- What is the Endoscopic Retrograde Cholangiopancreatography (Ercp)
- What is the sputum culture
- What is the Mantoux
- What is the Otoscopy
- What is the sigmoidoscopy
- What is the thoracoscopy
- What is Urography
What is Endoscopic Retrograde Cholangiopancreatography (Ercp)Endoscopic Retrograde Cholangiopancreatography, better known simply by his acronym ERCP, is a medical technique that exists since the end of the 1960's. Combines endoscopy and Radiology: on the one hand an endoscope is introduced from the mouth to the highest parts of the digestive tract and the technique by injection of contrast which is detected through x-rays, as it happens in the catheterization is controlled by another.
The endoscope used is more complex than that used for the gastroscopias or colonoscopies. It has a side camera, allows the injection of substances and at its end has different endings getting to perform complex techniques avoid surgeries of the digestive system. It is mainly used to solve problems of the bile, as gallstones, but they are also used for diseases of the pancreas and to address surgical complications.
The doctor who performs this technique is the gastroenterologist, the specialist in the digestive tract. He decides whether it is worth conducting the test based on previous data such as medical history and imaging (ultrasound, CT scan, etc). To undergo the test the patient will be slightly sedated, avoiding deep anesthesia and its risks. It may be somewhat uncomfortable, but never painful.
ERCP complications are rare. The most common are mild gastrointestinal upset and that can be solved on their own hours after undergoing the technique. Other more serious, such as intestinal perforation, are uncommon and require emergency surgery. Thank you for this test are avoided more complex digestive surgery requiring general anesthesia. It is therefore a "operation through the mouth".
When an ERCP is doneYou must perform an ERCP (Endoscopic Retrograde Cholangiopancreatography) when it is necessary to study or intervene on the bile ducts from the digestive tract, the ducts that carry bile from the liver to the small intestine. It can also be useful in certain pathologies of the duodenum (first part of the small intestine) and pancreas.
Before performing an ERCP usually necessary to test image showing the problem of the digestive system:
Gallstones: gallstones are real stones that form in the gallbladder and bile duct, producing obstructions that can be complicated with accumulation of bilirubin in the body, pancreatitis and abdominal pain can go. When the stones are the best solution in the gallbladder is removed it by surgery (cholecystectomy), but if calculations have gone to biliary ERCP can detect them and reach them with hooks, baskets or small balls that sweep the bile leaving it free. In some situations the ERCP is able to even destroy stones one by one, so they are caught and exerts pressure with force until they are powdered.
Stenosis of the biliary tract: stenoses of biliary tract are bottlenecks that occur in bile duct after inflammations and manipulations. They can be produced by surgery, but there are also diseases that cause them like gallstones, autoimmune diseases (such as sclerosing cholangitis) or different cancers that affect the area (the colangiosarcoma and pancreatic cancer). To solve the stenosis ERCP placed stents that dilate the biliary tract, these are a few small docks between the walls of the ducts, similar to those used in cardiology.
Sphincterotomy: bile separates from the small intestine by a valve which is called sphincter of Oddi. This sphincter is a circular muscle that opens and closes as needed or not the passage of content of the bile into the duodenum. To perform any procedure in the biliary tract (like the above) is necessary to make a cut that this sphincter open and allow passage to the final end of the endoscope, this is known as sphincterotomy. It could also solve local problems of the sphincter of Oddi, as obstructions which do not allow passage of the contents of the biliary tract.
Takes biopsies: some nearby organs to the biliary tract, pancreas or intestine, can be affected by malignant tumors of difficult access. Own bile duct have cancers such as cholangiocarcinoma, which only could reach it through surgery if it fails to be because with ERCP fairly remote areas are reached. Thanks to her we can take biopsies easily, obtaining the organ tissue cylinders to study.
ERCP preparationIf you are going to perform an Endoscopic Retrograde Cholangiopancreatography (Ercp) these are the issues that you must take into account:
Duration: the duration of the ERCP is variable. It can last from a few minutes to more than one hour. It usually lasts longer if complex techniques are performed.
Income: it may be necessary to enter the night before of the test. Sometimes you can come from home directly with previous recommendations. After ERCP usually will stay a few hours in observation, it is not usually necessary to enter the hospital for one night or longer.
Is necessary to be accompanied?: Yes, it is recommended to carry a passenger. It is a test not exempt of risks and is better that at the end there is someone to take home and be with you a few hours later.
Drugs: have to tell your doctor all the medicines that you take regularly, you will decide what interrupt and what to keep. Sometimes the specialist will recommend you take medication that will help to carry out the test, such as omeprazole to protect the stomach, but should be assessed to each patient individually. Drugs that are usually stopped before perform you ERCP include the antiplatelet agents, such as aspirin or ibuprofen.
Food: have to stay in an empty stomach at least four hours prior to the test, although it is often recommended eight hours.
Clothes: you can go to the ERCP with the same clothes every day. You will be prompted that you take it off and they will put a hospital that is more comfortable and hygienic gown.
Documents: it is recommended to carry the personal medical history, 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 rare. They will also you a series of basic pretest tests, such as an electrocardiogram or a blood analysis, take the results with you if you have taken them.
Pregnancy and breast-feeding: ERCP is contraindicated in these situations. If there is a minimal chance of being pregnant not you should submit to this test without confirming it, exposure to x-rays can cause damage to the proper development of the fetus. Normally the doctor carried out a pregnancy test prior to women who do not deny being pregnant, but you should notice.
Breastfeeding does not imply a direct contraindication, but it is preferable to avoid testing until the breast feeding period is complete unless it is strictly necessary to perform the test.
Contraindications: pregnancy is a contraindication for this test. It should not be if you have chronic kidney damage, since the radiocontrast can worsen it, although it is uncommon and you can prevent hydration and medication. People who have an active infection (gastroenteritis, cholecystitis or cholangitis) nor should undergo this test if it is not strictly necessary.
How ERCPFirst, they explain why it is necessary to perform ERCP and will ask you if you are agree to submit yourself to it. If so you will be asked to sign the informed consent where you will read what is the test. They will give you an appointment that you submit to the test another day, but if it's an emergency situation you can if it decides to put you to the test directly, but it's a bit common.
