- What is spirometry
- What is a pelvic exam
- What is the examination of fundus oculi
- What is a scan
- What is a gas analysis
- What is an upper endoscopy / gastroscopy
- What is the hysterosalpingography
- What is a holter
- What is laparoscopy
- What is laryngoscopy
What is spirometry
SpirometrySpirometry is a test that allows to know the State of the lungs of a person by measuring the air that is able to inspire and exhaling.
There are two types of basic spirometry:
Simple spirometry: consists in that the person slowly first breathe normally. Then you need to catch and release all the air that can. The volume of air that enters and leaves the lungs, and the maximum that could enter and exit is thus measured.
Forced spirometry: consists in that the person will pick all of the air that you can and then release suddenly until it can not expel more. It is most useful for the study of broncopatias. Flow, i.e., the amount of air per second which can expel a person is thus measured.
Spirometry will not say directly what is the lung problem that we face, but yes it tells us if the lung function is altered with an obstructive pattern (the air cannot leave easily) or restrictive (the air cannot enter). This helps a lot to decide a useful treatment, and allows you to focus on clinical diagnosis or other tests.
Other types of trials are those that are performed after a test of bronchodilation or provocation. The bronchodilation test are people with obstructive pattern in which you want to check if it can be reversed with the taking of aerosols. Provocation tests are performed when forced spirometry is normal but is suspected of having isolated obstruction episodes.
When doing a spirometrySpirometry he is recommended to everyone that a lung disease, both to diagnose it and to monitor its evolution is suspected. Diseases that benefit most from a spirometry are:
COPD: chronic obstructive pulmonary disease appears in smokers long time evolution. There are two variants: emphysema and chronic bronchitis, although they overlap sometimes. Spirometry can detect the obstructive pattern, check that it not reversed with bronchodilators, and watch the evolution of the disease.
Asthma: asthma is another obstructive disease of the respiratory system, but this time is reversible with bronchodilator aerosol. It can be persistent and last a lifetime, or be related to allergies and more temporary.
Allergies: there are allergic substances that have a direct effect on bronchial lung, making that they block temporarily. One of the most common would be the seasonal allergy to pollen or grass.
Pulmonary fibrosis: it's a disease with a strong genetic component and whose origin is not clear. Appears in the middle ages of life, when suddenly the lung begins to fibrosarse. Spirometry detects a restrictive pattern.
Sarcoidosis: is an autoimmune disease that affects the lungs and other organs in the body. Internal Granuloma obstructing the bronchi are formed. Spirometry serves to define the degree of involvement.
Bronchiectasis: are specific lung lesions that produce a (sometimes huge) dilation of the bronchi. Spirometry is usually not the definitive diagnostic test, but you can find inconclusive changes that encourage them to perform more tests.
Preparation for SpirometryIf you are performing a spirometry these are the issues that you must take into account:
Duration: usually takes very little time, about 10 minutes.
Admission: admission is not needed, it can be done on an outpatient basis.
Is necessary to be accompanied?: not, is a painless and not invasive, so you can only attend the clinic and return in the same way.
Drugs: don't need to take any prior medication. You must tell your doctor all the medicines that you eat so that you assess whether you should keep them or leave them. Especially if they are bronchodilators in spray.
Food: you can eat normally, it is not necessary to go on fasting to the clinic.
Clothes: you can wear normal street clothes. When you do the test take off sweaters or jackets that can bother you when you want to expand the lungs to inspire.
Documents: is better to carry the medical steering wheel with which calls for testing and health card. Maybe give you the results at the time of completion of the test and you need to save them.
Pregnancy and breast-feeding: neither pregnancy nor lactation are contraindications for performing this test.
How spirometryWhen you are in the query they will make you a few general questions about your state of health and the situations in which you have noticed difficulty breathing. You will also be asked if you have repeat cough, expectoration, or heard ringing in the chest. Just after you explore, paying special attention to the auscultation of the lungs. If the doctor considers it necessary it will ask for Spirometry, which may make you at that moment or another day.
In the appointment of spirometry ask you that you feel and get comfortable. Advantage to take off your coats and jackets that make you feel uncomfortable when performing the test. When you're seated they ask that you take a small (somewhat larger than a mobile phone) device that has a small disposable tube. You will have to get the tube into the mouth to breathe through it. They tend to get nose pliers so that you breathe through it.
Prepared once they ask that you breathe normally through the tube. So you will see that the machine well captures your breath and you breathe without problems. They will measure the air that you exchange through a normal respiratory rate. Then they ask you to take all the air you can and sewing it and sustain it for a few seconds, they will then tell you that you release it slowly until you can not already breathe more.
Here would be the simple spirometry. The next phase of the test would be forced spirometry. You will be asked to take all the air you can once again and sustain it for a couple of seconds. Then ask you that you let go of it suddenly, abruptly, and you keep releasing air until you can no more. It is normal that the technician who test yell and encourage you to release all the air quickly, sometimes with violence. It is the way that you see forced to perform the test properly, and if it doesn't you will have to repeat this last phase.
In cases where the obstructive pattern is detected, you can take the test of bronchodilation. This will give you a spray so you inhale a substance bronchodilator in two doses. A little while you repeat the forced spirometry.
Immediately after the test results, are obtained even if you have to go back to the doctor so that you assess them and you report.
Complications of spirometrySpirometry complications are not known. It is a safe test that does not entail risks for persons who are subjected to it. Associated with the test, have described asthma attacks but it is anecdotal and they can be prevented by detecting people who are not well respiratoriamente at the time of the test.
SpirometryThe spirometry results are obtained at the same time make it and must be performed by a pulmonologist or doctor with experience. In the report, there will be a series of data that help to understand what kind of alteration of lung function you have.
The values that they are obtained from the simple spirometry are:
Current volume: is the volume of air that we exchange with normal breathing. It is usually 0.5 l.
Inspiratory and expiratory reserve volume: is the volume of air that can inspire or breathe if we force the breath the most. We can come to inspire 3 more L & 1.1 L more than normal.
Vital capacity: is the sum of the current volume + inspiratory reserve volume + expiratory reserve volume. It is therefore the entire volume of air that can drop from a maximum inspiration.
What we can not study with a spirometry is the total lung capacity, i.e., the total volume of air that are capable of retaining the lungs. This happens because always remains something of air in the lungs even when we perform a maximum exhalation is the residual volume.
The values that they are obtained in a forced spirometry are:
Forced Expiratory Volume in one second (FEV1 or FEV1): is the volume of air that we are able to expel from blow in the first second of expiration.
Forced vital capacity (FVC or FVC): is the time it took us to expel all possible air from a maximum inspiration
Tiffeneau index: is obtained by dividing the FEV between the FVC. Thus it is known what percentage of volume is ejected in one second with respect to the total volume of air. It is the most important value because it allows to classify obstructive or restrictive pulmonary pattern . The normal value is 80%.
Forced expiratory flow between 25-75% of the FVC: is a value that has a complicated interpretation. It is the first to be altered in smokers and can detect if in the future there will be a serious pulmonary obstruction.
What is a pelvic exam
Pelvic examThe pelvic exam is the way that have doctors, usually gynaecologists, examine the female genital organs and other bodies that are within the pelvis.
They discussed the pelvic exam:
The vulva is the external genitalia of the female.
The uterus, patients also called the womb and vagina.
The neck of the uterus, which is the lower part of the uterus that opens to the vagina.
The fallopian tubes, which are tubes where are going the eggs from the ovaries to the inside of the uterus.
The ovaries, which are the organs which produce eggs.
The bladder of the urine.
The rectum, which is the final part of the large intestine before the year.
The pelvic examination is conducted during gynecological women on a regular basis to perform. It also occurs when a woman is pregnant, when the presence of a sexually transmitted disease is suspected, or when there are other symptoms of Gynecologic pelvic pain or abnormal flow.
Pelvic examination includes the genitals scan manually and the introduction of a Speculum to take a cervical cytology, or samples for the study of a sexually transmitted disease.
Pelvic exam prepThese are the issues that you must consider when you undergo a pelvic exam:
Duration: the test is performed in a few minutes.
Entry: the test is done on an outpatient basis.
Is necessary to be accompanied?: don't have to be accompanied by although it might help if it makes you feel more relaxed.
Drugs: is not necessary to take any prior medication.
Food: is not necessary to go on fasting.
Clothing: you can wear any clothes you want to but it should be easy to remove from the waist down.
Documents: any document is not necessary.
Contraindications: nor pelvic examinations are performed in very young women or who have never had sexual relations.
Pregnancy and lactation: not contraindicate the realization of the test, although it is important to tell your doctor the possibility of that is pregnant.
Other considerationsYou can be more comfortable if you empty the bladder and the bowel prior to testing.
If you are allergic to latex should warn their doctor explore it with gloves made of other materials like vinyl.
How pelvic examScan usually takes place in the consultation of the gynaecologist. Feel free to ask all questions you may have about exploration. The doctor or nurse be asked to undress from the waist down for privately. They provide a robe or a sheet to cover. To perform the scan you will be asked to it lay it face-up on a special table with the legs apart and your feet in some Stirrups.
First is inserted a Speculum in the vagina, which is an instrument with two valves that are separated and allow open the vaginal cavity and thoroughly observe the cervix. In this way, with a small spatula, brush, or they will be a cervical cytology.
