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Diagnonistic Test

Flexible Sigmoidoscopy

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Definition:
Flexible sigmoidoscopy is a procedure used to see inside the sigmoid(the lower portion of the large intestine) colon and rectum. Flexible sigmoidoscopy can detect inflamed tissue, abnormal growths, and ulcers. The procedure is used to look for early signs of cancer and can help doctors diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus, and weight loss.

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. The endoscope used for this test is about a half-inch wide and long enough to reach about two feet into the colon. A sigmoidoscopy can detect early cancers as well as polyps that could later become cancerous.

Sigmoidoscopy is an effective screening test for colon cancer if you have the procedure done every five years starting at age 50. Alternatively, you might choose to have a colonoscopy every 10 years to screen for colon cancer. In either case, it’s wise to have a fecal occult blood test in the years you don’t have a sigmoidoscopy or colonoscopy. A sigmoidoscopy is also useful for evaluating the cause of abdominal pain, blood in the stool, constipation, and diarrhea.

What are the sigmoid colon and rectum?
The sigmoid colon is the last one-third of the colon. The colon comprises three main parts: the ascending colon, the transverse colon, and the sigmoid colon—sometimes called the descending colon. The colon absorbs nutrients and water and forms stool.

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The sigmoid colon is the last one-third of the colon.

The rectum is about 6 inches long and connects the sigmoid colon to the anus. Stool leaves the body through the anus. Muscles and nerves in the rectum and anus control bowel movements.

Difference between flexible sigmoidoscopy and colonoscopy:
Flexible sigmoidoscopy enables the doctor to see only the sigmoid colon, whereas colonoscopy allows the doctor to see the entire colon. Colonoscopy is the preferred screening method for cancers of the colon and rectum; however, to prepare for and perform a flexible sigmoidoscopy usually requires less time.

How to Prepare for a Flexible Sigmoidoscopy:
To prepare for a flexible sigmoidoscopy, one or more enemas are performed about 2 hours before the procedure to remove all solids from the sigmoid colon. An enema is performed by flushing water, laxative, or sometimes a mild soap solution into the anus using a special wash bottle.

In some cases, the entire gastrointestinal tract must be emptied by following a clear liquid diet for 1 to 3 days before the procedure—similar to the preparation for colonoscopy. Patients should not drink beverages containing red or purple dye. Acceptable liquids include

*fat-free bouillon or broth
*strained fruit juice
*water
*plain coffee
*plain tea
*sports drinks, such as Gatorade
*gelatin

A laxative or an enema may also be required the night before a flexible sigmoidoscopy. A laxative is medicine that loosens stool and increases bowel movements. Laxatives are usually swallowed in pill form or as a powder dissolved in water.

Patients should inform their doctor of all medical conditions and any medications, vitamins, or supplements taken regularly, including

*aspirin
*arthritis medications
*blood thinners
*diabetes medications
*vitamins that contain iron

What happens when the test is performed?
You wear a hospital gown for the procedure and lie on your side on a table. After applying some clear jelly to his or her gloved hand, the doctor feels the inside of your rectum with a finger, then gently inserts one end of the sigmoidoscope inside.

The doctor will fill your intestine with air, which often causes some pain similar to the cramping you might get when you have gas. As the camera on the scope transmits pictures to a video screen, your doctor watches for any suspicious lesions on your bowel lining. If one appears, he or she might use some small clippers on the end of the scope to take a tissue sample to check under the microscope. When the test is finished, the doctor vacuums the air out of your intestine and slowly removes the tube. The test usually takes 10-30 minutes.

How is a flexible sigmoidoscopy performed?

Examination of the Sigmoid Colon:
During a flexible sigmoidoscopy, patients lie on their left side on an examination table. The doctor inserts a long, flexible, lighted tube called a sigmoidoscope, or scope, into the anus and slowly guides it through the rectum and into the sigmoid colon. The scope inflates the colon with air to give the doctor a better view. A small camera mounted on the scope transmits a video image from inside the colon to a computer screen, allowing the doctor to carefully examine the tissues lining the sigmoid colon and rectum. The doctor may ask the patient to move periodically so the scope can be adjusted for better viewing.