To make you the proof may be required that you enter the night before or not. If you go directly in the morning you should not forget to remain in fasting eight hours earlier. Go to the quiet and accompanied, hospital with enough time to not have to stress yourself before the test. Before entering the room where the test will make you ask yourself that you change your clothes and give you a batin's hospital. Once inside you will see multiple monitors and a stretcher where you tumbarás on the left side, so you leave free the area of the liver and bile duct.
Before starting the intervention you will you a sleeve on the arm to control blood pressure, several electrodes on the chest to control heart rate and a venous pathway on the other arm to inject you with sedative drugs that you relax. When you are sedated they will introduce you the endoscope through the mouth, it will pass the esophagus and the stomach and duodenum will be. You won't feel of Arcade or pain, just a slight feeling that you have something in your mouth and that swollen abdomen.
Upon reaching the duodenum the doctor look for sphincter of Oddi with the camera, so you can release air that dilate the duodenum. When you have found it will try to get through it and if necessary will perform a sphincterotomy allowing him to step. At various times are made with low radiation x-rays to see where is the endoscope.
When the endoscope is inside the bile will instil the radiocontrast. With it you will see the anatomy of the biliary tract and calculations, can be detected will be like shadows that do not let all the contrast. In the case of the stenosis also will be seen as the contrast may not pass well, but in this case the duct will be narrower.
Techniques carried out in bile duct will pass completely unnoticed for you. In no time you will notice nothing, in fact it is usual that you remember even after the test. When finished will withdraw the endoscope.
Finally, you will go to another room so that rest of the ERCP and keep you under surveillance awhile, there you will recover from sedation. It is normal that you feel heaviness in the stomach, as gases, and also some sore throat that can be in up to tres-cuatro days. When you recover you you can go home with, you can drive in any case. The week after the test you can not exercise or heavy lifting.
Complications of ERCPSerious complications in the ERCP are not very frequent, but some minor complications are very common and are resolved on their own. Some of which may occur occasionally are:
Discomfort, nausea and vomiting.
Heartburn or burning.
Fainting and loss of consciousness.
Alterations of blood pressure suddenly.
Allergic reaction to the x-ray contrast medium.
Perforation of intestine or bile duct.
Retention of urine.
In short, after an ERCP you may worry and emergency call only if you present severe abdominal pain, bleeding in the stool or vomiting, nausea and vomiting, or fever.
The ERCP resultsWhile ERCP can know the results. When the bile duct is clean there are well shaped edges, unobstructed or narrowness in the contrast. Because a diagnosis is possible at the time of the test, complex interventions that solve them in a direct and effective manner can also be.
At other times, the study should be more detailed. This happens mainly when suspected a tumor that affects the bile duct or the closeness and needed a biopsy that study under microscope for knowing its origin. In that case the ERCP does not solve the problem, but manages to expand the study to make decisions on treatment.
The most common is the gastroenterologist announce you the diagnosis and the results of the test just after making it, once it has passed you the sedation. But it will also be necessary to days after ERCP to have a consultation with gastroenterologist. There it will detail you what were the final results of the test and will inform you a diagnosis and long-term treatment (if necessary).
Sometimes the test is indicated by another physician (internists, oncologists or surgeons), so the query and the result may be with them. In the consultation shall be verified also that everything went correctly and that your evolution was favorable.
What is the sputum cultureSputum culture is a diagnostic test used in medicine for the study of respiratory tract infections. When there is an infection in the respiratory tree, there are plenty of bacteria that invade the lungs producing more or less defined pneumonia. These bacteria are floating in the mucus and can be found in the sputum.
A small amount of sputum should be collected then cultivate it and analyze it in the microbiology laboratory for cultivation. Cultivation is performed under aseptic conditions, i.e. without other germs from contaminating the sample collected. Studies performed on sputum are mainly:
Gram stain: is to dilute a small amount of sputum and apply a few dyes that are set in the germs that have upon him. The microscope may identify the shape and distribution that embrace the bacteria (e.g. Bacillus chain).
Traditional culture: in the same way that you can isolate microorganisms in the blood by a blood culture, or in the urine by a urine culture, sputum can be isolated in Petri dishes, which have special components that serve as food for the bacteria. Thus, these grow, reproduce, and can be identified.
Antibiogram: in the culture dish are placed antibiotics that broadcasting and eliminate the bacteria more or less effectively. So know what is the most useful antibiotic to cure the infection.
When a sputum culture is madeSputum culture is a test that is used very often in medicine because it is not great discomfort when performing it; It is cheap, and it can provide much useful information. The information provided helps us to identify the exact type of germ causing the respiratory infection that is being studied.
Situations where a sputum culture is most requested are acute respiratory infections, mainly pneumonia typical or atypical, but also bronchitis and tracheitis. It is not in the upper, as pharyngitis, respiratory tract infections, because in this case often there are more germs and alter the results of the study.
In certain chronic diseases affecting the lung a sputum culture may be performed if the doctor considers it necessary even if there is an established acute infection. Some of these diseases are cystic fibrosis, COPD, bronchiectasis, pulmonary fibrosis, etc.
Preparation for a sputum cultureIf you will perform a sputum culture , these are issues that you must take into account:
Duration: lasts a very short time. The sputum specimen collection is done in a simple way, expelling sputum in a boat. You can pick up the sputum of anytime, although it is preferable to pick it up first thing in the morning.
Admission: admission is never needed. It is a test that can be done on an outpatient basis. Sometimes this is done during an income.
Is it necessary to be accompanied?: no.
Drugs: don't need to take any prior medication. You have to tell your doctor all medications you are taking at that time, because some medications can alter the sample collected. It is important that you know the doctor if you have taken any antibiotics previously.
Food: avoid eating or drinking the hour prior to collection of the crop. Before ejecting the sputum rinse your mouth with a little water.
Clothes: you don't need special clothes or to collect the sample or to deliver it.
Documents: it is advisable to carry your health insurance card and the wheel of proof when you go to submit sample, if not they collect it you being entered.
Pregnancy and breast-feeding: the test can be taken without modifying any attitude, but it is better that advice the doctor that you are pregnant.
Contraindications: there are no contraindications.