After the PAP will draw the Speculum and the doctor will make a maneuver called bimanual examination. To do this, the doctor will be gloves and will introduce you two well lubricated fingers into the vagina previously. With the other hand you will feel and pressure above the pubic to explore the pelvic organs. Sometimes also performed a rectal examination. To do this, after put on the gloves, it introduces is a finger well lubricated anal hole looking for tumors or other abnormalities previously.
Pelvic scan can be a bit annoying but not painful. Just need to be calm and relaxed as possible. No complication is expected.
Pelvic exam resultsFinds that the doctor normally observed in the pelvic exam you will be discussed immediately after the scan. Sampling for cytology or studies of possible infections is sent to different laboratories so that they are analyzed. The results of these tests can take several weeks.
The report with all results will include data on the technique used and the findings found. The type of discovery can vary widely:
· There may be skin lesions on the external genitalia suggestive of a like a herpes, syphilis or genital warts-sexually transmitted infection.
- It may be a pathological flow characteristic of disorders such as candidiasis, trichomoniasis or gonorrhea.
- In the neck of the uterus may be lesions suggestive of a tumor. The uterus may be enlarged and suggestive masses of fibroids can be felt.
- She is seen and felt the ovaries increased in size with lesions suggestive of ovarian cysts, etc.
What is the examination of fundus oculi
Dilated eye examFunduscopia, ophthalmoscopy or dilated eye exam is a medical technique that allows to visualize the inside of the eye to make a diagnosis. So dilates the pupil with drugs that are deposited in the form of drops on the surface of the eye; so, the ophthalmologist can see easily the interior of the eyeball with an instrument called ophthalmoscope.
The ophthalmoscope invented in 1850 the medical and German physicist Hermann von Helmholtz. It consists of an apparatus comprising a series of mirrors and crystals that illuminate the retina of the eye without that light is reflected. If it weren't for the ophthalmoscope light flashes it would and could not see the bottom of eye well, something like what happens when a camera flash take out red eye. Today two types of ophtalmological equipment have been developed:
Direct ophthalmoscope: is the first that is designed and the easier of the two. The doctor can only see one eye at the same time. The technique requires some skill, but it is used many times in the day to day by ophthalmologists and other doctors.
Indirect ophthalmoscope: is more complex than the previous one; with it, the ophthalmologist can see both eyes of the patient at the same time.
Sometimes it is not enough to use a simple ophthalmoscope and other devices that help examine the fundus oculi are needed. The most widely used is the slit-lamp, a complicated magnifying glass with light in which the patient supports the Chin and forehead so the doctor explore their eyes. Other new techniques would be digital fundus photographs (that allow to compare the evolution of the retina) or the fluorescein angiography (which studies the blood vessels directly).
When doing an examination of fundus oculiThe eye examination serves to diagnose a disease or observe their evolution towards improvement or worsening. It is not the intermediate towards any treatment step. Diseases in which it is intended to perform a dilated eye exam are:
- Diabetes mellitus: diabetes is the leading cause of blindness in the working population in developed countries, and thanks to the fundus examination we can observe directly the small blood vessels that supply the retina.
- High blood pressure: in the same way that we can observe in diabetes, alterations of blood vessels that occur in high blood pressure. It also serves to identify the degree of evolution of the disease.
- Retinal embolism: is used to confirm the presence of a plunger in a retinal artery that blocks the passage of blood into a particular area. A spot in the retina appears red cherry.
- Venous thrombosis: we can see if the blood flow is correct through you the veins or is interrupted by thrombi. See pictures of flares by across the retina.
- Retinal detachment: eye fundus examination allows you to see if there is any area of the retina that has lifted from the inside of the eye; If so, would be falling like a curtain.
- Retinitis pigmentosa: is one of the tests in this genetic disease. Be observed spicules, an aspect similar to the bone, in the periphery of the retina.
- Posterior Uveitis: cottony buildup ahead of the retina, which are the result of local infection are observed.
- Macular degeneration: is the cause of most frequent blindness among the elderly. You can see changes in the central area of the retina, called the macula. Sometimes you can see edema clearly.
- Chronic glaucoma: in this disease the optic nerve erodes little by little in its final part, the optic nerve head. The eye examination can serve to see that damage to the naked eye, but today there are more reliable techniques.
- Optical neuritis: optic nerve can become inflamed as a result of a viral infection, and thus appears in a dilated eye exam.
- Ischemic neuropathy: blood flow also can be interrupted at the optic nerve, as a result of diabetes, hypertension or autoimmune diseases.
- Multiple sclerosis: this neurological disease is common vision is disturbed by the optic nerve involvement. A dilated eye exam should always be done to rule out other causes.
- Intracranial hypertension: pressure inside the skull increases cause edema of papilla (papilledema). The reasons are varied, they include meningitis, hydrocephalus, brain tumors, bleeding, etc. Examination of fundus oculi, moreover, is a forced test before performing a lumbar puncture, since the existence of papilledema is an absolute contraindication.
Preparation for the examination of fundus oculiIf you will perform a dilated eye exam, these are the issues that you must take into account:
Duration: examination of fundus oculi itself lasts a short time, just a few minutes. However, the dilation of the pupil can take up to an hour, time in which you'll be waiting in a waiting room until the expansion is adequate.
Entry: eye fundus examination is performed on an outpatient basis. It is not necessary to enter for this test.
Is necessary to be accompanied?: Yes, it is recommended to carry a passenger. After hard pupil dilation test several hours, in which the vision will be altered, and is not recommended driving. If only attending the meeting, you must go and return to the hospital in public transport.
Drugs: is not necessary to take any prior medication. Medicines that you are taking very seldom can affect this test. It only reports the doctor if you are missing you eye drops.
Food: it is not necessary to keep fasting.
Clothing: can go to the appointment with any type of clothing. Sunglasses, is recommended since leaving pupils will be very dilated and light of the Sun will be especially annoying.
Documents: don't need to take any special documentation.
Contraindications: a relative contraindication is suffering from a closed angle glaucoma, since when the pupil dilates the disease may get worse quickly. It must also take special care when the patient has cataracts in the eyes, because the lens may be thickened. Your doctor will know how to intervene properly to carry out the test without unnecessary risks.
Pregnancy and lactation: is a test that can be performed safely during pregnancy and lactation.
How the eye examinationTo get an eye examination, when you get to the consultation of ophthalmologist the nurse will begin to instil you with a few drops of eye drops in the eye that you gradually dilate the pupil; These drops can be a little escocer. This process may take several minutes to an hour. The nurse will be checking how dilates the pupil until you consider that it is in the ideal State to be able to perform the test.
Then you'll enter the consultation of ophthalmologist and you sentarás in a Chair. The lights will turn off to facilitate the vision of the interior of the eye. If your doctor uses a slit lamp, it will ask you that you support the Chin and forehead on a metal structure, to gaze and use magnifiers and lights that allow the eye exam.
If the ophthalmoscope is direct, the doctor will need to see an eye first and then the other eye. Ophthalmoscope used is indirect, the doctor can see both eyes at the same time with a light that will normally be placed in their own front; in this case, you'll stay reclining or lying. During the test, your doctor will ask you that you set the view on one point and that you not blinking for a few seconds.
Once the eye examination you can relax the look and perform a normal life. That Yes, the dilation of the pupils will last you a few more hours, so the sunlight bothered you and you can have a visual disturbance; the most frequent is you can not read, so it is recommended to postpone activities that require it.
It not always necessary that the eye examination is conducted in these conditions. Neurologists and other physicians in the emergency room to perform the examination of fundus oculi unexpanded before the pupil, since there's no time to do so. This does not allow an in-depth study of the retina and other parts of the eye, but it is possible to observe the essential parts that interest them (for example, the presence of papilledema).
Complications of the eye examinationSerious complications on the fundus exam are not very frequent. Some that can ever occur are:
- Irritation of the ocular conjunctiva or itching intense eye to eye you drops to dilate the pupil.
- Allergy to the medication used to dilate the pupil.
- Aggravation of an attack of acute glaucoma, to dilate the pupil the channel which drains fluid from the inside of the eye closes and can greatly increase the intraocular pressure.
Results of the examination of fundus oculiThe study of fundus allows the ophthalmologist see eye inside in real time, so that the findings can be interpreted immediately and establish a successful diagnosis. However, the doctor usually write a report describing all changes if any.
The results of an eye examination report will describe all parts of the inside of the eye and its State. The essential parts have to describe are the optic nerve, macula or central area of vision, small blood vessels, and the periphery of the retina. The other structures are usually described only when they are altered.
If the eye examination does not have a diagnostic purpose, but is used for the monitoring of systemic diseases such as diabetes or hypertension, it is often necessary to take photographs that the doctor may be stored on your computer or print at the time, to attach them to your medical history. If it is not possible to take pictures, the description will have to be more precise.
When it is not possible to perform a dilated eye exam you can resort to other techniques depending on what you want to study. An ultrasound of the eye can be to see internal alterations, or for studies of retinal scan of coherence Optics (OCT), which allows to get images of each cell of the retina as if it were a biopsy can be performed.
What is a scan
ScanThe scan is an imaging test - similar to x-rays, computed tomography, magnetic resonance imaging...-, which is very helpful to diagnose certain diseases, mainly some pathologies of the appliance endocrinological, bone, respiratory, and renal, although it can be used almost in any organ of the human body.
