Colonoscopy

This test is used to diagnose obstruction, bleeding, change in bowel habits, and
colon cancer, among other conditions. An informed consent is obtained before the
patient is given any type of anesthesia. A colonoscope is passed through the rectum
to visualize the anus, sigmoid, descending colon, splenic flexure, transverse
colon, hepatic flexure, ascending colon, and the ileo-cecal valve. The colon may
be insufflated to aid in visualization of the structures. Biopsies are obtained as
indicated. The scope is withdrawn and anesthesia is reversed. The patient may
experience abdominal distention. Risks include perforation of the large intestine.
The test is commonly performed as an outpatient procedure.

Reason for procedure:

Conditions that call for colonoscopies include gastrointestinal hemorrhage, unexplained
changes in bowel habit and suspicion of malignancy. Colonoscopies are often used to
diagnose colon cancer, but are also frequently used to diagnose inflammatory bowel disease. In
older patients (sometimes even younger ones) an unexplained drop in hematocrit (one sign
of anemia) is an indication that calls for a colonoscopy, usually along with
an esophagogastroduodenoscopy (EGD), even if no obvious blood has been seen in
the stool (feces).
Fecal occult blood is a quick test which can be done to test for microscopic traces of
blood in the stool. A positive test is almost always an indication to do a colonoscopy. In most
cases the positive result is just due to hemorrhoids; however, it can also be due to diverticulosis,
inflammatory bowel disease (Crohn's disease, ulcerative colitis), colon cancer, or polyps.
However—since its development by Dr. Hiromi Shinya and Dr. William I. Wolff in the 1960s--
polypectomy has become a routine part of colonoscopy, allowing for quick and simple removal
of polyps without invasive surgery.
Due to the high mortality associated with colon cancer and the high effectivity and low
risks associated with colonoscopy, it is now becoming a routine screening test for people
50 years of age or older. Subsequent rescreenings are then scheduled based on the initial
results found, with a five- or ten-year recall being common for colonoscopies that produce
normal results. Patients with a family history of colon cancer are often first screened during their
teenage years.
A study published in the New England Journal of Medicine (September 18, 2008) has
found that among people who have had an initial colonoscopy that found no polyps, the risk of
developing colorectal cancer within five years is extremely low. Therefore, there is no need for
those people to have another colonoscopy sooner than five years after the first screening.

Nursing Intervention:
Before the test—A thorough colon prep is necessary to ensure complete emptying
of the bowel prior to the procedure. The patient is NPO for several hours
prior to the test due to the use of an anesthetic agent.

After the test—Assess the abdomen for bowel sounds and tenderness. Monitor
vital signs. Assess the patient for side effects of anesthesia.