How a sputum cultureSputum culture He is carried out for the study of respiratory infections. If you have cough, fever and increase in mucus you must see a doctor. When you get to the consultation the doctor will make you some general questions about your state of health (fever, cough, shortness of breath, etc). After perform you a physical examination general, insisting on pulmonary auscultation, and assess if it is convenient to make a sputum culture. It will give you a flyer which asks the test, or directly proceed to the collection itself.
Sample must be collected in the clinic or hospital; Thus they ensure that it is well covered. You will need a sterile pot that will give you at the doctor. When you go to collect the specimen it is recommended that you rinses you mouth with water and is better that you've not eaten prior to testing time. You have to try to start mucus from the lungs, and for that they will ask you you to cough forcefully. Avoid blowing, won't get a good sample and only hurt your throat.
It is sometimes very difficult to cough; to facilitate this the doctor may indicate that they apply a few sprays or physiotherapy. Sprays are applied with mask and contain substances that dilate the bronchi, making it easier so that the mucus is released. Respiratory physiotherapy consists of mobilizing mucus making concrete positions and firmly hitting the ribcage.
You have to collect small amounts of sputum, taking care to not touch the edges of the pot. When you are done collecting the sample closes the boat carefully but firmly, to make it airtight. At that time they will take you to the laboratory of Microbiology for study. The results may take several days and will give them to you in the consultation of the doctor; Meanwhile, you will receive a treatment of coverage.
Complications of the sputum cultureThere are no complications of the sputum culture.
Results of the sputum cultureThe results of the sputum culture may take several days. The physician will receive the report from the laboratory of Microbiology and interpreted the information received. If the doctor thinks that culture information is not important, or that it does not change the treatment or the prognosis of your condition, you can that you do not report the results and you don't worry about it.
The doctor examines these aspects in the result:
Gram stain: stained bacteria that has sputum allowing you to see its shape and its disposal. The bacteria are divided with this staining Gram-positive or gram-negative, depending on the color that wrinkles. It allows a first approach to the very useful microbiological study.
Isolation of bacteria: when sputum culture is left for several days to grow colonies of bacteria that can isolate and study individually. Thanks to different tests can identify the genus and species of each bacterium. The bacteria that cause respiratory infections, type pneumonia, most often are the Streptococcus pneumoniae.
Antibiogram: is the result which takes longer because it must be after all the previous results obtained. It consists of applying soaked disks of different antibiotics within the culture plates. If the bacteria die around is that the antibiotic is effective. According to the results your doctor will keep the treatment or change by one really effective.
What is the MantouxThe Mantoux, or test of the tuberculin, is used daily in consultations around the world, and serves to detect people who have had contact with the tubercle Bacillus, Mycobacterium, head of the tuberculosis. All people who are infected tuberculosis ever develop defenses against Bacillus, caused an infection in the body or not. These reactive defenses remain in the body silent and reactivated when they meet up again with the Bacillus.
This test seeks to reactivate these defenses and identify a reaction that demonstrates this sensitivity. For that they inject antigens of the bacillus of tuberculosis in the skin. The antigens are pieces of the bacteria, purified and without ability to lead an active infection. They are injected into the dermis, the thickness of the skin, with a very fine needle and remain there waiting for the emergence of an immunological reaction or not.
It is used in all situations in which you want to rule out active or latent TB infection. Keep in mind that tuberculosis is an infection whose severity depends on the immune status of the patient, therefore the test will take place in all situations involving a significant immunosuppression, such as HIV infection or the taking of biological drugs. It is also used when you want to rule out infection from tuberculosis in people who have had contact with TB patients known.
The test is very simple and cheap. It is not a very important nuisance to the patient, just a small puncture in the forearm. Thanks to this test you can take important decisions in the management of tuberculosis or other complex diseases that involve an alteration of the immune system. There is no possibility of serious complications, so it is used on a daily basis in medical consultations around the world.
When the Mantoux is madeThe Mantoux is done in situations that are important to rule out a latent infection by the tuberculosis Bacillus. The degree of infection essentially depends on each person's immune system, so the situations in which it is committed are the most important to keep in mind:
People infected with HIV.
Patients with risk factors for developing a tuberculosis, such as those who suffer from diabetes mellitus, silicosis, chronic renal failure, cancer...
Prior to the administration of immunosuppressive drugs: corticosteroids powerful in prolonged guideline, biological, anti-cancer drugs, etc.
People who have had contact with known TB patients.
Immigrants from areas where tuberculosis is endemic.
After detecting signs of suspicion of tuberculosis in routine controls (swollen, abnormalities on chest x-ray, etc).
Systematically to health employees or prison officers, for the added risk of coming into contact with the Bacillus.
Preparation for the MantouxIf you will perform a Mantoux, these are the issues that you must take into account:
Duration: the test will consist of two visits to the consultation by the doctor or nurse, each of which will last for ten minutes in total.
Income: is always performed on an outpatient basis. Just go one day to the doctor and again three days later. If you are entered they can ask the test during the own income.
Is it necessary to be accompanied?: it is not necessary to be accompanied.
Drugs: don't need to take any prior medication. Should be communicated to the doctor all the medicines taken regularly also is important to report allergies to medications or other products, if you have them.
Food: it is not necessary to remain in fasting prior to testing or after. You can drink and eat whatever you want before the test. If for any reason it should go on fasting to test the doctor you warn.
Clothes: you can perform the test with the same clothes every day. When you get to the hospital or doctor's office ask you to discover a forearm.
Documents: it is preferable that you bring with you the steering wheel which shows the performance of this test. The health insurance card is recommended. Normally you will not you any document after the test because it takes days to analyze the results and communicate it to you directly.
Pregnancy and breast-feeding: the Mantoux is not contraindicated in pregnancy or lactation, but that State must know because sometimes the results will be altered.
Contraindications: do not have any specific contraindication.
How the MantouxFirst the doctor will decide in a previous consultation if necessary or not to perform a Mantoux, and so assess your immune status, the diseases that present and epidemiological contacts. It is important that you discuss you countries you have visited and what you work.
The Mantoux may be carried out on the same day or in another different appointment. If necessary, they will measure you blood pressure or will make you a blood analysis before you undergo the test, because then it would be more awkward.
Prepared once you will be asked to sit in an armchair in a position that will facilitate the completion of the test, and you have to put one of the two forearms on the armrests, with the inside facing up. You should be relaxed and alert if something goes wrong during the test, although remember that it lasts only a few seconds.