The interpretation of the test depends on the body that we want to study and also the suspected diagnosis that you have in mind. The test can be used to detect tumors, ensure the good functioning of a gland, identify failures of blood perfusion, checking the existence of active infections, etc.
The Administration of a radiopharmaceutical that designates the affected parts of the bodies that we want to study is required for its realization. A radiopharmaceutical is a molecule capable of attached to specific proteins and cells. The cells can be inflammatory (designated infection or immune processes), cancer (tumors detected), blood (draws the blood supply) or any other type. Each radiopharmaceutical therefore has a specific role and is different for each organ and suspected diagnosis.
This molecule is attached to a radioactive isotope that emits detectable energy by means of cameras sensitive to radiation. Therefore it is a technique that involves a previous preparation and subsequent care somewhat cumbersome, that makes that this is not done urgently, but it is used in patients or as out-patient study.
While it seems a very innovative practice, the scan is one of the first imaging techniques that have been used in medicine. So the experience in its interpretation is wide and there are a large number of studies on their safety. It is normal that the words 'radioactivity' or 'isotope' thinking that it is a dangerous test, however, the radiation is a natural source of energy and every day we are exposed to radioactive energy that comes from the rocks and soil, mainly. The dose of radioactivity has been much lower years and today the benefits of this test outweigh the risks.
When a scan is doneWe can divide the indications of the scan according to the organs to study with her. In each one there are different uses of this test:
Bone scan:· To detect bone tumors or Metastases of tumours of other organs of the body.
· Identify sources of infection (osteomyelitis, spondylodiscitis, etc.).
· Study of bone pain of unknown causes.
· Rating diseases of bone metabolism: osteoporosis, osteomalacia, Paget's disease, hyperparathyroidism...
· Identify bone fractures when routine radiographs are dubious and are not sufficient to diagnose them.
- Global study of the kidneys when CT cannot be performed with radiocontrast by allergy or severe renal impairment.
- Signs of rejection in transplanted kidney.
- Identify possible kidney damage and scars on children who have reflux vesicoureteral (RVU), which predisposes to repeated infections.
- Study of thyroid: is one of the most common uses of the scan.
- Detect thyroid nodules and guide if they are benign or malignant.
- Study the overall functioning of the thyroid gland, if it is hiperactivada or little working.
- Check the existence of goiter and what their activity.
- Study of adrenal glands:
- Complete study of the adrenal glands when the TAC was not enough.
- Identify a pheochromocytoma, a product derived from the adrenaline-producing tumor.
- Identify a neuroblastoma, a tumor that appears in children of congenital form.
- Evaluation of pulmonary thromboembolism, to check parts of the lungs that lack them blood flow while you get them properly air through the bronchi.
- Study perfusion isolation of specific regions of the body, to identify infection or ischemia.
- Detection of Meckel's Diverticulum, a malformation of the gastrointestinal tract that can produce very far from stomach ulcers in the wall of the small intestine.
- Study of digestive bleeding.
- Evaluation of the liver function and bile ducts associated for the diagnosis of congenital malformations.
- Identify rare intestinal tumors.
- Identify very early episodes of ischemia with exercise.
- Research of nerve pathways of neurotransmitters in the brain.
Preparation for the scanIf you are performing a scan these are issues you must keep in mind to help you prepare for the test:
Duration: the test usually lasts two to three hours, since the administration of the radiopharmaceutical until you can leave the hospital.
Admission: admission is not needed, it can be done on an outpatient basis.
Is necessary to be accompanied?: not, is a painless and not invasive, so you can only attend the clinic and return in the same way.
Drugs: don't need to take any prior medication. You must tell your doctor all the medicines that you eat so that you assess whether to modify any or not.
Food: many times it is recommended to go on fasting to the scan. Ask your doctor when send you the test.
Clothing: is better to go with comfortable clothes at the hospital will be changed by a gown to make it easy to expose part of the body being studied.
Documents: pretest you will be asked to sign informed consent which will explain why it is necessary to perform the scan and the potential risks involved. You only need to carry the health insurance card and the wheel of the test the day you go to do it. Normally you will not you any report of results.
Pregnancy and breast-feeding: the scan is a test fully prohibited during pregnancy, since it implies an exposure to radioactivity. If there is minimal risk of being pregnant you should get a pregnancy test before to dismiss it (even women carrying the IUD should do it). Breastfeeding is also a contraindication for the scan, as 2-3 days after the test it is recommended not to keep close contact with small children, because they are more sensitive to radioactivity.
Contraindications: pregnancy, breastfeeding and allergy to the radiopharmaceutical are absolute contraindications. Other more relative contraindications according to each concrete with renal or hepatic insufficiency, and having another scan the two months prior to the test.
How is the scanWhen you arrive at the clinic to make you a scan, they will call you that passes to a room of nursing where will be administered a radiopharmaceutical intravenously. To spend the radiopharmaceutical to the blood you may notice heat or cold, depends on the supplied molecule. The radiopharmaceutical will be different according to the organ and pathology to study (for example, for the thyroid is the iodine-131 and for infections 67 gallium). Sometimes the radiopharmaceutical may be given by mouth or inhaled form.
You have to wait an hour until the radiopharmaceutical begins to take effect and be able to track the area to study with the camera. Meanwhile, you can go to a dressing room where you will change your clothes for a more comfortable gown and leave your personal belongings. Sometimes you don't need to put on a gown and you can spend with your street clothes and then you here the part of the body wanting to explore you. Sometimes also need to wait that long, it is necessary to track the camera minutes after the administration of the radiopharmaceutical and perform serial during the hour after images.
When you have passed an hour you will be taken to the room where the appliance that performs the scan, you'll see a table or Chair and beside a machine with an arm that can move and head towards the area of the body to study. You will be asked to lean on the table in a specific position according to the area who want to measure. If we study the thyroid you tumbarás you face up to capture the neck area. If you measure the kidneys you are sitting or lying down with an outdoor lumbar back area. Once settled you won't need to worry about anything else, just be relax and remain still.
The sanitary technician will handle the machine and begin measuring the radiation that emits the radiopharmaceutical when it is attached to the cells and proteins. Sometimes not only performs a fixed image of radiation, a video that see the radiopharmaceutical distribution through circulation can be blood or moving the organ to study. This is an important advantage over static such as x-ray or computed tomography Imaging tests.
Throughout this process you won't feel anything. A few minutes later the sanitary technician will tell you that the test has finished and you can already get up from the couch. You can also ask you to wait a few minutes in the waiting room to check that you don't have any dizziness or late adverse reaction to administration of the radiopharmaceutical.
After the test you won't feel anything unusual in the area in which that have measured the radioactivity. You can collect your things from the dressing room and leave the clinic in the same way that you've come. For the next 2-3 days is recommended to avoid contact with young children or people with Hematology, since you emitirás radioactivity that the days will decrease to disappear.
Complications of the scanThe complications of the scan are very similar to other imaging tests that require before administering a substance that allows to visualize organs (such as the intravenous contrast). The most frequent complication is the allergy to the radiopharmaceutical, usually mild allergic reactions and anaphylactic shock is very rare.
To be a test that uses radiation, there is an increased risk of developing tumors in the long run. It should take into account this fact to only put to the test when necessary, though the risk is minimal and the benefits are greater. Indeed, there are studies showing that reduced doses of radiation can reduce the risk to develop tumors, since they eliminate potentially malignant cells.
It is not necessary to use lead radiation shields in any case, since the radiopharmaceutical is delivered intravenously and also reach throughout the body.
Results of the scanThe results of the scan are obtained at the same time make it, but it is necessary a physician specializing in this type of evidence to interpret them. The doctor who is usually responsible for the scan is nuclear medicine specialist, who oversees the test and analyses the results obtained writing a report that will give to the doctor who has commissioned the test (rheumatologist, pulmonologist, endocrinologist, etc).
The results will be interpreted very differently depending on the studied organ and the context of the patient. Some of the more frequent the scan results would be:
Bone scan:· Tumors or metastases: it sees an increase in radiation in the form of more or less defined nodules.
· Infection: is an increased radiation diffuse areas that appears a few minutes after the administration of the radiopharmaceutical.
- Metabolic diseases: there are bone loss and the issuance of global radiation in osteoporosis or osteomalacia. Paget's disease is a bone metabolism, so it will appear areas with radiation increased in size and intensity.
- Fractures: sees an increase in radiation in recent fractures by active inflammation. If they are old fractures radiation may be less by focal bone mass decrease.
- Chronic kidney disease: are the kidney areas that do not emit radiation by fibrosis.
- Vesicoureteral reflux: If there are scars are identified by a decrease in the radiation, sometimes in the form of star.
- Study of thyroid:
- Hiperfuncionantes nodules: is focal increased radiation. They tend to be benign tumors.
- Hipocaptantes nodules: is focal decrease of radiation. They tend to be malignant tumors.
- Hyperthyroidism: increased global radiation. Typical of Graves disease.
- Hypothyroidism: overall decrease of radiation.
- Thyroiditis: absence of radiation on a global basis by destruction of the thyroid gland.
- Study of adrenal glands:
- Pheochromocytoma or neuroblastoma: increased focal radiation. Depending on the age of the patient and the used radiopharmaceutical is suspected one or another tumor.
- Pulmonary embolism: see decrease in the radiation of the areas little perfundidas with a normal ventilation radiation emission.
- Meckel's diverticulum: increased radiation located at a midpoint of the small intestine (near the navel).
