Overview of GI Procedures – Transcript
Hi, my name is Mary Jane Harrington, I’m a GI nurse with Health Partners Riverside … GI stands for gastroenterology. We look at everything that has to do with your digestive tract and your digestive system. We’re here today to kind of explain a few things about some of the equipment we use and what to expect when you come in for a couple of tests your doctor might order.
We’re going to start with, I want to show you a small diagram, actually, it’s to scale, of the digestive tract. And we’re going to start with the top. You might have some problems that your doctor wants you to come in and have an exam called an EGD. It stands for esophogastroduodenoscopy, which is a little bit of a long name.
When you come in for this exam, you’ll come into a room that looks like this. Your nurse will have you lie down on the bed. You will be hooked up to some monitoring equipment, a blood pressure cuff, because you’re going to receive what’s called conscious sedation during this exam. Conscious sedation is not putting you to sleep. We’ll insert a small catheter in to your vein, which will be the avenue the doctor uses to give you sedation. You will receive two types of sedation for this exam. One of them is the narcotic. The narcotic is called Fentanyl. It’s a synthetic narcotic similar to Morphine, but it’s shorter-acting and much safer. You will also receive a sedative called Versed. Versed is similar to Valium, but there again it’s much shorter-acting and it’s much safer.
The reason for these two medications with this EGD exam are not because the exam is painful. It does not hurt. These two medications combined with the spray we use at the back of the throat (are) to relax your muscles and get rid of your gag reflex. In this examination most people are afraid they’re going to choke or gag. This is actually very unusual. The scope the doctor uses is this small. It’s smaller than most food you swallow. The diameter of the scope is actually smaller than a Tylenol tablet.
During this procedure, you’ll be lying on the left side, on your left side on a bed like this with your head on a pillow. The doctor will be on the side with the instrument and a nurse will be at the head of the bed. The nurse is there to monitor you, watch your vital signs, assist the physician and give you the medications. The doctor is concentrating his efforts on what he is doing with you.
He will have you insert a small bite block into your mouth, which you just gently bite with your teeth. He’ll insert the scope through this, across the back of your tongue and he will insert it down, all the way down your esophagus and into your stomach, look all around through your stomach with it. The scope is articulated so the doctor can look in every corner of your stomach. This does not hurt. You need to concentrate on your breathing and think about your breathing to keep you relaxed and keep your muscles relaxed. The exam itself takes between five and 10 minutes. And if the doctor takes any biopsies, if he gets in your esophagus or stomach, sees some irritated areas, or perhaps thinks you may have the bacteria that cause ulcers, they’ll take a little tissue sample. You do not feel this at all and this does not cause any problems or distress. It’s just a tiny piece of tissue. A person isn’t even aware that this is being done at the time.
Another type of test your doctor may send you to for various symptoms is called a colonoscopy. The colonoscopy is done with a video scope similar to the one for the upper, obviously, it’s a little bit larger and longer. It’s also articulated at the end, it’s very soft and very flexible. There’s a port in the scope to blow air into the colon, there’s a suction port, and there’s also a very bright light. There’s a video chip on the end of the scope. So the physician is actually watching on a television monitor.
You’ll have a nurse on one side of the bed, a physician on the other, the nurse will be giving the conscious sedation which is similar to what is used in the other exam.
During this test, most people experience the feeling of fullness, as if they’re going to have a bowel movement. This is from the air that the doctor is putting in. He needs air to expand the colon. He’ll enter through the rectum, and as he goes through the colon, he’s making his way all the way to the end of the large intestine, where it joins the small intestine. As he’s doing this and he’s turning the corners in the colon, there’s the sensation of fullness and sometimes some cramping, they feel like gas cramps. They don’t last very long. They can be intense but they usually last a matter of seconds. When the doctor gets to the end of the colon, those feelings go away and this is when they really get the good look. As he comes out of the colon, he’ll be using the scope. The doctor will look at every inch of the colon. It’s actually a visualization of the inside. If there are any small growths, which are called polyps — which are not cancerous, they are just growths, polyps themselves are not a cancerous, they can be a pre-cancerous condition — at that time, the doctor will remove them. There’s no pain involved in this removal. The colon only has the nerve endings that respond to pressure. That’s why any of the sensations in the colon feel like either a gas cramp or air movement.
Ah, if the doctor might see some pockets in the colon, called diverticulitus…
Some patients are very concerned about their privacy and dignity during these exams. We are very cognizant of that and want to keep, we do keep peoples’ privacy. During the exam the patient will remove their underwear and their pants in a private changing room. They’ll wear a pair of these shorts that are called moon pants because the patient is going to moon the doctor. The flap is facing the physician. The patient is covered up. The nurse is on the opposite side. So it’s actually very modest and very private.
If the doctor does remove any tissue during these exams or remove any polyps, which are small non-cancerous growths, you will be told about that before you leave and those pieces of tissue will be sent to the hospital to a pathologist, who will give a reading on them. Then your doctor will let you know within two weeks what the results of those are.
So, that’s it from the GI clinic. I hope this has helped relieve some fears people might have and answered some questions that you may have about what to expect with these exams. With these tests that we do, the worst part of it is getting ready for it. The tests themselves are a piece of cake.