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Colonoscopy
Last reviewed: 23.04.2024
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Indications for the procedure
The goals of the colonoscopy
Differential diagnosis of diseases occurring with diarrhea, helminthic invasions with inflammatory (ulcerative colitis, Crohn's disease, etc.) and oncological diseases of the colon. Evaluation of the course of mucosal repair in infectious diseases that occur with the destruction of the mucosa.
Indications for colonoscopy
Colonoscopy is indicated to the patient with an infectious disease in case of suspected tumor, ulcerative colitis and Crohn's disease, preservation of pathological impurities in bowel movements in patients with diarrhea.
The study is used in emergency situations with intestinal bleeding, intestinal obstruction, the presence of foreign bodies.
These methods allow you to refine the data obtained by X-ray, ultrasound or other studies.
Preparation
Preparation for research
Preparation for colonoscopy is possible in two ways.
The first way. 3-4 days before the study, it is necessary to switch to a slag-free diet, excluding from the diet fresh vegetables and fruits, legumes, black bread, cabbage in any form (both fresh and past culinary processing). On the eve of the study at 4:00 pm it is necessary to take 40-60 g of castor oil. After an independent chair, you need to make 2 enemas of 1-1.5 liters. Enema is done at 20:00 and 22:00. In the morning on the day of the study, 2 more enemas (at 7:00 and 8:00) should be made.
The second way. On the eve of the study, drink a solution of macrogol (fortrans) in 1 liter of water for an hour (from 15:00 to 16:00) for 1 glass every 15 minutes. Repeat the same procedure 3 more times, i.e. 1 liter of solution every hour until 19: 00-20: 00.
Technique Colonoscopy
Colonoscopy procedure
The study is conducted according to the generally accepted methodology. Equipment - flexible endoscopes (fibrocolonoscopes) with a set of tools for biopsy and taking material for bacteriological examination.
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Contraindications to the procedure
Contraindications to the colonoscopy
The extremely serious condition of the patient, late stages of cardiac and pulmonary insufficiency, fresh myocardial infarction, acute typhoparathyphoid disease, acute diverticulitis, peritonitis, abdominal surgery, severe ulcerative and ischemic colitis, fulminant granulomatous colitis, technical complexity of the study (rectal cancer ), pregnancy.
Normal performance
Interpretation of results
Shigellosis is characterized by damage to the distal part of the colon (proctosigmoiditis, sphincteritis). In severe cases, the lesion can spread to the entire intestine. The degree of severity of morphological changes corresponds to the severity of the course of the disease. The changes are focal. Possible catarrhal, catarrhal-hemorrhagic proctosigmoiditis, in more severe cases inflammation is fibrinous in nature with the formation of erosions and ulcers. In this case, ulcerative defects, as a rule, shallow, with a pronounced inflammatory shaft, having a clear contour, measuring up to 1 cm.
In case of salmonellosis, the lesion of the colon is detected with a gastroenterocolitis variant of the disease, there is a picture of catarrhal proctosigmoiditis, in rare cases - catarrhal-follicular or hemorrhagic-necrotic colitis.
With campylobacteriosis, changes in the colon are limited to diffuse edema and hyperemia, sometimes with hemorrhages, in rare cases - ulcerative necrotic changes.
With yersiniotic colitis, ulcers can be detected in places of accumulation of lymphoid tissue. In the ileum, longitudinal ulcers are observed, in thick - oval or point erosions. Characterized by the presence of severe swelling in the affected segments.
With amebiasis on the mucous membrane of the colon, ulcers are formed, which increase along the periphery and into the interior, reaching the muscular and (rarely) serous layer. Scarring ulcers is accompanied by the formation of strictures. Ulcers are sharply delimited from the surrounding tissue, have uneven edges. The bottom of the ulcers is covered with necrotic masses, the edges are undermined and raised, hyperemia around ulcers is not pronounced. Ulcers can be isolated and multiple, localized mainly in the caecum. The second most frequent localization is the rectum and sigmoid colon, less often the colon, appendix and terminal terminal of the ileum.
For balantidiasis at the onset of the disease is characterized by the development of necrotic areas of small sizes, surrounded by small hemorrhages, in the colon. Then necrosis passes into ulcers of a slit-shaped form with a jagged edge, their sizes reach 1x2 cm. Ulcers are covered with fine-grained curdled mass.