To proceed with the injection of the Antigen the area should be cleaned with an antiseptic such as chlorhexidine or the betadine. Then the nurse prick the skin without in-depth and will inject 0.1 mL of Antigen, which tends to be a substance called tuberculin. When the liquid is injected it is normal that you feel pain and burning, sometimes very intense, but lasts less than 10 seconds in any case.
After you withdraw the needle and will give you a cotton so you compress the area of prick and avoid that you bleed. With this you can already go to home, but you'll need 72 hours later, i.e., three days later, to check the results. Results are read directly on the skin, as a local immune reaction in the area of prick, has or not. If major alterations in the area of prick you notases before that date you must see a doctor.
Complications of the mantouxAll the evidence that damage the skin have risks, even if the invasion is mild. They tend to be infrequent complications and in the majority of cases have easy solutions. They can appear during or after the test, and whenever they arise you should go to the emergency room. Some of the most common complications in the Mantoux are:
- Bleeding from the site of injection, which is almost always at least.
- Infection very unlikely, local with a fever.
- Uncontrollable pain.
- Reaction to tuberculin. With intense pain, redness, and swelling. Treatment must be received to interrupt the immune reaction.
The Mantoux resultsThe Mantoux results They are received 72 hours after injection in the forearm of the tuberculin or Antigen that matches. Let spend that time so the immunological reaction to develop enough. The doctor or nurse will assess the local skin reaction, measuring induration that present the surface (which should not be confused with the redness, which tends to be higher). According to the diameter of the reaction the result will be positive in that it engages:
- More than 15 mm: for all healthy persons without risk factors.
- More than 10 mm: for people with risk factors (diabetes, cancer, etc) or to work in jobs with added risk.
- More than 5 mm: If you have a State of severe immunosuppression (HIV, immunosuppressants, and so on).
To alleviate these falsely negative results make the effect booster, which consists of the repetition of the Mantoux a few days after the first test. Thus the immune system remembers the first injection to the tuberculosis Bacillus, and with the second injection reacts adequately against it.
What is the OtoscopyOtoscopy is a type of medical examination, which consists of the examination of the ear from the hole in the ear canal, which is in the ear. Through it we can see all the inner conduit and the tympanic membrane. If we are lucky we can see structures through the eardrum by translucency, as the ossicular chain. The test is performed directly the doctor, with the help of a small device called an Otoscope.
The Otoscope is the length of a ballpoint pen, with a thickness of 2 cm and one end has a hollow head. One end of the head is thin and is inserted into the ear, another has a transparent lens and inside the ear is seen through it. To view the area well head has a small internal light. It is a relatively cheap device that can be used many times and is all basic queries of any pediatrician or family doctor.
It is a painless, easy-to-perform test and that provides us much valuable information to make decisions. For example, can be diagnosed infections of the inner ear, the eardrum breaks or tumors, among many other things. In young children, it is more difficult to make because they are easily frightened and usually move to prevent the Otoscope. Any doctor can perform the test, but more experienced physicians are family doctors, pediatricians and otolaryngologists, because they are those who perform the test daily to many people.
Occasionally, when it is not enough to make a simple otoscopy or this indicates that something goes well, should be assessed the use of other more complex and more advanced such as computed tomography or magnetic resonance imaging techniques. Precise images of the inside of the ear will be with them. However the otoscopy is still the first choice to study ear for its simplicity and useful.
When doing an otoscopyThe ear by otoscopy exam serves to diagnose diseases that affect segment external and middle ear. It also allows to study the evolution of the disease toward improvement or worsening. Diseases in which it is intended to perform an otoscopy are:
Infection of the outer ear: the ear is inflamed, red and painful.
Infection of the middle ear: the ear drum is red and inflamed, in addition you can see bubbles through it because it will be filled with exudate or pus.
Cholesteatoma: it is a benign tumor but that locally destroys the ear, you can see the perforated eardrum and gnawed chunks of bone.
Head injuries: when a blow to the skull is very intense bones which form the ear canal can fracture. A step or hemorrhages in the skin of the Canal can be seen with the Otoscope.
Perforation of the eardrum: directly seen a hole in the eardrum. It can be drilled by an infection or tumor, but the most frequent remain hygienic canes for the ears.
Insects: it is not rare that some insect among the ear through causing itching or pain. With the otoscopy is directly.
Plug of wax: ear wax can accumulate inside the ear and form plugs. The best way to prevent them is to not introduce swabs or other objects, cerumen removed by itself only.
Preparation for an otoscopyIf you are performing an otoscopy these are issues you must keep in mind to go properly prepared to test:
Duration: the otoscopy takes very little time, just a few minutes. This is done in the context of a medical consultation during a general exploration.
Income: the otoscopy is performed on an outpatient basis. It is not necessary to enter for this test.
Is necessary to be accompanied?: no, can you the test only. It is not painful or prevent you after you leave your own foot.
Drugs: no need to take any prior medication. Medicines that you are taking very seldom can affect this test. Only communicates to the doctor if it is throwing topical antibiotics in the form of drops for ears or other medications.
Food: don't need that keep fasting or take care with some food in particular.
Clothes: you can keep the appointment with any type of clothing.
Documents: don't need to take any special documentation.
Pregnancy and breast-feeding: is a test that can be performed safely during pregnancy and lactation.
Contraindications: there are no real contraindications. It is usually to avoid the test to people recently operated ear, but it is not always a contraindication. Your doctor know how to intervene properly to carry out the test without unnecessary risks.
How an otoscopyWhen you get to the doctor to make you an otoscopy, will execute you some general questions about your state of health and the inconvenience that queries. When finished it will begin to explore you part by part of the body. If your discomfort is focused on your ears you will go directly to explore them. It will first feel the ear and ear canal nearby, if they are painful could indicate a local infection.
Then you will use the Otoscope to explore you the Canal and middle ear. Sometimes it is necessary that the doctor turn off query light so the only light that receives either the Otoscope and approach correctly the ear. It will introduce the end of the head through the hole in the ear, while you gently pull the ear upwards and backwards, so duct auditory straightens and can explore more comfortably. It can be a bit annoying, but you will not notice pain unless you have a local infection.