When the scope reaches the transverse colon, the scope is slowly withdrawn while the lining of the colon is carefully examined again.

Risk Factors:
The risks are minimal. The chance of perforation is less than for a colonoscopy. A few people have a small amount of bleeding after the procedure if a biopsy has been taken.

Must you do anything special after the test is over?
You should feel fine and be able to return to your regular activities immediately after the test. Call your doctor if you have more than light bleeding from the rectum or if you have continuing abdominal pain

Biopsy and Removal of Colon Polyps
The doctor can remove growths, called polyps, during flexible sigmoidoscopy using special tools passed through the scope. Polyps are common in adults and are usually harmless. However, most colon cancer begins as a polyp, so removing polyps early is an effective way to prevent cancer. If bleeding occurs, the doctor can usually stop it with an electrical probe or special medications passed through the scope.

During a flexible sigmoidoscopy, the doctor can also take samples from abnormal-looking tissues. Called a biopsy, this procedure allows the doctor to later look at the tissue with a microscope for signs of disease.

Tissue removal and the treatments to stop bleeding are usually painless. If polyps or other abnormal tissues are found, the doctor may suggest examining the rest of the colon with a colonoscopy.

Recovery
A flexible sigmoidoscopy takes about 20 minutes. Cramping or bloating may occur during the first hour after the procedure. Bleeding and puncture of the large intestine are possible but uncommon complications. Discharge instructions should be carefully read and followed.

Patients who develop any of these rare side effects should contact their doctor immediately:-
*severe abdominal pain
*fever
*bloody bowel movements
*dizziness
*weakness

Points to Remember
*Flexible sigmoidoscopy is a procedure used to see inside the sigmoid colon and rectum.
*One or more enemas are performed about 2 hours before the procedure to remove all solids from the sigmoid colon.
*In some cases, the entire gastrointestinal tract must be emptied—similar to the preparation for colonoscopy.
*A sigmoidoscope transmits a video image from inside the colon to a computer screen.
*A doctor can biopsy abnormal-looking tissues during a flexible sigmoidoscopy.
*Polyps can be removed using special tools passed through the sigmoidoscope.
*If polyps or other abnormal tissues are found, the doctor may suggest examining the rest of the colon with a colonoscopy.
*A flexible sigmoidoscopy takes about 20 minutes.

Hope through Research
The National Institute of Diabetes and Digestive and Kidney Diseases conducts and supports basic and clinical research into many digestive disorders.

Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit www.ClinicalTrials.gov.

For More Information
Fact sheets about other diagnostic tests are available from the National Digestive Diseases Information Clearinghouse at www.digestive.niddk.nih.gov, including

Resources:
http://digestive.niddk.nih.gov/ddiseases/pubs/sigmoidoscopy/
https://www.health.harvard.edu/fhg/diagnostics/flexible-sigmoidoscopy.shtml

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Diagnonistic Test

Fecal Occult Blood Test

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Alternative Names: Guaiac smear test; Fecal occult blood test – guaiac smear; Stool occult blood test – guaiac smear

Definition
The stool guaiac test finds hidden (occult) blood in the stool (bowel movement). It is the most common form of fecal occult blood test (FOBT) in use today.…..click & see

click & see the pictures

 

This test detects blood in your stool, which can be a sign of bleeding anywhere from your nose and mouth to your rectum, such as from an ulcer, a polyp, or cancer. If you’re over 50, you should have this test annually during the years when you don’t have either a colonoscopy or sigmoidoscopy to screen for colon cancer. Keep in mind, however, that both colonoscopy and sigmoidoscopy are better at detecting cancer than a fecal occult blood test.

How the Test is Performed
If the test is performed in an office or hospital, stool may be collected by a doctor during an examination.
If the test is performed at home, a stool sample from three consecutive bowel movements is collected, smeared on a card, and mailed to a laboratory for processing. In order to ensure the accuracy of the guaiac test, follow the manufacturer’s instructions on how to collect the stool.

There are many ways to collect the samples. You can catch the stool on plastic wrap that is loosely placed over the toilet bowl and held in place by the toilet seat. Then put the sample in a clean container. One test kit supplies a special toilet tissue that you use to collect the sample, then put the sample in a clean container. Do not take stool samples from the toilet bowl water, because this can cause errors.

