Endoscopy
The endoscopic evaluation of the patient with colorectal complaints forms the keystone of the physical examination. These examinations allow for the visualization of the entire intestinal tract and include anoscopy, proctoscopy, and colonoscopy as well as
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Key Concepts • The endoscopic examination is critical for patients with colorectal complaints and is a key component of the complete colorectal examination. • The anoscopic examination is the best way to adequately evaluate the anoderm, dentate line and evaluate for internal and external hemorrhoids, and anal masses. • Multiple bowel preparation regimens exist, but regardless of which prep is chosen, splitting the timing into the half the day prior to and half the day of the procedure results in a better prep. • There is no ideal sedation medication, but the endoscopist must be familiar with the side effect profile of any medications being used and be prepared and comfortable with any reversal agents. • Adjunctive maneuvers employed with endoscopy serve as the markers between seasoned experts and novices: these include abdominal pressure, adjusting position, torqueing, and dithering. • PillCam endoscopy allows the clinician to evaluate the small bowel for occult gastrointestinal bleeding, insipient tumors, polyposis syndromes, or Crohn’s disease.
The Complete Anorectal Examination While performing any anorectal or endoscopic examination, an anxiety-free and modest environment must be created. Most patients will exhibit nervousness, and apprehension, which can cause anal or gluteal spasm that will preclude an accurate assessment. The examiner must reassure the patient and keep anxiety and embarrassment to a minimum. This can be accomplished by effective communication, keeping the patient covered as much as possible, keeping ancillary personnel in the room to a minimum and not rushing through the examination. Physicians should strive to actively communicate with the patient as the examination is progressing. Before a discussion on endoscopic techniques, a thorough understanding of the initial steps of the anorectal examination is compulsory for success and patient well-being and satisfaction. Before any instrument is inserted, a focused history must be obtained coupled with a local examination. The local examination is an important precursor to any endoscopic examination and consists of: proper patient positioning, visual inspection, and manual palpation of the anorectal region followed by the digital rectal examination. Once this stepwise examination is complete, then inspection of the colon, rectum, and anus can commence.
Introduction The endoscopic evaluation of the patient with colorectal complaints forms the keystone of the physical examination. It allows the physician to visually assess the entirety of the intestinal tract from the mouth to the anus and allows for the diagnosis, treatment, and monitoring of the effectiveness of any therapy. It is imperative for all physicians treating patients with colorectal diseases to be facile in the more common endoscopic diagnostic and therapeutic techniques.
Patient Position There are two positions that may be used for effective anorectal examination. The choice of position may depend on several variables including available equipment, patient age and comorbid status,
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