The first thing the doctor will look at is the appearance of the ear canal. It is normal to be covered with a pink skin, with some fine hairs and remnants of wax. If there is an infection the skin will be more reddened, swollen and there will be more amount of ear wax. If there is a plug of wax you will not be beyond him, and if there is an insect or another object will directly.
Then it will scan the eardrum, which is the most delicate part of the exploration. You will need to check that it is not convex, red or swollen. The doctor will make sure that structures are kept in their proper position, the most important are: the cone of light (where the light is reflected), the handle of the hammer (which is inserted the ossicular chain) and the flabby part (thin part that ignites easily).
Once seen an ear doctor will take out the Otoscope and cleaned it, then it will be to explore the other ear to compare. He will repeat the same scan in a meticulous way and when you have finished already you can leave paragraph Otoscope. It will be then when you say if you see something suspicious or that worries him. If you can you diagnose a disease and will propose you a treatment. If the pathology is more complex you can request further testing or you will derive the Otolaryngologist for a surgical treatment or other options.
Complications of the otoscopySerious complications in the otoscopy are not very frequent. Some that occur after are:
Irritation of the ear canal with pain, which is often the case when there is a local infection.
I contagion from an ear infection to another, which prevents to properly clean the Otoscope.
Perforation of the eardrum, which is uncommon because the end of the head is very short.
Results of the examination of the otoscopyOtoscopy enables note to physician the outer ear and part of the ear in real time, by proving it can be interpreted immediately and give a successful diagnosis. The doctor tends to draw up a report in which describe all changes if any, along with the rest of the physical examination.
The results of a hearing test report will describe all parties explored. The essential parts have to describe are the external ear canal and eardrum. Today the doctor can attach the report photographs of the otoscopy, although that alone is usually done when it is necessary to any disease of the ear, usually by an Otolaryngologist who have more sophisticated otoscopes narrow track.
With the otoscopy doctor can confirm or discard suspected local infections or tumors. If it can provide you immediate treatment will do so, but sometimes necessary consultation with other specialist for further testing or schedule more advanced treatments, such as surgery.
When it is not possible to diagnose the disease through an otoscopy they can turn to other techniques depending on what you want to study. You can be a computed tomography (CT) that allows to obtain images in cut around the skull with very precise images of the bones or MRI that is equally useful on occasions.
What ees sigmoidoscopySigmoidoscopy is a technique that allows to visualize the final part of the large intestine, the sigma and the rectum. This test can detect local alterations of the colon, from bleeding to tumors. Contrast that with colonoscopy, with sigmoidoscopy does not you can study the entire colon, which serves only to carry out an initial study, but sometimes this is enough.
To perform this test using a sigmoidoscope, which is a fine scope that is about 15-20 cm long and less than 1 cm in diameter. Flexible sigmoidoscopes, which are safer because they bend easily between the curvatures of the sigma are used today. In the end it has a halogen light, that does not emit heat, and a simple camera that records live images and transmit them via fiber optics to a screen.
Performs the technique the gastroenterologist, is the specialist in digestive tract, and that is who will consider when it is necessary to perform it and when can provide useful information. Since it is not introduced by the entire colon, prior preparation is easier than necessary for a colonoscopy. You only need to clean the sigma and the rectum so the feces do not hamper the study of intestinal mucosa.
Sigmoidoscopy in no time causes pain to the patient, even can be done without sedation, unlike colonoscopy. For its comfort and its effectiveness is considered a rapid test for the diagnosis of diseases of the lower part of the large intestine, which may be sufficient to obtain a direct diagnosis, or be the first step to perform a colonoscopy.
When a sigmoidoscopy is doneA sigmoidoscopy is performed when you want to study the interior of the large intestine, from the anal canal to the sigma, passing through the rectum. Inflammatory or tumoral diseases can be diagnosed with a simple direct vision. The most frequent indications of sigmoidoscopy are:
Diarrhoea or constipation: changes in the bowel of intermittently may be due to inflammatory intestinal diseases (such as ulcerative colitis or Crohn's disease). Sigmoidoscopy can identify areas of inflammation that justify those changes.
Hemorrhage: a sigmoidoscopy may be performed to identify the source of bleeding with feces. It may be due to hemorrhoids, fissures, wounds, or tumors. If there is a bleeding point is should be assessed to perform a colonoscopy.
Abdominal pain: severe pain may be due to diseases of the intestinal tract; If it is accompanied by other symptoms, it may be the initial presentation of Crohn's disease. Sigmoidoscopy could identify local inflammation.
Weight loss: weight loss may be related to intestinal malabsorption (infectious diarrhea or inflammatory bowel disease) or cancer. It may be useful to detect cancer, but it is the prevention of cancer because to do so you should study all of the colon in its entirety.
Preparation for sigmoidoscopyIf you will perform a sigmoidoscopy , these are the issues that you must take into account:
Duration: sigmoidoscopy has a variable duration according to the technique you are going to be made. It will usually last a few minutes, long enough to see the area of the large intestine to study.
Income: it can be either scheduled or urgent, and don't need to be admitted to the hospital. You can put yourself to the test and go your home a little while. Stay entered or not will depend on your state of health, not the test.
Is necessary to be accompanied?: depends on. Sigmoidoscopy is a technique of minimally invasive that does not hurt or leave discomfort after making it, but if you are weak it's best that someone be with you.
Drugs: sometimes it is necessary to take laxatives or enemas prior, since testing must be done with the empty rectum. You have to tell your doctor all the medicines you take regularly and will decide which suspend or maintain.
Food: it is not necessary to remain in fasting prior to testing, but the days before and after it is recommended to avoid a diet high in fiber (fiber improves intestinal transit, but not digested and difficult visualization of the walls of the colon). It is recommended that the three days before the test diet is based on the possible water, fruit juices, broths, etc.
Clothing: can keep the appointment with the doctor with the same clothes every day.
Documents: before the test you will be asked to sign an informed consent which you agree to make yourself the sigmoidoscopy. If you cite for you test a specific day, it is recommended that you carry with you the health card and the steering wheel where the test is requested.
Pregnancy and breast-feeding: sigmoidoscopy is not contraindicated in these situations. The doctor must know that you are pregnant to consider postponing the test, since sometimes there are physiological changes associated with pregnancy that can alter the results of the test.