- Digestive bleeding: is detected radiation of red blood cells marked within the digestive tract.
- Hepato-Biliary malformation: absence of radiation in the bile ducts.
- Coronary ischemia: decrease of radiation in localized areas of the wall of the heart, are detected by performing moderate physical exercise.
- Research: the traces of radiation emission can be brain nerve pathways of specific molecules.
What is a gas analysis
Gas analysisThe gases is a diagnostic test that is used most often in hospitals and medical emergencies. With it you can know the number of gases that are dissolved in the blood. It consists of collecting a small amount of venous or arterial blood for later analysis in the laboratory. The types of gases according to the source of collection can be divided:
Arterial venous gas: collected blood from one vein either, just as is done when a routine blood test. With this blood gas analysis is not very useful because the blood flowing through the veins always will be poor in oxygen and rich in carbon dioxide, but it is useful to know the blood pH and bicarbonate levels.
Arterial blood gases: collects blood from an artery, usually the radial artery in the wrist. It is somewhat painful, but it is the only blood that allows us to know what is the amount of oxygen that passes into the blood from the lungs. It is the test most used and the only one that allows for the diagnosis of respiratory failure.
With this test can identify situations in which the human body's metabolism is altered, and also check if the situation is so serious as to require intensive treatment in an ICU. Does not involve large costs, injury to the patient is minimal, and the benefits are great.
When an arterial gas becomesThe gases is a test that is very frequently used in medicine because it is a minimally invasive to the patient and can provide lots of useful information. Why it calls routine to detect abnormalities that compromise the level of gases and body metabolism. Some of these situations are:
Respiratory failure: although it could be suspected when a person presents a respiratory failure, can only be diagnosed through an arterial blood gases. Respiratory failure situations can be diverse, some of them would be asthma, COPD, pulmonary fibrosis, acute Lung edema, etc.
Hyperventilation: when a person breathes very quickly and emotionally can eject more than should be carbon dioxide, and blood would have been less. This produces metabolic alterations of calcium (tetany) and blood pH (alkalosis).
Situations of acidosis: venous or arterial gas analysis allows to know the levels of blood pH. There are situations in which the acid levels in blood are too high. Some of the most important are Diabetic Ketoacidosis (you cannot use glucose and ketone bodies are produced) and sepsis (oxygen is not used and it produces lactic acid).
Alterations of renal metabolism: the functioning of the lungs is linked to the kidney. When an arterial gas is disturbed it can mean the alteration of one of the two systems. Bicarbonate which is reabsorbed in the kidney tubules can help guide us in one direction or another.
Preparation for a gas analysisIf you are performing an arterial gas these are the issues that you must take into account:
Duration: takes very little time. The collection of the blood sample consists of a small puncture to remove a small tube of blood.
Entry: admission is not needed, but it should be done in a hospital with adequate asepsis conditions environment, and to carry the sample to the laboratory in less than half an hour. Anyway, it is usually done in patients admitted with neumologicos problems or emergency situations.
Is necessary to be accompanied?: no.
Drugs: is not necessary to take any prior medication. You should tell your doctor all medications you are taking at that time. Some medications can alter the normal characteristics of the gases, as diuretics, for example.
Food: is a test that is not altered by eating in the hours before, so it is not necessary to save fast.
Clothing: don't need a garment special, just to wear sleeves allowing to discover the arm for blood collection.
Documents: it is advisable to carry your health card, but at the time of you gas analysis do not usually ask you for any identification.
Pregnancy and lactation: test can be taken without modifying any attitude. It is better that the doctor knows you are pregnant because the gases may be slightly different.
Contraindications: there are no contraindications.
How a gas analysisWhen you get to the inquiry or to the emergency room doctor will make you some general questions about your state of health (important diseases, risk factors, lifestyle, workplace, etc.), and above all insist the symptoms that have led you to consult. After perform you a general physical examination, and assess the realization of an arterial gas if it believes it may be useful for diagnosis and treatment.
At the same time, a doctor or a nurse shall draw you needed blood for testing. If it is an arterial venous blood from the front of the elbow, as an any blood test should be extracted. But most often, it is necessary to obtain a sample of arterial blood, and so you will have to draw blood the radial artery located on the wrist, or the blood humeral which is on the inner side of the elbow.
First clean the surface of the skin with an antiseptic substance to eliminate germs. After the health will feel the pulse of the artery which want to puncture and when it located puncionará with a sterile needle. It's difficult to make technique and that takes practice. If it is correct, then leaves bright red blood enters the syringe; It tends to fly out because the artery has a high pressure. Prick is rather painful, but when you remove blood from routine. But only lasts a few seconds, so you have to keep calm and hold.
When you are finished collecting the sample they will be placed you at the point of puncture cotton and will ask you that strong pressure for 10-15 minutes. That will let bleeding and prevent the formation of a hematoma. The sample is sent then to the laboratory, where will discuss it with a unit specialized in as. Results, which may be interpreted by the doctor will be in 30-60 minutes.
Complications of arterial gasRarely appear complications when performing a gas analysis. It's a test with little risk, and the few complications that may appear are not serious. Some of them are:
Gases without success: happens with enough frequency that is not able to extract blood from the artery on the first try, even in toilets with experience. When this happens there to repeat it, which produces another prick is painful to the patient, even if they do not increase other risks.
Local infection: whenever you go through the skin the risk of an infection. Today it is very rare to appear, since the antisepsis measures are extreme for the gases.
Hematoma: is common to spill some blood from the artery puncionada to the surrounding tissues. To avoid this is should be compressed the artery for a few minutes after the extraction.
Haemorrhage: it is extremely rare, since the needle that punctures are made points artery is very thin and bleeding is usually self-limiting within minutes.
Gas analysis resultsThe results of the gases consist of a series of values of different blood components that have been analyzed in the laboratory, as with other analytical blood or urine. The values that are studied are:
Partial oxygen (pO2) pressure: analyzes the amount of oxygen that is dissolved in the blood. Normal results vary between 75 mmHg and 100 mmHg. It is considered that a person develops respiratory failure when the pO2 is less than 60 mmHg. You can only be analyzed in arterial blood.
(PCO2) carbon dioxide partial pressure: is to analyze the amount of carbon dioxide dissolved that there is in the blood, as well as with the pO2. Normal results vary between 35 mmHg and 45 mmHg. If the level is low you can indicate respiratory alkalosis; If they are high it may indicate respiratory acidosis. You can only be analyzed in arterial blood.
blood pH: is to analyze the number of protons (H +) that are dissolved in the blood, and which add acidity to plasma. Normal values vary between 7.35 and 7.45. If the pH is lower than the person presents acidosis or acidemia; If it is higher, it will present alkalosis or alcalemia. You can analyze in arterial and venous blood.
Saturation of oxygen (SatO2): Although the pO2 is the method that has been established for diagnosing respiratory failure, sometimes is not the most accurate. It should take into account that the oxygen in the blood is partly dissolved and partly attached to hemoglobin. PO2 analyzes only the dissolved, and to find out the attached to hemoglobin to be studied oxygen saturation. Analysed using studies of light polarized in the blood sample. Normal values are usually between 95-100%, although sometimes above 90% you can be normal. It can be studied only in arterial blood.
Bicarbonate (HCO3): the amount of bicarbonate in the blood depends on the resorption that occurs in the. He is responsible for neutralizing acid in the blood, so it will be increased when there is a situation of acidosis in time, and decreased when a lasting alkalosis. Normal values vary between 22-28 mEq. You can analyze in arterial and venous blood.
What is an upper endoscopy / gastroscopy
Upper endoscopy or gastroscopyThe high digestive endoscopy, also known as gastroscopy, is a medical test used to diagnose and treat diseases of the upper digestive tract, i.e. of the esophagus, stomach, and duodenum.
This is done through an Endoscope, which is a device that consists of a hose of about one centimeter in diameter and slightly more than 100 cm in length. The endoscope is inserted through the mouth and is advanced by all of the upper intestine. Lets you view the inside of the bowel, because it has a video camera on its end, whose image is seen through a monitor.
In addition, endoscope tube has several channels inside where you can enter various instruments, and allow diagnostic testing such as the taking of biopsies, or even perform treatments such as Cauterization of bleeding vessels or the removal of polyps.
When an upper endoscopy is doneThe most common reasons for which you can request the realization of an upper endoscopy or gastroscopy are as follows:
To study problems of the esophagus as esophagitis, narrowing of the esophagus or tumors.
Studying problems of the stomach gastritis, gastric ulcers and tumors.
To study problems of the duodenum as duodenal ulcer.
Diagnose a hiatal hernia or gastroesophageal reflux.
Find the cause of the vomiting up blood (hematemesis).
Before anemias ferropenicas (due to lack of iron), when it is suspected that they are due to chronic blood loss by the upper digestive tract.
The presence of black stools (Melena) that are due to the mixture of feces with digested blood caused by a hemorrhage of the upper intestine.
Find the cause of symptoms such as upper abdominal pain, difficulty swallowing (dysphagia), vomiting, or unexplained weight loss.
In patients with liver cirrhosis, because this disease produces a thickening of veins of the esophagus and stomach. These thickenings are called varices. They have the risk of rupture and bleed, so it can be controlled through the upper endoscopy.
Samples taken to diagnose diseases such as celiac, infection by Helicobacter pylori (a closely related gastroduodenal ulcer bacterium), or digestive tumors.
