT) surgery to put the eggs back into the fallopian tubes

Risk Factors:
Some of the risks are briefly described below:

*The most significant risks are from trocar injuries to either blood vessels or small or large bowel. The risk of such injuries is increased in patients who are obese or have a history of prior abdominal surgery. The initial trocar is typically inserted blindly. While these injuries are rare, significant complications can occur. Vascular injuries can result in hemorrhage that may be life threatening. Injuries to the bowel can cause a delayed peritonitis. It is very important that these injuries be recognized as early as possible.[2]

*Some patients have sustained electrical burns unseen by surgeons who are working with electrodes that leak current into surrounding tissue. The resulting injuries can result in perforated organs and can also lead to peritonitis.

*There may be an increased risk of hypothermia and peritoneal trauma due to increased exposure to cold, dry gases during insufflation. The use of heated and humidified CO2 may reduce this risk.

*Many patients with existing pulmonary disorders may not tolerate pneumoperitoneum (gas in the abdominal cavity), resulting in a need for conversion to open surgery after the initial attempt at laparoscopic approach.

*Not all of the CO2 introduced into the abdominal cavity is removed through the incisions during surgery. Gas tends to rise, and when a pocket of CO2 rises in the abdomen, it pushes against the diaphragm (the muscle that separates the abdominal from the thoracic cavities and facilitates breathing), and can exert pressure on the phrenic nerve. This produces a sensation of pain that may extend to the patient’s shoulders. For an appendectomy, the right shoulder can be particularly painful. In some cases this can also cause considerable pain when breathing. In all cases, however, the pain is transient, as the body tissues will absorb the CO2 and eliminate it through respiration. [4]

*Coagulation disorders and dense adhesions (scar tissue) from previous abdominal surgery may pose added risk for laparoscopic surgery and are considered relative contra-indications for this approach.

*Patients can often have trouble walking after surgery for a few days
It is easier for patients to recover from laparoscopy compared with regular abdominal surgery (often called “open” surgery) because the wounds from the incisions are so small. You will have a small straight scar (less than an inch long) wherever the instruments were inserted.

*Sometimes a small amount of the gas used to expand the abdomen will remain after the surgery for a day or two, before it dissolves away. This can cause some shoulder pain. Depending on the type of operation your laparoscopy involved, you might also have some cramping in the pelvis or abdomen. Some laparoscopy procedures in the pelvis normally cause a small amount of bleeding through the vagina. Some patients experience some nausea from the medicines used for anesthesia or anxiety.

*General anesthesia is safe for most patients, but it is estimated to result in major or minor complications in 3%-10% of people having surgery of all types. These complications are mostly heart and lung problems and infections. For laparoscopy, the risk of complications from anesthesia are smaller than average, because most surgeries done with laparoscopy are fairly simple and do not require you to have anesthesia for much longer than an hour.

You may click & see also
*Arthroscopy
*Natural Orifice Transluminal Endoscopic Surgery (NOTES)
*Single port access surgery, also known as single incision laparoscopic surgery

Must you do anything special after the test is over?
You will be watched for a few hours after your surgery to make sure that you are recovering well. You may be asked to sit up and drink liquids. For many laparoscopic procedures, you can go home the same day. You should not drive or drink alcohol the day of your test.

You should contact your doctor if you develop a fever over 101° F, strong pain, or bleeding from the vagina that is heavier than expected.

You will have a follow-up visit with your doctor to remove stitches if needed and to make sure you are recovering well.

How long is it before the result of the test is known?

If your laparoscopy was done to look for a cause of pain or other diagnosis, your doctor can tell you right after the surgery what was seen during the test. If a biopsy sample is removed, you may have to wait several days for the report.
Robotics and technology
The process of minimally invasive surgery has been augmented by specialized tools for decades. However, in recent years, electronic tools have been developed to aid surgeons. Some of the features include:

*Visual magnification – use of a large viewing screen improves visibility
*Stabilization – Electromechanical damping of vibrations, due to machinery or shaky human hands
*Simulators – use of specialized virtual reality training tools to improve physicians’ proficiency in surgery
*Reduced number of incisions
Robotic surgery has been touted as a solution to underdeveloped nations, whereby a single central hospital can operate several remote machines at distant locations. The potential for robotic surgery has had strong military interest as well, with the intention of providing mobile medical care while keeping trained doctors safe from battle.
Click to enlarge->..

Non robotic hand guided assistance systems
There are also user-friendly non robotic assistance systems that are single hand guided devices with a high potential to save time and money. These assistance devices are not bound by the restrictions of common medical robotic systems. The systems enhance the manual possibilities of the surgeon and his team, regarding the need of replacing static holding force during the intervention.