Contraindications: it is preferable to not perform the test without a previous preparation of the large intestine. Nor is recommended when there is a serious inflammatory diarrhea or continuous bleeding.
How the sigmoidoscopyFirst the doctor will ask you if you're in agreement with put you to the test. He will explain you why you think sigmoidoscopy important at that time. It will be necessary to sign a written consent, after this another day will quote you for the study, and will take place at the time if necessary.
When you perform the test ask you that you have taken depositions hours before subjecting you to it; arriving at the hospital they will put an enema an hour before and so will ensure that your bowels are empty. The days before the test seeks to take little fiber, and the morning of the test you can have breakfast something light and liquid (coffee, for example). Before the test you should also go to the bathroom to empty the bladder.
Then ask you that you take off the pants or skirt, and underwear. You tumbarás on a table on the left side, with legs flexed so that you can hug your knees. Once the doctor first thing will make will be seen outside of the year. It will check if there are external injuries and if the skin has no alterations. Then it will be you a rectal examination with lubricant to touch the inside of the anal canal and check that nothing will obstruct the passage of the sigmoidoscope.
To introduce the scope you will notice a feeling of heaviness in the part low belly, similar to that you feel during a bowel movement. If insufflate air feeling of desire to defecate will be greater still. Once introduced the sigmoidoscope gets gradually along its length to observe the inside of the large intestine as much as possible. When you reach the end, the scope will be withdrawn slowly and will be reviewed throughout the study area.
A biopsymay be taken if suspicious areas of tumor are observed during the test. For this purpose are used small pliers that are at the end of the sigmoidoscope and allow boot small samples from the suspected tumor. You can feel a prick during the biopsy that will last for a moment. The days of sigmoidoscopy it is normal that you bleed a little with Lee, but it should disappear within a few days.
Complications of sigmoidoscopyIn general you do not presentarás any complication after sigmoidoscopy. Please maintain a diet rich in fruit and fiber, and stay well hydrated with water to maintain a normal bowel. It is very important to avoid constipation. You must see a doctor when you notice fever, chills, pain, or continued bleeding throughout the year.
Complications in the sigmoidoscopy that can occur are:
Perforation of the wall of the rectum or the sigma, which can force an urgent surgery.
Local infection, requiring to be antibiotic treatment to prevent the formation of an abscess.
Bleeding, more frequent if you biopsy.
Sigmoidoscopy resultsWhen performing a diagnostic sigmoidoscopy the doctor can get the results of the test at the same time approximately. It is a useful test as a first approach and enables to propose initial treatments if there is a specific problem (Crohn's disease or infectious diarrhea).
Where are cancer suspect lesions, can that just can not confirm the diagnosis and biopsybe required. If so, your doctor will give you an appointment for a consultation weeks later and she will give you the results of the biopsy. In the case of Crohn's disease, alterations similar to the of a tumor can be seen and it may also be necessary to take samples for biopsy.
Quote from the results of a biopsy you explain if there are microscopic alterations in the cells of the intestinal tissue were collected. If any, explain until that point are malignant and treatment options. In inflammatory bowel disease also explain what kind of changes are and if it is confirmed the diagnosis.
If the test is not conclusive the doctor can be considered more testing that allow knowing the source of your problems, such as a colonoscopy or Imaging type CT or MRI. So you can discover why present some specific symptoms. It is important to remember that sigmoidoscopy does not fully ensures there is no colon cancer, colonoscopy only allows to study the entire colon.
What is the thoracoscopyThe thoracoscopy is a surgical technique that allows to visualize directly inside the rib cage, either to study the lungs and other organs of its interior, or to carry out treatments and surgeries. For this small incisuras are made with a scalpel into the chest wall, and endoscopes are introduced through them with cameras, clamps, and other small devices that allow you to manipulate internal organs without having to open all of the rib cage.
The thoracoscopy was first described in 1910 by Jacobaeus, a Professor of medicine at Stockholm, he demonstrated its use for the treatment of sequelae of tuberculosis. For 40 years it was only used for that, but gradually more uses were discovered, and currently has practical use in many diseases of the lung. In 1980 they began to design specific instruments that allowed the taking of samples for biopsy and also to intervene directly in the organs of the inside of the chest cavity. At the end of the 1980s were designed video cameras that were adapted to the endoscopes; Thus arose the VATS (video-assisted thoracic surgery).
He is considered to as a surgery technique thoracoscopy minimally invasive (same as arthroscopy, laparoscopy, or Ercp). However, continuing to treat is surgery, which should be performed in an operating room under general anesthesia and a thoracic surgeon. Since a few years ago has begun to divide the thoracoscopy between "health" and "surgical". The first could be performed by Thoracic Surgeons or pulmonologists, to treat disorders of tuberculosis or other diseases under local anesthesia, while the second only Thoracic Surgeons perform it to perform complex techniques under general anesthesia.
Techniques minimally invasive as the thoracoscopy have allowed that postoperative patients is less painful, short and more satisfactory. Not having to take so many pills for the pain and reduce time in hospitals cost saving is very important. It also decreases the number of infections in the postoperative period because the invasion toward the inside of the rib cage with small incisions, surgical wounds are minimal.
When a thoracoscopy is performedBut the thoracoscopy can be used for diagnostic purposes (view the lungs directly, biopsy), its most important use is based on surgical interventions, which every day are more advanced. Most frequent situations in which it is used are:
Take biopsies of tumors not studied.
Collapse the chest cavity to avoid that you fill with liquid (serum, pus, blood, etc). This is known as pleurodesis.
Remove Lung Tumors, as solitary pulmonary nodules.
Treat the collapsed lung tissue (atelectasis).
Extract blood, clots, or artifacts that are around the lung after an accident.
Remove Caverns of tuberculosis to re-expand the lung.
Clean lesions, local accumulations of pus.
Preparation for the thoracoscopyIf they are going to perform a thoracoscopy , these are issues that must be considered:
Duration: the thoracoscopy has a very different duration according to the surgical technique to be performed. It can last from hours (removal of blood or pus) to a whole morning or afternoon (surgery of Lung Tumors).
Income: the thoracoscopy usually requires hospital admission from the night before the operation. Then the postoperative period can be extended about three or four days, if all goes well will not be more than one week. If the thoracoscopy has only been for biopsy you can get discharged within 24 hours.