Provides access to the output of the bile into the duodenum. There a contrast may be injected to draw via biliary and pancreatic and diagnose diseases at this level. This test is called endoscopic retrograde cholangiography.
Therapeutic uses of the gastroscopyIn addition to diagnose digestive diseases, the procedure can be used for therapeutic as in the following cases:
Remove foreign bodies that may have been swallowed and nestled in the upper intestine.
Dilating the esophagus in cases of esophageal narrowing, as that occurs in a disease called achalasia achalasia.
Remove the upper intestine polyps.
Treat digestive bleeding through the Cauterization of the bleeding vessel or ligand varicose veins varices that may bleed.
Unlike colonoscopy, endoscopy in digestive high not is required a special preparation of the digestive tract.
Preparation for an upper endoscopyThese are the issues that you must consider when you undergo an upper endoscopy or gastroscopy:
Duration: test is performed in about 15-30 minutes, although it may take longer depending on the findings, which is, or if it carries out any therapeutic procedure or take biopsies.
Entry: the test can be done on an outpatient basis.
Is necessary to be accompanied?: is usually given a sedative to relax during the test, so it is recommended that someone accompany you to take you home then.
Drugs: is not required any special medication.
Food: is necessary to remain without ingesting water or food for 6-8 hours before the test. This facilitates the exploration of the intestine. In addition, it reduces the possibility of vomiting with the consequent risk of vomiting to enter through the airway and give serious lung problems. It should become an urgent (mainly in cases of major bleeding) endoscopy is usually attach a tube through the nose into the stomach (a nasogastric tube), which will empty the stomach of food scraps.
Clothing: you can wear any clothes you want to but it should be easy to remove, as they will remove it part of the clothing and will facilitate you a hospital gown.
Documents: should be informed consent, which is a role where they explain you what is the test and its potential risks. You should read it carefully and take it signed. You must take the wheel of the test request.
Contraindications: You should not do a gastroscopy in the following cases:
- Intestinal diseases that may worsen with the completion of the test as a perforation of the upper intestine, recent intestinal surgery, etc.
- Serious or "unstable" patients with significant hypotension, respiratory failure, serious arrhythmias, etc.
- Pregnancy is a relative contraindication.
- Diseases that limit the mobility of the neck and preclude the introduction of the endoscope as severe cervical scoliosis
- Serious blood clotting problems.
Other considerations on gastroscopyYou must tell your doctor if you have allergies to medications, particularly to anaesthetics.
If you are taking aspirin, NSAIDs, or iron supplements may indicate you to stop taking them the 7-14 days prior to the test. This must be that aspirin and anti-inflammatory drugs would facilitate the bleeding where necessary take a biopsy or remove a polyp, and iron sticks on the wall of the intestine and hinders their exploration. The doctor will instruct you when to resume this medication.
If you are taking anticoagulants, it is very important to warn the doctor, then it will be necessary to temporarily stop them. The doctor will give you instructions in this sense depending on the anticoagulant that take.
You must also tell if you've had a test with contrast of the upper intestine in two days prior to the test. Barium used as contrast can remain in the intestine and make it difficult to scan.
You must not take the day of the test, antacid or sucralfate because they interfere with the correct visualization of the upper intestine.
How the high digestive endoscopyEndoscopy digestive signup or gastroscopy is usually done a medical specialist in digestive system, along with an Assistant who may be nursing staff. Initially, they will tell you to undress from the waist up and put on a hospital gown. It will pick up a vein in the arm. There you can pass a drug that will make you to be relaxed and drowsy during the test. It is possible to then not remember much about the procedure.
You will have a device in the mouth to prevent it closing it and damage to the teeth with the endoscope. It is usually given an anesthetic spray in the mouth and throat to lessen the discomfort and facilitate the introduction of the endoscope. They defeated him on a stretcher on the left side and then the doctor will proceed to introduce the endoscope previously lubricated by the mouth. You will be asked to swallow to facilitate its passage through the pharynx and will to progress to the duodenum. We must try not to swallow during the procedure unless directed him to do so. The saliva that can form in the mouth will be sucked by the wizard using a small vacuum cleaner tube. In an attached screen the doctor can see the entire surface of the upper intestine with clarity. During the test, you may be asked to change position to facilitate the movement of the endoscope.
The doctor has tools such as microtweezers, capsula, etc., that you can get the channels that has the endoscope, and that allow you to perform some diagnostic or therapeutic procedures. For example, can suck secretions, take a biopsy, removing a polyp coagulate bleeding, remove a body odd, etc.
After all this, the endoscope carefully take and leave him 1-2 hours under observation in an enclosed room until it recovers the sedative effect. As an anesthetic throat have applied you, it is necessary not to eat or drink until you pass the effect of anesthesia. Otherwise it could happen that food was by the respiratory route. It is recommended that you do not drive or operate dangerous machinery during the 12 hours following the test. Your doctor will instruct you when you can eat normally and restart normal activities. This depends on the procedure that have yet done you and medication which provided him.
Complications of the upper endoscopyThe upper endoscopy or gastroscopy is a very safe test. It is also rare to have side effects from drugs that can be administered as sedatives. The anesthetic spray that will have in the throat knows something bitter and makes you feel tingling and swelling in the throat and tongue.
Some people notice shortness of breath following the introduction of the endoscope through the mouth, but due to the anesthesia of the throat. Don't worry, as there is sufficient space around the endoscope as to which you breathe normally. It is important to stay calm and make slow, deep breaths. One can notice some discomfort such as nausea, abdominal cramps or gas while the procedure is done. If you notice any significant discomfort can be noted the doctor giving him a small hit in the arm or with any previously agreed signal.
After the procedure you will feel drowsy for a few hours, and is likely to not remember much of what happened. You may also notice abdominal bloating and gas, which will go out little by little. You may notice some discomfort in the throat for a few days. If you've had a biopsy or have had your a polyp removed, you can see that the stool is black for a few days to be mixed with traces of blood.
It is very rare that there is a serious complication for an upper endoscopy. In rare cases the procedure can cause cardiac arrhythmias. Sometimes, the endoscope can damage the surface of the mucosa and cause bleeding. If vomiting occurs during the test, there is a risk that part of it will be by the respiratory route and originate a pneumonia. This event requires treatment with antibiotics. Some cases of punctures of the intestine with the endoscope, have been which is a completely exceptional circumstance. This complication requires to be repaired by surgical treatment.
If after the test Note chest pain, shortness of breath, fever, severe dizziness, or any other symptom that worries you, should immediately contact their doctor. It must also consult urgently if you vomit blood, whether it is fresh red blood - which indicates that it is a hemorrhage recently-, as blood-like "coffee grounds", which indicates that it is blood that it takes a while in the intestine.
The high digestive endoscopy resultsDuring gastroscopy or upper endoscopy the surface of the intestine, is seen with what your doctor can diagnose many diseases directly. It is possible that later you any results the day of the test. The specialist will make a written report that will give you a few days of the test, possibly along with some photos of possible pathological as ulcers or polyps findings.
When biopsies have been taken, the samples will be studied under a microscope by a pathologist and a report will be made separately with this result. You can also that you have caught samples for microbiological study of possible intestinal infections. This will result in a third report by a specialist in microbiology. All these results may take several weeks to be available.
The report of the result of the high digestive endoscopy will include data on the quality of the preparation of the bowel, where has been reached with the endoscope, medication that has been given him, and possible eventualities that have occurred during the test. Describe the appearance of the bowel and possible pathologies such as polyps, diverticula, tumors, ulcers, bleeding, inflammation, etc. Specify possible diagnostic or therapeutic procedures that have been made, like biopsies or removal of polyps, and to which lab extracted samples have been sent. The report will be completed in a few weeks with the results of these samples.
It is advisable to go to pick up the result and not assume everything is normal because the results you are not delivered in a few weeks. The doctor has asked the test will give you the results and will instruct you to need to make other complementary examinations or treatment.
What is the hysterosalpingography
HysterosalpingographyHysterosalpingography is a technique based on the x-ray that allows to study the internal shape of the uterus and fallopian tubes. Is commonly used to verify that the fallopian tubes are not blocked and to see if there are abnormalities in the shape of the uterine cavity.
Some of its uses has been displaced by ultrasound or the ureteroscopy (enter through the cervix a small camera), although it is still essential for the study of sterility and other gynecological diseases, since he studied in a simple way the patency of the fallopian tubes.
This test was invented in 1914 by Dr. Carey. At the beginning of fatty radiopaque dye that was useful for testing was used, but the risk of fat embolism and allergic reactions was much higher than that which exists with the media used today. Hysterosalpingography is still a test routine in all hospitals, they manage to make a week hundreds of them in a tertiary hospital.
It is not a risk-free trial, but it is very rare that there are serious complications, so that the benefit of test predominates over the risks. Today, this is done in a few minutes and is neither necessary nor income hospital or anesthesia. Your own gynecologist can interpret the results, although sometimes a radiologist can provide help for a full diagnosis.
When doing a hysterosalpingographyA hysterosalpingogram is done when it wants to study the interior of the female genital tract by any of these problems:
Sterility: is an essential in any study of sterility test. With it you can know if the fallopian tubes are open to receive the egg produced by each one of the ovaries.
Uterine malformation: uterine SEPTA, bicornuate Uteri or Rokitansky malformation can be diagnosed with this test.