Some of the features are:

*The Stabilisation of the camera picture because the whole static workload is conveyed by the assistance system.
*Some systems enable a fast repositioning and very short time for fixation of less than 0.02 seconds at the desired position. Some systems are lightweight constructions (18kg) and can withstand a force of 20 N in any position and direction.
*The benefit – a physically relaxed intervention team can work concentrated on the main goals during the intervention.
*The potentials of these systems enhance the possibilities of the mobile medical care with those lightweight assistance systems. These assistance systems meet the demands of true solo surgery assistance systems and are robust, versatile and easy to use.
Resources:

https://www.health.harvard.edu/fhg/diagnostics/laparoscopy.shtml

http://en.wikipedia.org/wiki/Laparoscopic_surgery

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Hysteroscopy

Definition:
Hysteroscopy is the inspection of the uterine cavity by endoscopy. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention (operative hysteroscopy).
……………….
The hysteroscope is a long tube, about the size of a straw, which has a built-in viewing device. Hysteroscopy is useful for diagnosing and treating some problems that cause infertility, miscarriages, and abnormal menstrual bleeding. Sometimes other procedures, such as laparoscopy, are done at the same time as hysteroscopy.

Method:-
The hysteroscope is an optical instrument connected to a video unit with a fiber optic light source, and to the channels for delivery and removal of a distention medium. The uterine cavity is a potential cavity and needs to be distended to allow for inspection. Thus during hysteroscopy either fluids or CO2 gas is introduced to expand the cavity. The choice is dependent on the procedure and the patient’s condition. Fluids can be used for both diagnostic and operative procedures. However, CO2 gas does not allow the clearing of blood and endometrial debris during the procedure, which could make the imaging visualization difficult. Gas embolism may also arise as a complication. Since the success of the procedure is totally depending on the quality of the high-resolution video images in front of surgeon’s eyes, CO2 gas is not commonly used as the distention medium. Electrolytic solutions include normal saline and lactated Ringer’s. Current recommendation is to use the electrolytic fluids in diagnostic cases, and in operative cases in which mechanical, laser, or bipolar energy is used. Since they are conducting electricity, these fluids should not be used with monopolar electrosurgical devices. Non-electrolytic fluids eliminate problems with electrical conductivity, but can increase the risk of hyponatremia. These solutions include glucose, glycine, dextran (Hyskon), mannitol, sorbitol and a mannitol/sorbital mixture (Purisol). Water was once used routinely, however, problems with water intoxication and hemolysis discontinued its use by 1990. Each of these distention fluids is associated with unique physiological changes that should be considered when selecting a distention fluid. Glucose is contraindicated in patients with glucose intolerance. Sorbitol metabolizes to fructose in the liver and is contraindicated if patients has fructose intolerance. High-viscous Dextran also has potential complications which can be physiological and mechanical. It may crystallize on instruments and obstruct the valves and channels. Coagulation abnormalities and adult respiratory distress syndrome (ARDS) have been reported. Glycine metabolizes into ammonia and can cross the blood brain barrier, causing agitation, vomiting and coma. Mannitol 5% should be used instead of glycine or sorbitol when using monopolar electrosurgical devices. Mannitol 5% has a diuretic effect and can also cause hypotension and circulatory collapse. The mannitol/sorbitol mixture (Purisol) should be avoided in fructose intolerant patients.

A hysteroscope is in fact a modification of the traditional resectoscope, which is used for transurethral resection of the prostate. It has a double-channeled sheath allowing for continuous flow of fluid or gas media into the uterus through the larger channel, while allowing for less outflow through the smaller channel. This results in the distention of the uterine cavity. With modern optical technologies, hysteroscopes are getting smaller in diameter yet able to provide larger and brighter images for surgeons’ convenience.

After cervical dilation, the hysteroscope is guided into the uterine cavity and an inspection is performed. If abnormalities are found, an operative hysteroscope with a channel to allow specialized instruments to enter the cavity is used to perform the surgery. Typical procedures include endometrial ablation, submucosal fibroid resection, and endometrial polypectomy. Typically hysteroscopic intervention is done under general endotracheal anesthesia or Monitored Anesthesia Care (MAC), but a short diagnostic procedure can be performed in a gynecologist‘s office with just a paracervical block using the Lidocaine injection in the upper part of the cervix.

Why it is Done:
Hysteroscopy is useful in a number of uterine conditions:

Asherman’s syndrome (ie. intrauterine adhesions). Hysteroscopic adhesiolysis is the technique of lysing adhesions in the
*uterus using either microscissors (recommended) or thermal energy modalities. Hysteroscopy can be used in conjunction with laparascopy or other methods to reduce the risk of perforation during the procedure.
*Endometrial polyp. Polypectomy.
*Gynecologic bleeding
*Uterine fibroids. Myomectomy.
*Congenital Uterine malformations (also known as Mullerian malformations). Eg.septum,
*Evacuation of retained products of conception in selected cases.