Is necessary to be accompanied?: Yes, is recommended. After the thoracoscopy efforts should not be and you may need help to go to the bathroom or merge. When you receive the high it is not recommended that you drive for the next 24 hours, at least.
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. You should avoid taking medications that hamper the clotting of blood two weeks prior to the thoracoscopy, such as aspirin, ibuprofen, and other anti-inflammatory drugs.
Food: must remain in fasting 8 hours before the thoracoscopy. If you need to take any medication, take the pills with a small SIP of water.
Clothing: once he enters the hospital you will put a gown more comfortable and suitable for the operating room. Clothing is recommended for sleep and comfortable footwear for the entry.
Documents: it is recommended to take the medical history that described the disease is going to intervene, although the doctor will already have it with him. Before you undergo the intervention you will sign the informed consent with which you agree to make yourself the technique and you will know the potential risks.
Pregnancy and breast-feeding: the thoracoscopy should be limited to the second trimester of pregnancy and only where necessary, only in urgent situations. There is nothing that contraindicated the thoracoscopy during lactation, although the postoperative period and the hospital admission may hinder proper breastfeeding.
Contraindications: the main contraindication is having an once in a lifetime a pleurodesis has collapsed the thoracic cavity and not allowing its opening. Other contraindications are acute respiratory failure, advanced heart failure, problems with clotting, or active infection. Smoking is a contraindication in many cases of chronic smokers because it hinders the postoperative and compromises the good progress after surgery.
How the thoracoscopyFirst, you will be mentioned in the consultation of the thoracic surgeon, who will assess disease, alteration or no-show and if you are a candidate to submit to a thoracoscopy. Perform you a physical exam and ask you some questions. It is important that you communicate if you smoke, and if so you will have to abandon the tobacco several weeks before surgery. In this consultation, they will tell you what medications you can take.
When you arrive at the hospital the day of surgery you will pass to the ante-room to the operating room, where you anestesiarán so that you don't feel any pain throughout the procedure. Anesthesia is almost always general, so you'll be asleep and you will not remember nothing after; in a few cases, this is done under local anesthesia . The chest wall is then disinfected and covered with a surgical sheet with which the area of the chest is involved is limited. You must normally placed side, with an arm raised up to gain access to the rib cage comfortably.
The surgeon will make three incisuras in the abdominal wall that will introduce the camera, the gas that inflate inside the rib cage, and other instruments such as tweezers or scalpels. Before that, the lung to operate side will deflate and the passage of air will not be allowed inside. The camera allows to observe the inside of the chest, and gas that is introduced is carbon dioxide, as in laparoscopy.
Once inside, the surgeon will study and explore well the lungs, pleura, and associated nodes. The technique to perform will be planned before the surgery, but is often to during the change of opinion to identify findings that have gone unnoticed in computed tomography or magnetic resonance. During surgery the main surgeon will be assisted by at least another surgeon more, and a nurse who will give you the necessary material. The anaesthetist will be at all times in the operating room to your vital signs are good.
The intervention is recorded on video so the surgeon can get back to see her, and also so that others can learn. If it is necessary to remove a piece of the inside of the chest you can put in plastic bags that are then removed through a larger incisura. This is how solitary pulmonary nodules removed or extensive lung resections are made. So nodes suspect have metastasis or infections are caught.
When the intervention ends, all instruments are removed and the incisions are closed with simple points that cover with bandages or dressings. Always leave a tube that serves as a drain of possible internal bleeding or inflammatory interstitial fluid.
Complications of the thoracoscopyThe thoracoscopy is a safe and widely used technique today, but it is not without risk, as in all surgical operations. The most common complications are:
- Bleeding through the incisions or inside the cavity of the thorax.
- Pulmonary thromboembolism by clots that travel to the lungs of the legs.
- In the postoperative surgical wound infections; Preoperative antibiotic prevents them to a large extent.
- Damage during the operation of arteries, veins or bronchial tree.
- Problems caused by general anaesthesia (allergies, respiratory problems).
- Difficulty the lung expands, by accumulation of blood (hemothorax) or air (pneumothorax).
Results of the thoracoscopyThe thoracoscopy recovery is much quicker, less painful and more satisfying than when operating the chest open with a wide incision directly (Thoracotomy).
When you wake up from the anesthesia it will be drowsy, and you can have nausea. You will pass to the area of awakening, where you remain in observation several minutes to verify that anesthesia is no longer have an effect. A few hours stop feel as well, and you'll be more awake and active.
You will then send admitted plant, where you'll be a few days recovering you. Drains leave them posts until you do not pick up liquids. Also likely chest incisions to painful, especially to make efforts as coughing, it is therefore advisable to take painkillers that you will tell the doctor. If you do not cough with normal you can accumulate mucus secretions that form eventually pneumonia.
If a diagnostic thoracoscopy the doctor you can communicate your result shortly after completing it, but sometimes you have to wait for the analysis of biological samples such as biopsies, which can take several weeks to be analyzed.
A few days later you cite in the hospital or outpatient to check abdominal incisions to heal properly. In this meeting they discussed you also the results of the operation, and you can ask details about your illness. If everything is OK you can this type of surgery is sufficient and is not necessary to follow other treatment.
What is UrographyUrography is a technique based on the x-ray that allows to study the urinary tract and its route. The urinary tract consists of the kidneys, ureters, bladder and urethra, and is in charge of purging the blood of toxins and waste products of metabolism. Test involves injecting dye into the bloodstream, which once inside spreads throughout the body and is filtered by the kidneys to pass into the urine. X-ray we can see urinary tract drawn in the image.
This test was invented in Germany in the Decade of 1920 due to the development of the iodinated x-ray contrast. During their first years of life urography was used almost for any Urinary tract pathology, from obstructions to the diagnosis of cancer. Some of its uses has been displaced by ultrasonography and computed tomography, which allows, studying the anatomy of around with great precision, but still today is also essential for the study of nefriticos colic, to plan a ureters cancer surgery, or to diagnose malformations.
It is not a risk-free test, but complications are rare. The dose of radiation received is much higher than that received by a simple chest x-ray. Today will seek to use less aggressive patient techniques whenever possible, with a much higher for a more successful diagnostic image definition.