Tubal ligation operation check: after performing this surgery, sometimes are asked to perform this test to make sure that the tubes are properly locked.
Uterine polyps and other tumors: the hysterosalpingogram can help identify benign and malignant tumors of the uterine endometrium.
Asherman syndrome: consists of the disappearance of the uterine cavity when sticking their walls each other after a surgery or curettage.
Preparing for hysterosalpingographyIf you are performing a hysterosalpingography these are the issues that you must take into account:
Duration: hysterosalpingography lasts a few minutes. Normally you will be in the hospital a couple of hours while waiting, prepare yourself for the test and is performed.
Income: the hysterosalpingogram can be done on an outpatient basis. You can put yourself to the test and go your home a little while.
Is necessary to be accompanied?: Yes, it is recommended to take a companion if any complications occur during the development of the test. However, it is not a test that limits the person once. It is normal that you can drive and go home by your own foot after.
Drugs: don't need to take any prior medication. Should be communicated to the doctor all the medicines taken regularly and will decide which suspend or maintain. Sometimes the doctor will prescribe you an antibiotic and a painkiller to take before the test, but will assess these medications according to each person.
Food: it is not necessary to remain in fasting prior to testing. You can drink all you want but he is not recommended to take coffee, alcohol or beverages exciting hours before the test to avoid being nervous and have muscle tension.
Clothing: can keep the appointment with the gynecologist with the same clothes every day. For the test you will be prompted that you take off your pants or skirt, and underwear.
Documents: is advisable to take the medical history on the gynecological diseases, if you have them. Although the doctor will already have it with him. Before undergoing the test you will sign the informed consent with which you agree to make yourself the technique and you will know the potential risks, which are very uncommon.
Pregnancy and breast-feeding: hysterosalpingography is absolutely contraindicated in these situations. If there is a minimal chance of being pregnant you should not submit to this test. Usually the doctor carried out a pregnancy test.
Breastfeeding does not imply a direct contraindication, but it is better to avoid the test until the end the period of breast feeding, since its usefulness focuses on the study of sterility.
Contraindications: the pregnancy would be the first absolute contrindicacion to perform this test. You should not be if you have a genital infectious process, such as pelvic inflammatory disease, or vaginal bleeding prior to test day.
How hysterosalpingographyWhen making a hysterosalpingogram, firstly, will ask you if you're in agreement with put yourself to the test and you will be asked to sign the informed consent where you will read what is the test. That day may make you the proof, but most often is that you cite so that you submit to hysterosalpingography another day.
The day you have proof you don't have why change your routine. Just take the antibiotic and painkillers if the gynecologist prescribed you before. The best is that you go not nerve to the test, will last only a few minutes. Attempts to get some before the agreed time, it is best that you wait a bit in the hospital before that get quickly and stressed.
To perform the test ask you first to tumbes in the gynecological position, i.e., naked from the waist down and with her legs open so the doctor can properly explore the vulva. The first thing you will do is insert a Speculum through the vagina to visualize the cervix, which is the entrance into the uterine cavity. Sometimes at the moment anesthetized the entrance of the cervix with a small pinch of local anesthesia which is a bit annoying, but often prefers to not anesthetize since the test does not involve pain.
Stun or not, a small plastic tube is inserted through the cervix. At the end of the tube there is a ball of plastic that swells tube is not out of the uterine cavity. Once, put you next to an x-ray machine and begin to introduce a substance inside the uterine cavity. This substance is a means of radiopaque contrast, i.e., can be viewed on an x-ray. You should not feel pain when you enter the contrast medium, if it hurts is often due to any alteration of the uterus that does not pass the contrast medium.
Several x-rays to get a proper image will be. You may be asked to change your position in order to improve the image. It is essential that you notice the contrast dye flows out through the fallopian tubes into the abdominal cavity.
Achieved once ideal image checks out you tube placed through the cervix and will be able to get dressed. You won't have to wait for the results, the gynaecologist usually save them to study them and evaluate them alongside the rest of tests in another query.
Complications of hysterosalpingographyHysterosalpingography complications are very rare. And which occur most often have little relevance and can be easily resolved. Some that occur occasionally are:
- Discomfort, nausea and vomiting.
- Fainting and loss of consciousness.
- Cramping and abdominal pain.
- Vaginal bleeding due to small injuries.
- Pelvic infection with fever and chills.
- Allergy to contrast dye.
- Other serious and extremely uncommon complications (embolisms, uterine perforation...).
Results of hysterosalpingographyNothing else made the hysterosalpingography you can see the same data. However, slight alterations of the test may be misinterpreted and that it is better that gynecologist carefully study them and assess them in relation to the rest of the evidence that you made.
It is normal a few days after the test have a consultation with the gynaecologist. There, it will tell you is the result of hysterosalpingography and communicate a diagnosis and treatment if the test has been altered and is final.
Display an oval accumulation of contrast medium, which is the uterine cavity, with two thin lines coming out of its top, the ducts of the fallopian tube in hysterosalpingography image. Under normal conditions the contrast medium will pass through these ducts and would be as spilled into the inside of the abdominal cavity.
What is a holter
HolterThe holter is an instrument that is used to record the electrical activity of the heart for several hours. Also called holter-ecg or holter monitor. The main advantage presenting this device is to make a record of your heart rate for a long time, since a routine electrocardiogram only allows us to know what is the cardiac electrical circuit at that time and we do not know whether before or after it was altered.
The name of this test is because Norman Holter, an American physicist from the beginning of the 20th century that focused his studies in the field of Biophysics. The development a monitor light, the size of a Briefcase, easily transportable and with the ability to write a continuous recording of the heart rate. Before this invention, electrocardiograms were occupying an exclusive hospital room and required much time and previous preparation. During the rest of the 20th century the holter has been improved, making it more lightweight and smaller, and with a digital record that facilitates their realization to the patient and the doctor.
This appliance only measure the activity of electrocardiography, heart and breathing ratecan be. It is not usual that blood pressure should be measured at the same time. At night, the holter can be complemented with other devices that measure the oxygen saturation in blood, among other parameters, as is done in polysomnography.
It is a test that is not excessive spending, but has a difficult to interpret, so must be carried out by experts and only when you go to be useful to determine a diagnosis or adjust a treatment. Can be performed on an outpatient basis, in a way that does not interrupt the daily routine of the patient too, you just have to pick up and deliver in the hospital or clinic usual holter. Today it is a test that is performed daily in many hospitals, even in children.
When doing a holterPerform a holter is useful when certain situations occur or are suspected the following diseases:
Fainting or syncope recurrence: Although an isolated fainting is not cause for concern, when they recur spontaneously and suspect that the cause is cardiac, a holter can help to find out what type of cardiac alterations there are basic.
Palpitations: sensation that the heart beats faster than normal, or printing note beats in the neck, can be signs of arrhythmias in people of a certain age. If it is an intermittent sense, a holter can identify alterations throughout day.
After a heart attack: depending on how the heart attack has been (extension, gravity, involvement of electrical pathways, etc.) you can tell the realization of a holter to timely detect electrical alterations that may be fatal.
Study of arrhythmias: Although the cardiac arrhythmia is known, a holter study can help identify what triggers it, its duration and classify them in specific types (locks, supraventricular tachycardia, atrial fibrillation...).
Study of cardiomyopathies: cardiomyopathies are diseases of the own heart muscle infarction and arrhythmias independent reasons. However, they may be in themselves cause of arrhythmias and holter can identify them, even if they do not give symptoms.
Monitor treatment with drugs: many of cardiological drug treatments require verification of its effects on the electrical rhythm of the heart throughout the day.
Preparation for holterIf they are going to perform a holter these are the issues you should keep in mind to go well prepared for the test:
Duration: holter lasts almost always 24 hours. To perform throughout the day is not a waste of time very important the person who completes you, because you can take your life without alterations. The only extra time would be the collection and delivery of the device after the test.
Income: holter outpatients can be performed at home and you can make a normal during those hours life, although it is not recommended to carry out an intense physical exercise after the completion of the test.
Is necessary to be accompanied?: is not necessary to be accompanied. During the day you can go back home or go to work directly.
Drugs: don't need to take any prior medication. Should be communicated to the doctor all the medicines taken regularly and will decide which suspend or maintain, especially if you take drugs for epilepsy, psychiatric illnesses, antiarrhythmics, relaxing muscle or have received anesthesia the previous days for any reason.
Food: there is no why stay in fasting prior to testing or after. A light dinner is recommended to sleep at ease and avoid taking all day coffee, alcohol and other exciting substances, including also the day prior to the test.
Clothes: you can use the same clothes every day. That Yes, we recommend showering before placing the holter, since during the test you can not bathe or shower. During the 24 hours that last test you should avoid approaching electromagnetic areas and devices of that type: power stations, electric blankets, MRIs, blood pressure monitors, detectors of metals...
Documents: is essential to take with you the steering wheel which shows the performance of this test, as well as the card. Normally you will not you any document after the test because it takes time to analyze them.
Pregnancy and breast-feeding: holter is not contraindicated in pregnancy or lactation, although Yes it is you need to know if you are in that State because some biological constants that are studied will be altered from itself during these stages.
Contraindications: holter does not have any specific contraindication.
How the holterFirst, the doctor will assess if it may be useful to perform the holter in your home. Most of the times is a 24-hour holter, although there are special situations where you can indicate perform a holter for less or more hours.