Hysteroscopy has the benefit of allowing direct visualization of the uterus, thereby avoiding or reducing iatrogenic trauma to delicate reproductive tissue which may result in Asherman’s syndrome.
How do you prepare for the test
The time that you schedule this test can be important. Your gynecologist is able to get the best view of the uterine lining during the week that follows your period. If you have regular cycles, it is helpful for you to anticipate the timing of your next period and plan to have the hysteroscopy done in the following week.

Tell your doctor ahead of time if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office. Discuss different options for anesthesia with your doctor in advance.

If your doctor plans on giving you any anti-anxiety medicines before the procedure, or if you are going to have other tests done at the same time as hysteroscopy, you might be told not to eat or drink for eighthours or more before the test. Just before the test, you should empty your bladder.

Risk Factors:

After the procedure, you may have slight vaginal bleeding and cramps for one or two days. Sometimes a small amount of the gas used to expand the uterus can float up to the top of the abdomen and remain there for a day or two before it dissolves away. This can cause some shoulder pain. Some patients experience nausea from medicines used for anesthesia or anxiety.

Some of the procedures that are done along with hysteroscopy have risks of their own. You should ask your doctor about special risks that might come along with additional procedures planned for you.

A common problem is the uterine perforation when the instrument breaches the wall of the uterus. This can lead to bleeding and damage to other organs. A life-threatening condition is the bowel perforation by the instruments after the uterine perforation, resulting in acute peritonitis which can be fatal. Furthermore, cervical laceration, intrauterine infection (especially in prolonged procedures), electrical and laser injuries, and complications caused by the distention media described above are also not uncommon. The overall complication rate for diagnostic and operative hysteroscopy is 2% with serious complications occurring in less then 1% of cases.

How long is it before the result of the test is known
Your doctor can tell you what was seen through the hysteroscope right away. If a biopsy sample is removed, the analysis might take several days.

Resources:

https://www.health.harvard.edu/fhg/diagnostics/hysteroscopy.shtml

http://en.wikipedia.org/wiki/Hysteroscopy

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Endoscopic Retrograde Cholangiopancreatography (ERCP)

Definition:
Endoscopic retrograde cholangiopancreatography  (ERCP) enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas. The liver is a large organ that, among other things, makes a liquid called bile that helps with digestion. The gallbladder is a small, pear-shaped organ that stores bile until it is needed for digestion. The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine. These ducts are sometimes called the biliary tree. The pancreas is a large gland that produces chemicals that help with digestion and hormones such as insulin.
click & see the pictures
This procedure uses x-rays and an endoscope to see inside your digestive system and diagnose problems such as tumors, gallstones, and inflammation in your liver, gallbladder, bile ducts, or pancreas. Your doctor might use the test to investigate the cause of jaundice, upper abdominal pain, or unexplained weight loss.

Why an ERCP is Performed
ERCP is most commonly performed to diagnose conditions of the pancreas or bile ducts, and is also used to treat those conditions. It is used to evaluate symptoms suggestive of disease in these organs, or to further clarify abnormal results from blood tests or imaging tests such as ultrasound or CT scan. The most common reasons to do ERCP include abdominal pain, weight loss, jaundice, or an ultrasound or CT scan that shows stones or a mass in these organs.

ERCP may be used before or after gallbladder surgery to assist in the performance of that operation. Bile duct stones can be diagnosed and removed with an ERCP. Tumors, both cancerous and noncancerous, can be diagnosed and then treated with indwelling plastic tubes that are used to bypass a blockage of the bile duct. Complications from gallbladder surgery can also sometimes be diagnosed and treated with ERCP.

In patients with suspected or known pancreatic disease, ERCP will help determine the need for surgery or the best type of surgical procedure to be performed. Occasionally, pancreatic stones can be removed by ERCP.

If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove or relieve the obstruction. Also, tissue samples (biopsy) can be taken for further testing.

Preparation
For a week before the test, don’t take aspirin or other NSAIDs because they can irritate the stomach lining and increase your chance of bleeding during the procedure. Also tell the doctor if you are taking blood-thinning medicines or any diabetes medications. People with heart valve problems may also have to take antibiotics before the procedure. Avoid eating or drinking anything for eight hours before the test because it needs to be done on an empty stomach.

Tell your doctor if you are allergic to iodine, which is used for the procedure. Arrange for someone to drive you home because the medication given during the test will make you drowsy.