For infants and young children wearing diapers, you can line the diaper with plastic wrap. The plastic wrap is positioned so that it keeps the stool away from any urine. Mixing of urine and stool can spoil the sample.

Laboratory procedures may vary. In one type of test, a small sample of stool is placed on a paper card and a drop or two of testing solution is added. A color change indicates the presence of blood in the stool.
How do you prepare for the test?
Do not eat red meat, any blood-containing food, cantaloupe, uncooked broccoli, turnip, radish, or horseradish for 3 days prior to the test.

You may need to stop taking medicines that can interfere with the test. These include vitamin C and aspirin. Check with your health care provider regarding medication changes that may be necessary. Never stop or decrease any medication without consulting your health care provider.

For several days before taking the samples, you must avoid medicines that can interfere with the results. These include NSAIDs and blood thinners  which can cause minor stomach bleeding, thereby giving an abnormal test result. If you have hemorrhoids, wait until they stop bleeding before doing the test. Women shouldn’t collect stool samples near the time of menstruation. Finally, avoid using toilet bowl cleaners for several days before the test, because these chemicals can affect the results if they come in contact with your stool sample.

For several days before the test, you also need to avoid foods and vitamins that can affect the test result. Foods to avoid include red meat (the blood it contains can turn your test positive), radishes, turnips, cabbage, cauliflower, horseradish, uncooked broccoli, and cantaloupe (all of which contain a chemical that can turn the test positive), and citrus fruits and vitamin C supplements (which can turn the test falsely negative).
What happens when the test is performed?
If one of the traditional tests is used, you collect three stool samples, ideally on three different days. Some kits include tissue paper that you can lay on the surface of the toilet bowl water to help keep the stool sample from sinking. As an alternative, you can pass your bowel movement into a disposable container. Once you’ve had a bowel movement, obtain a very small sample of the stool using the thin wooden sticks in your kit and smear it on a card from your kit. Then fold over the card to protect your sample.When you have all three samples, mail the cards to the clinic or lab in the plastic-lined envelope given to you.Make sure that your name is written on each card.

In the lab, the cards are treated with a chemical that produces a blue color when blood is present in the sample. This test works fine no matter how long it took your samples to reach the lab.

If you have the flush pad test, you drop the pad into the toilet bowl after you’ve had a bowel movement, for three consecutive days. The pads change color when blood is present in the toilet bowl. You can flush the toilet to dispose of the pads, but-if blood is detected-should contact your doctor.

How the Test Will Feel
There is no discomfort when the test is done at home, because this test only involves normal bowel functions. If stool is collected during an exam, there may be some discomfort in the anal canal and rectum.

Why the Test is Performed: This test is a screening test to detect blood in the digestive tract.

Risk Factors: No risk. But there can be false-positive and false-negative results. Using the right collection technique, avoiding certain drugs, and observing food restrictions can reduce errors.

RESULTS:
Normal Results : –
A negative test result means that there is NO blood in the stool.

What Abnormal Results Mean:-
Abnormal results may indicate:

*Angiodysplasia of the GI tract
*Colon cancer or other gastrointestinal (GI) tumors
*Colon polyps
*Esophageal varices and portal hypertensive gastropathy
*Esophagitis
*Gastritis
*GI infections
*GI trauma or bleeding from recent GI surgery
*Hemorrhoids
*Inflammatory bowel disease
*Peptic ulcer

Stool guaiac testing is sometimes used to screen for colon cancer, but it is not a reliable test for this purpose, and other screening methods should be used.

Additional non-GI related causes of positive guaiac test may include:

*Nose bleed
*Coughing up blood
Abnormal tests require follow-up with your doctor.
How long is it before the result of the test is known?
With the flush pad method, results are available immediately.With the more traditional methods, testing is performed in only a few minutes once the lab receives your sample. Some clinics or labs do this testing in batches and wait to process the test until samples have been received from several people. You should hear from your doctor’s office within a week after the lab has received your specimen. If your test is positive, it means you have blood in your stool, and your doctor will recommend some additional testing to find out the cause.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/fecal-occult-blood-test.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/003393.htm

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