When doing a urographyA urography is performed when you want to study the urinary tract (kidneys, ureters, bladder or urethra), whether for diagnostic reasons (you want to detect or confirm any disease), or for planning interventions. Situations in which most commonly used urography are as follows:
Renal colic: happens when dissolved in the urine salts precipitate and form real stones that remain embedded in the urinary tract, obstructing the passage of urine. They produce big headaches, and to detect them it is not enough for an ultrasound or x-ray of abdomen, you need many times a urography.
Ureteral stenosis: sometimes the ureters narrowed too much, favoring the interlocking of calculations and preventing the passage of urine. Its origin can be congenital (from birth) or caused by infection or surgery.
Malformation of the urinary tract: the urografico study allows us to visualize UTIs in their shape and size. Hypoplasias (lack of development) of any part of the urinary tract are sometimes given. Other times they may be to detect even a kidney of more or other benign disorders.
Internal holes: sometimes it is not easy to identify what is the point that urine loss is occurring. Urography allows you to see directly where the rupture of ureter or bladder that escapes the radiocontrast.
Blood loss: urinating blood can happen for many reasons, one of them is the active bleeding in some area of the urinary tract. You could see an arrival of iodinated contrast through a particular point much until it is filtered by the kidneys naturally.
Identification of tumors: a urography may help locate malignant and benign tumors, which your blood circulation is very irregular and differs in the kidney. Where tumors occur in the bladder or ureters notching iodinated contrast, as an occupation of the interior of the tract shall be respected
Surgery planning: urography is sometimes used before surgery of the urinary tract to be able to learn more about the anatomy of that region of the body. Today it is used very little thanks to the development of computed tomography (CT) and magnetic resonance imaging (MRI).
Preparation for urographyIf you are performing a urography these are the issues that you must take into account:
Duration: urography can last more than one hour. Not only does it take to perform the test, but that preparation involved also quite some time. It calculates that you you must invest a morning or afternoon whole in testing you, approximately.
Income: usually not necessary to enter the hospital. After the test you will usually be hours in observation.
Is necessary to be accompanied?: Yes, it is recommended to carry a passenger. It is a test that is not without risk, and is better that there is someone to accompany you home when you are finished.
Drugs: you must tell your doctor all the medicines you take regularly and will decide which suspend or maintain. Sometimes the doctor will recommend you take medication that will help to carry out the test; typically the prescription of laxatives to clean colon and which hinders not the visualization of the kidneys. The doctor will ask if you have antidiabetic oral, since otherwise they must check the proper functioning of your kidneys.
Food: is better to remain in fasting 8 hours before the test.
Clothes: you can go to the test with the same clothes every day. For the test you will be prompted that you take it off and they will put a robe of income which is more hygienic and comfortable to be able to test you.
Documents: it is recommended to carry the personal medical history, although the doctor will already have it with him. Before put you to 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 rare. They will also a series of basic tests before the urography, such as an electrocardiogram or a blood analysis; take the results with you if you have taken them.
Pregnancy and breast-feeding: urography is contraindicated in these situations. If there is a minimal chance of being pregnant not you should submit to this test, since exposure to X rays and the radiocontrast may harm the fetus. Usually the doctor performed a pregnancy test prior to women who do not deny being pregnant.
Breast-feeding is not a contraindication direct, but is best avoided the test until the end the period of breast feeding, unless strictly necessary.
Contraindications: pregnancy is a contraindication for this test. It should not be if you have chronic kidney damage, since the radiocontrast can disable them. People who have an active infection nor should undergo this test if it is not strictly necessary.
How urographyFirstly they will ask you if you're in agreement with submit to urography and you will be asked to sign the informed consent, where you will read what is the test. You cite that you submit to the test another day and explain how you have to keep the appointment.
For the test to attend directly in the morning; You must not forget to stay in fasting 8 hours before. The days leading up to the test will give you a few dietary recommendations to keep the colon clean (fiber one week prior to the test, and then soft diet with soups). Go to the quiet and accompanied, hospital with enough time so you're not stressed before the test. Before entering the room where you will be urography ask you that you change your clothes and give you a batin's hospital. Once inside you will see multiple monitors and a table where you tumbarás you face up.
Before starting the intervention you will you a sleeve on the arm to control blood pressure, several electrodes on the chest to control heart rate, and a venous pathway on the other arm to inject you with iodinated contrast. To inject it, you will notice heat punctured arm and also widespread hot flashes. This is normal and you should not alarm you. It is also frequent that you notice a metallic taste in the mouth that lasts a few seconds.
Once injected contrast you must remain still. The radiologist will make you x-rays serial low-intensity, so will take photos of the urinary tract painted by contrast at different stages. If you move those pictures come out blurry and will have to do more. This part of the test lasts several minutes, until all the contrast has been leaked by the kidneys and has expelled by urine.
Finally, you will go to another room so that rest of the test and will keep you under surveillance a while. You will be asked to drink plenty of water, both in the hospital and at home; that is the best way to cleanse your body of the contrast and prevent acute kidney damage. Before you leave the hospital, they will ask you that you urinate to see the appearance of the urine and check so it's normal.
Complications of urographyUrography complications are very rare. He is usually discarded the test to people who may have a high risk of adverse effects. Some of the complications that can occur on occasions are:
- Upset, nausea and vomiting
- Fainting and loss of consciousness
- Disorders of the thyroid gland.
- Changes of blood pressure suddenly
- The x-ray contrast medium allergic reaction
- Serious acute renal failure.
- Local clots and embolisms
- Metabolic acidosis.
Results from the urographyNothing else done urography because you can see the same data. When the urinary tract are intact are observed well outlined, no nicks or loss of contrast.
Urography results They are obtained in several phases: a first part of initial filter that allows to study the kidneys, the following would be more advanced and with it are studied more thoroughly the kidneys and part more initial ureters, after the passage of the contrast by the ureters, and finally, the retention of urine in the bladder.
However, small changes in the test may be misinterpreted if rapid diagnosis. Therefore, it is best that the radiologist or the doctor who carried out the urography carefully study and assess it in relation to the rest of the evidence that you made.
More typically, a few days after the test have a consultation with the doctor. There it will tell you what have been the results of the test and will inform you a diagnosis and treatment if the test has been altered and is final.