One will quote you one day to pick up the device and they explain the basic measures that you need to know to put you to the test. The best thing is that you get to the hospital early, to arrive at time of pick up the device and perform a daily activity daily the rest of the day, since it is not necessary for you to change your habits the day of the test. Only be recommended not to take from the day before coffee, alcohol and beverages exciting. Avoid any stressful activity plan the day you go to perform the holter, even moderate sport (such as running or make bike). It is only intended to perform this type of exercise if symptoms studied appear during the same and are not serious symptoms.
At the Medical Center, will be placed you a series of sensors in the skin of the chest, which will lead into a small device that collects electric data. If you're allergic to the adhesive bandage or any substance used to set the sensors you must communicate this previously. Today there are hölters which are a simple tape that surrounds the chest, without any wires or loose sensors. After it you will see that all sensors work and properly capture the electrical measurements of the heart.
Once placed all sensors you can be a normal everyday life, without great effort or large excesses. The food should be light, it must ensure a good night's sleep and is recommended. Overnight does not you'll notice that carry the device. You'll sleep like you any night.
The next morning to attend to the Medical Center and they will help you to remove all sensors with acetone, diluting the glue. Should you not stay to wait for results, as the doctor should carefully study your holter data. Some modern holter sent by computer the results of the study directly, even there are fixed hölters accompanied by simultaneous pacemaker.
Complications of holterThe holter is a completely safe test, which does not represent any risk for people who perform it. The only complication that is known of her is that some of the sensors that are stuck to the skin can irritate it in especially sensitive people, something not very common.
A holter can never alter the heart rate, since it is not able to emit electric shocks and the sensors are placed on the surface of the skin.
The only cases of complications related to the holter are due to a bad use of the same, especially when the patient who carries it decides to take a shower or bathe. In the end it is an electrical device which must not get wet.
The holter resultsThroughout the day the sensors capture the electrical activity of the heart and are stored in a digital record. At the same time that the test you can see these measurements if the holter is a model of high-tech, but it is virtually impossible to analyze them because it takes time and dedication to study all the components at the same time, moreover, is only useful in complex and serious heart disease patients.
The holter registration consists of the drawing of the electric pace. As in the electrocardiogram, a line appears with several waves and peaks that are a reflection of the electrical activity of the heart. There are three groups of waves that are repeated in every heartbeat: P wave (showing the contraction of the Atria), the QRS wave (which designates the contraction of the ventricle) and T-wave (where the heart relaxes and readies for another heartbeat). This path is drawn on a grid to help measure the duration of each wave and the distance between them.
You can go to pick up the medical specialist who sent you the test, holter results normally is a cardiologist. On that date it explain the alterations that have been throughout the study. Maybe that changes electrical rhythm that are related or not with the cardiac or respiratory frequency should be observed. As a result of the results the doctor will propose possible solutions. For example, an increase in heart rate may relate to a change in QRS waves and therefore I would point out a fault of the contraction of the ventricles. Following the results the doctor will propose possible solutions that can consist of medication or the realization of a catheterization.
What is laparoscopy
LaparoscopyLaparoscopy is a surgical technique that allows to see inside the abdomen to establish a diagnosis and is also used to perform an operation. This small incisuras are made in the abdominal wall, and through them, put cameras, clips, knives and other very small devices that allow you to manipulate the internal viscera without having to open the abdomen. Laparoscopy is considered a technique of minimally invasive surgery, arthroscopy, and eRCP, neuroendoscopy, among others. Despite this, it remains a surgical operation, so it should be in an aseptic surgery and general anesthesia.
The first laparoscopic were practised by Dr Heinz Kalk in the first half of the 20th century. This surgeon published more than 2,000 studies of diagnostic laparoscopies with very good results. Gradually more techniques were done through laparoscopy, such as biopsy or minimal interventions, until in 1977 in Holland the first extraction of Appendix by laparoscopy. Almost at the same time, the Argentine Dr Aldo Kleiman performs extractions of the gallbladder (cholecystectomy) by laparoscopy, but do not find any support in his native country, where to reject it. In Spain, the first laparoscopic cholecystectomy was performed in 1990 at the San Carlos Hospital in Madrid by the Dra Vincent, and soon spread to the rest of public hospitals. A year later, in 1991, American doctors Jacobs and Plasencia published the first operations in the world of colon cancer by laparoscopy.
Minimally invasive techniques such as laparoscopy have allowed that postoperative patients is shorter and less painful, so you do not need to take so many pills for pain and hospitals saves costs to be the shorter hospital stay. They also reduced the number of infections in the postoperative period.
When a laparoscopy is doneLaparoscopy, as we have explained, can be done to establish a diagnosis, or as surgical treatment of a disease. Why are distinguished several types of laparoscopic, carried out as it is indicated in each case:
Exploratory or diagnostic laparoscopyServes to directly observe the abdominal viscera, such as the small intestine, the large intestine, stomach, etc. In this type of laparoscopic is does not operate anything, and they are only used in order to determine a diagnosis then used to indicate treatment. Usually when do Imaging tests (CT, ultrasound...) have not been useful or not they have been able to perform, or also when it is necessary to take biopsies of digestive or gynecological tumors. Some of the diseases where it is more frequent that indicated a diagnostic laparoscopy are:
- Pictures of acute abdominal pain without a clear cause.
- Adhesions and bowel flanges.
- Spills and intestinal infarction.
- Hidden hernias and eventrations.
- Pelvic inflammatory disease, endometriosis, ectopic pregnancy, and other gynecological conditions that can be mistaken for appendicitis.
Surgical laparoscopyThis is laparoscopy that has developed in recent years, and increasingly complicated surgical operations can be performed with it. Diseases that can be treated through laparoscopic techniques most frequently are:
- Hiatal hernia.
- Cholelithiasis, cholecystitis and other diseases of the gallbladder.
- Intestinal obstructions.
- Hernias and eventrations in the abdominal wall.
- Acute appendicitis.
- Acute abdomen.
- Tumors of the colon and rectum, both benign and malignant.
- Multitude of gynecological diseases: endometriosis, ovarian cysts, tubal ligation, pregnancy ectopic, urinary incontinence, uterine and bladder prolapse, fibroids, uterus extractions, etc.
Experimental laparoscopyIt is named to the laparoscopic in which surgical techniques are practiced for the first time to check if it is possible in the future. First, they are made in animals, such as pork, and later in very selected people. One of the techniques that is being investigated in recent years is the surgery NOTES, a laparoscopic technique through natural orifices such as the navel or the vagina.
Laparoscopy is doneTo perform a laparoscopy, first you anestesiarán so that you don't feel any pain throughout the procedure. Anesthesia tends to be general, so you'll be unconscious; in few cases it is performed with local anesthesia. Then be disinfected all of the abdominal wall and will be covered with a surgical sheet which limited the area of the abdomen that is operated.
The surgeon will make three incisuras in the abdominal wall that will introduce camera, gas, and other instruments such as tweezers or scalpels. The camera allows you to see the inside of the abdomen (controls it a second surgeon) and the gas which is introduced for the abdomen bulge is carbon dioxide because it is not flammable when the electrical scalpel is used, and it can be easily removed. Each incision must be well separated from the other two so that the instruments do not strike each other to move inside the abdomen.
The instruments used in laparoscopy are very varied: tweezers, scalpel, punches, sutures, etc. With them, the surgeon manipulates the inside of the abdomen and seeks to solve the problem. Throughout the procedure is recorded on video so the doctor can get back to see her, and also so that others can learn. If we had to remove a piece from the inside of the abdomen can be put in plastic bags, which are then removed through one major incisura.
When the intervention is finished all the instruments are removed and the incisions are closed with simple points, which are covered with bandages or dressings.
Preparation for laparoscopyIf they are going to perform a laparoscopy, these are issues that you must consider when ready to test:
Duration: laparoscopy has a variable duration according to the surgical technique that is going to be done. It can take from a few hours (resections of Appendix, repair hernias, etc.), up to a whole morning or afternoon (solve intestinal obstructions or resection of tumors).
Entry: laparoscopy usually requires hospital admission the night before the operation. Later, the postoperative can be extended about three or four days, but if all goes well it will not arrive a week as a general rule. If laparoscopy has only been exploratory you can get discharged within 24 hours.
Is necessary to be accompanied?: Yes, is recommended. After the laparoscopy must not make efforts, and you may need help to go to the bathroom or merge. When you receive the high it is not recommended that you drive any vehicle, especially if the laparoscopy done before 24 hours approximately.
Drugs: is not necessary to take any prior medication. Must be communicated to the doctor all the medicines taken regularly, and will decide which suspend or maintain. You should avoid taking medications that hamper the clotting of blood two weeks prior to laparoscopy, such as aspirin, ibuprofen and other NSAIDs.
Food: must remain in fasting from the eight hours before the laparoscopy. If you need to take any medication, take the pills with a small SIP of water.
Clothing: once the street clothes enters hospital is changed by a gown more comfortable and suitable for the operating room. Clothing is recommended for sleep and comfortable footwear for the entry.
Documents: is advisable to take the medical history about the disease is going to intervene, although the doctor will already have it. Before you undergo the intervention you will sign the informed consent, which you agree to make yourself the technique and you will know the potential risks.