Your stomach and duodenum must be empty for the procedure to be accurate and safe. You will not be able to eat or drink anything after midnight the night before the procedure, or for 6 to 8 hours beforehand, depending on the time of your procedure. Also, the physician will need to know whether you have any allergies, especially to iodine, which is in the dye. You must also arrange for someone to take you home—you will not be allowed to drive because of the sedatives. The physician may give you other special instructions.

What can be expected during ERCP
Your throat will be sprayed with a local anesthetic before the test begins to numb your throat and prevent gagging. You will be given medication intravenously to help you relax during the examination. While you are lying in a comfortable position on an X-ray table, an endoscope will be gently passed through your mouth, down your esophagus, and into your stomach and duodenum. The procedure usually lasts about an hour. The endoscope does not interfere with your breathing. Most patients fall asleep during the procedure or find it only slightly uncomfortable. You may feel temporarily bloated during and after the procedure due to the air used to inflate the duodenum. As X-ray contrast material is injected into the pancreatic or bile ducts, you may feel some minor discomfort.

What happens when the test is performed
The test is performed by a specially trained gastroenterologist either in the doctor’s office or in a hospital. You are usually given a sedative through an IV line. You wear a hospital gown for the procedure and lie on your side against a backrest on an x-ray table. If you wear dentures, remove them. A local anesthetic is sprayed into your throat to prevent you from having a gag reflex (choking feeling) when the endoscope is placed inside. The endoscope is about a third of an inch in diameter and 21/2 feet long with a light on the end. It also has holes at the end that allow your doctor to pump air into your intestine, squirt fluid, and suck out liquid or air.

You are asked to swallow at the moment the tube is placed into your throat. This helps guide the endoscope into your esophagus.You are likely to feel pressure against your throat while the tube is in place and you might experience a “full” feeling in your stomach. The doctor or doctor’s assistant gently advances the tube until it reaches your duodenum, the first part of the small intestine.

Next, the doctor inserts a slender tube, called a cannula, through the endoscope, and places the tip of the cannula into the bile duct or the pancreatic duct. These ducts are natural tubes of tissue that drain liquids out of the liver and pancreas. Once the tip of the cannula is lodged inside one of these ducts, the doctor injects contrast dye (usually iodine) through the cannula. The dye can be seen by x-rays, so it lights up the ducts clearly on an x-ray image, showing any obstruction (such as from gallstones or cancer) or unusual widening of the ducts (indicating an obstruction in the past). It also can light up the gallbladder, which connects to the bile duct, and helps the doctor to visualize the liver and pancreatic tissue around the ducts.

Depending on what the x-rays show, the doctor may undertake different interventions using tools operated through the endoscope. The doctor can remove gallstones or take biopsies of suspicious tissue. He or she can prop open narrowed bile ducts with a stent, a tube-shaped object that can be inserted through the scope. Depending on what is done, the test can take from 30 minutes to two hours.

Risk Factors:Complications are rare. One possibility is aspiration-accidentally inhaling saliva into the lungs – which can cause pneumonia. Other risks include inflammation of the pancreas, infection, and bleeding. Injury to the lining of the stomach, esophagus, or intestine, as well as abdominal pain and fever, can also occur.

Possible complications of ERCP include pancreatitis (inflammation of the pancreas), infection, bleeding, and perforation of the duodenum. Except for pancreatitis, such problems are uncommon.
You may have tenderness or a lump where the sedative was injected, but that should go away in a few days.

Time required to do the test:
ERCP takes 30 minutes to 2 hours. You may have some discomfort when the physician blows air into the duodenum and injects the dye into the ducts. However, the pain medicine and sedative should keep you from feeling too much discomfort. After the procedure, you will need to stay at the hospital for 1 to 2 hours until the sedative wears off. The physician will make sure you do not have signs of complications before you leave. If any kind of treatment is done during ERCP, such as removing a gallstone, you may need to stay in the hospital overnight.

What happens after the Test is over
You will be monitored in the endoscopy area for 1-2 hours until the effects of the sedatives have worn off. Your throat may be a little sore for a day or two. You will be able to resume your diet and take your routine medication after you leave the endoscopy area, unless otherwise instructed.

Your surgeon will usually inform you of your test results on the day of the procedure. Biopsy results take several days to return, and you should make arrangements with your surgeon to get these results. The effects of sedation may make you forget what you were instructed after the procedure. Call your surgeon’s office for the results.

Resources:

https://www.health.harvard.edu/fhg/diagnostics/endoscopic-retrograde-cholangiopancreatography.shtml

http://digestive.niddk.nih.gov/ddiseases/pubs/ercp/

http://www.alabangmedicalcenter.ph/patientscorner/ERCP.htm