Colonoscopy: Definition, Indications, and Procedure.

Colonoscopy is the visual examination of the inner surface of the colon (large intestine) with a colonoscope.
It is done for the indication of colon cancer screening, rectal bleeding, constipation, angiodysplasias, peptic ulcer disease, erosive gastritis, colitis etc. The bowel will be emptied with laxatives and the patient will be kept NPO prior to the procedure.
Medical instruments used for colonoscopy: Olympus PCF-160 colonoscope.
Below given are some case studies which will help in portraying a larger picture of colonoscopy and its indications, procedure, medications used etc.

CASE STUDY #1:
PREOPERATIVE DIAGNOSES: A 60-year-old male who needs colon cancer screening. Chronic mild bright red rectal bleeding with episodes of constipation.
MEDICATIONS USED: Fentanyl 100 mcg IV and Versed 4 mg IV.
DESCRIPTION OF PROCEDURE: The patient was placed in the left lateral position and a rectal examination done which was normal. After receiving above intravenous conscious sedation, an Olympus PCF160 pediatric colonoscope was introduced into the rectum under direct visualization. The scope was advanced through the entire colon,into the cecum which was identified by the ileocecal valve,appendiceal orifice, and triradiate fold. Throughout the colon,the bowel prep was satisfactory and adequate visualization of thecolon mucosa was obtained. The entire colon exam and colon mucosawas normal. There was no evidence of colitis, colon polyps, or mass lesions. Retroflexion exam in the rectum revealed moderate-sized internal hemorrhoids. The entire colonoscopy was normal. The procedure was completed without any complications.
RECOMMENDATIONS: Anusol HC cream 2.5% to the rectal area once a day for two weeks. Followup colonoscopy in ten years.

CASE STUDY #2:
PREOPERATIVE DIAGNOSES: A 66-year-old patient who needs colon cancer screening. Past history of mild left lower quadrant abdominal pain. Past history of chronic mild bright red rectal bleeding attributed to hemorrhoids. Family history of colon cancer.
MEDICATIONS USED: Fentanyl 100 mcg IV and Versed 4 mg IV.
DESCRIPTION OF PROCEDURE: The patient was placed in the left lateral position and a rectal examination done which was normal. An Olympus PCF-160 pediatric colonoscope was introduced into the rectum under direct visualization. The scope was advanced through the entire colon into the cecum which was identified by the ileocecal valve,appendiceal orifice, and triradiate fold. Throughout the colon, the bowel prep was satisfactory and adequate visualization of thecolon mucosa was obtained. Few small scattered diverticula werenoted in the sigmoid colon. The rest of the colon exam wascompletely normal. Retroflexion exam in the rectum revealed moderate size internal hemorrhoids. There was no active bleedingseen. The procedure was completed without any complications. The rest of the colonoscopy was normal.
RECOMMENDATIONS: High fiber diet and dietary precautions for diverticulosis. Anusol HC cream 2.5% to the rectal area once a day for two weeks. Follow up colonoscopy in five years.

CASE STUDY #3
PREOPERATIVE DIAGNOSES: A 41-year-old patient with melena, anemia of blood loss, rule out ulcerative colitis, Crohn's colitis, colon polyps, and colon cancer.
MEDICATIONS USED: Fentanyl 150 mcg IV and Versed 6 mg IV.
DESCRIPTION OF PROCEDURE: The patient was placed in the left lateral position and a rectal examination done which was normal. After receiving above intravenous conscious sedation, an Olympus PCF-160 pediatric colonoscope was introduced into the rectum under direct visualization. The scope was advanced through the entire colon into the cecum, which was identified by the ileocecal valve, appendiceal orifice, and triradiate fold. Throughout the colon, the bowel prep was satisfactory and adequate visualization of thecolon mucosa was obtained. There was slight amount of solid stool mixed with liquid stools in the cecum, however this area was thoroughly irrigated with water and adequate visualization was obtained. The entire colon exam and colon mucosa was normal. There was no evidence of colitis, colon polyps, or mass lesions. Retroflexion exam in the rectum revealed small internal hemorrhoids. There was no active bleeding seen.
RECOMMENDATIONS: Follow up on hemoglobin and hematocrit. Protonix. Follow up on gastric biopsy results.