Contraindications: main contraindication is having an once in a lifetime to abdominal surgery, laparoscopy or not, because when the abdomen is always operated internal viscera rozan and form ties between them, i.e. fibrous scars that unite the intestines and other internal organs together making it difficult to separate them, which complicates their manipulation in laparoscopy. Another contraindication would be urgent situations in which there is no time to prepare a laparoscopy.
Pregnancy and lactation: laparoscopy should be limited to the second trimester of pregnancy when necessary; in very urgent situations can be at any time, although the risk of pregnancy is higher. There is nothing that contraindicated laparoscopy during lactation, although the postoperative period and the hospital admission may hinder breastfeeding schedule.
Complications of laparoscopyLaparoscopy is a safe and widely used technique today, but it is not without risk, as with any surgical operation. The complications which arise most frequently are:
Bleeding from the cuts by poor healing.
Hernias or eventrations through the incisions.
In the postoperative surgical wound infections; take antibiotics before operation prevents them to a large extent. In extreme situations infection can be on the inside of the abdomen and cause a peritonitis.
Injury during operation of arteries, veins, intestines, stomach, ureters or other abdominal viscera. This complication requires to open the abdomen immediately via laparotomy.
Problems caused by general anaesthesia, as happens in other procedures.
Results of laparoscopyLaparoscopy results tend to be very good, since the recovery of such interventions is much more rapid, painless and grateful that when operating the abdomen by opening it with a wide incision directly.
When you wake up from the anesthesia you're drowsy, and you can have nausea. A few hours stop feel as well and you can recover your normal life in a few days. It is also likely that abdominal incisions painful, especially to make efforts such as coughing, so it is advisable to take the painkillers the doctor you.
It is usual that the abdomen is slightly distended because some gas is always inside after the laparoscopy. You can put pressure on the bladder, thus increasing urination, and you can also press to the liver or diaphragm, causing pain in the shoulders. If the intestines have operated is often recommended fasting for a variable time until they return to work properly.
In case of a diagnostic laparoscopy the doctor can communicate its outcome shortly after completing it, unless you have to wait for the analysis of biological samples such as biopsies.
A few days of the intervention you cite in the hospital or the clinic to check abdominal incisions to heal properly.
What is laryngoscopy
LaryngoscopyLaryngoscopy is a technique that allows to observe the interior of the pharynx and the upper part of the larynx. This test allows us to study the interior of the upper airway, and also allows other procedures more invasive, as biopsies, surgeries little invasive and intubation of the airway in people unconscious or anesthetized. The specialist that used this technique is the Otolaryngologist, though also used by anaesthetists and the intensivists.
The pharynx has three parts: the nasopharynx (just behind the nose), Oropharynx (in the background of the mouth), and the hypopharynx (which connects to the esophagus and the airway). Laryngoscope, which is called the unit that held the laryngoscopy, allows to observe the three parts and the upper part of the larynx, where in addition the vocal cords will be.
Since there is this technique have been developed different laryngoscopes, that are used today are:
Indirect laryngoscope: is a rigid bar that is inserted through the mouth until the end of the language. In the end you have a mirror which reflects the upper part of the larynx and hypopharynx. Only allows the display, other procedures are not performed with him.
Rigid direct laryngoscope: consists of a small rigid joystick that is inserted through the mouth and move the tongue forward, in such a way that the larynx can be seen directly at a glance. It is a technique that requires that the person is unconscious or anesthetized, since it would be extremely upset if not. It is the instrument that most Anesthetists and the medical intensivists, used since it allows them to intubate the Airways.
Flexible direct laryngoscope or fibrolaringosopio: is the most widely used routinely in conscious people. It is a small flexible tube containing optical fibers with a camera on the end. It is inserted through the nose and pharynx up to lower part flows through.
When a laryngoscopy is madeLaryngoscopy is a useful technique in the following situations or health problems:
Study of chronic throat pain: laryngoscopy serves to identify lesions which can cause sore throat for more than three weeks and does not respond to standard medical treatment.
Alterations of voice: can diagnose diseases of vocal cords. Before for this purpose, you must wait three weeks because in many cases are transitory laryngitis that do not require study.
Chronic cough: when a person begins to cough for more than three weeks or habitual cough changes shape, should be studied to verify that no alterations in the upper airway.
Suspicion of cancer: laryngoscopy can observe if there are tumors of the Airways above, very frequent in smokers.
Choking: confirms the blocking of foreign elements upper airway. Sometimes it allows you to reach them and pull them.
Difficulty swallowing: this test allows to discard physical injuries that hamper the action of swallowing. You can see live the movement of the pharyngeal muscles.
Taken from biopsies: suspicious masses of cancer, polyps of vocal cords or chronic ulcers, you can take samples with a small pair of tweezers or needle.
The airway intubation: anaesthetists and intensivists doctors used the laryngoscope in people unconscious to observe the upper airway and to introduce a hollow tube that allows to ventilate the patient and keep your breathing artificially.
How laryngoscopyFirst, the doctor will assess if it may be useful to perform the laryngoscopy. If so one day one will quote you to carry it out or you will be at that time. The day of the test must carry out a normal life, and you can eat or drink just before the procedure. When you arrive at the clinic they ask you that you sit in a Chair and relax.
When you are comfortable you will introduce you a thin, flexible tube through one of the nostrils. When ask you that you finish as if you were drinking a drink of water. You will notice a strange feeling, as if you had some food into the throat. Despite this does not tend to feel strong nausea and it is very rare that des arcades. The best is to be relaxed and keep a regular and rhythmic breathing.
Once inside the Otolaryngologist will see inside the walls of the pharynx. It will look for alterations or malformations. Then be set at the top of the larynx made the same observations, and will focus on the vocal cords. Maybe calling you that you speak, you make a high-pitched sound and some serious. Thus the vocal cords move and you can see if there is any paralysis or injury (polyps, ulcers, edema...).
It will then leave the fibrolaringoscopio without stopping in more observations. If it is necessary to perform some procedure, the doctor will decide if hacelro at the same time or quote you for another day. It depends on the urgency of the same and if necessary suspend any medication before.
In the case of the direct laringoscopias, you'll be anesthetized or unconscious, so it does not you will notice nothing. When you recover the knowledge it is frequent that notes any discomfort in the throat or any alteration in the voice. The culprit is usually the laryngoscopy itself, but of the airway intubation.
Complications of laryngoscopyLaryngoscopy tends not to have complications. However, some of the problems that can occur are:
- Nausea with or without vomiting.
- Injury with bleeding from the tongue, nose, pharynx or larynx.
- Transmission of infections, especially if there has been an injury before.
- Spasm of the vocal cords, which can be closed when that region of the airway is handled.
- Typical complications of anesthesia (allergy, arrhythmias, etc.) when used for intubation.
Preparation for laryngoscopyLet's focus on direct flexible laryngoscopy or fibrolaringoscopia, since it is the most common procedure in a consultation to explain the preparation of laryngoscopy. Rigid direct laryngoscopy is used in emergencies (without preparation) or to carry out Surgery Anesthesia (for which the preparation for this test would be the surgery).
If they are going to perform a fibrolaringoscopia these are the issues you should keep in mind to go well prepared to test:
Duration: the test lasts a short time. Less than five minutes may be sufficient. In the case of some procedure (biopsies, aspirates, extraction of foreign elements, etc) the duration may be higher, but normally not exceed half an hour, because more time would be annoying.
Income: the fibrolaringoscopia can be done in a clinic or in a hospital. Income is not necessary.
Is necessary to be accompanied?: do not need to be accompanied. It is a little annoying and low risk test. Although if they are going to perform some procedure it may be good idea to have someone accompany you to go more quiet.
Drugs: don't need to take any prior medication. Should be communicated to the doctor all the medicines taken regularly and will decide which suspend or maintain, especially if you take antiplatelet drugs (aspirin, ibuprofen...) or anticoagulants (acenocoumarol, dabigatran) that may hinder the taking of biopsies.
Food: it is not necessary to remain in fasting hours before the test or after. Nausea that causes the fibrolaringoscopia they are minimal, but it is prudent to not have eaten just before the test case. In the case of the laringoscopias rigid if it is necessary to stay in fasting, as requested before a surgery.
Clothes: you can go to the quote from the test with the same clothes every day.
Documents: is essential to bring with you the steering wheel which shows the performance of this test. The health insurance card is recommended. After the laryngoscopy deliver you a report, but if they have collected samples they will take a time to analyse them.
Pregnancy and lactation: this technique is not contraindicated in pregnancy or lactation.
Contraindications: laryngoscopy does not have any specific contraindication. In people with anatomical disorders of the nose or pharynx may be difficult to perform this test.
Results of the laringosocopiaDuring laryngoscopy the doctor will go watching injuries and disorders of the upper airway. At the same time you can perform Diagnostics with enough safety, since there are very typical alterations that are identified with the naked eye. At other times you will need to perform any test sample (biopsy, crops...) to confirm the diagnosis.
All the results of the laryngoscopy will write them in a report that you can make at the end of the consultation and surrender in hand, or if it is extensive may prefer to write it calmly and send it to you or the doctor who has asked you to test. When there is outstanding evidence it will wait for results to give a definitive diagnosis. In this report you can also include photos that you have made during the test, something very useful when it is necessary to track if you change known lesions.
When you pick up the report, the doctor will explain the alterations that have been throughout the study. Following the results, it will propose more testing if he deems it necessary or will provide possible solutions to the problem you have, whether medical or surgical interventions.