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Upper endoscopy enables the physician to look
inside the esophagus, stomach, and duodenum (first part of the small
intestine). The procedure might be used to discover the reason for
swallowing difficulties, nausea, vomiting, reflux, bleeding,
indigestion, abdominal pain, or chest pain. Upper endoscopy is also
called EGD, which stands for esophagogastroduodenoscopy
(eh-SAH-fuh-goh-GAS-troh-doo-AH-duh-NAH-skuh-pee).
For the procedure you will swallow a thin,
flexible, lighted tube called an endoscope (EN-doh-skope). Right before
the procedure the physician will spray your throat with a numbing agent
that may help prevent gagging. You may also receive pain medicine and a
sedative to help you relax during the exam. The endoscope transmits an
image of the inside of the esophagus, stomach, and duodenum, so the
physician can carefully examine the lining of these organs. The scope
also blows air into the stomach; this expands the folds of tissue and
makes it easier for the physician to examine the stomach.
The physician can see abnormalities, like
inflammation or bleeding, through the endoscope that don't show up well
on x rays. The physician can also insert instruments into the scope to
remove samples of tissue (biopsy) for further tests or treat bleeding
abnormalities.
Possible complications of upper endoscopy include
bleeding and puncture of the stomach lining. However, such complications
are rare. Most people will probably have nothing more than a mild sore
throat after the procedure.
The procedure takes 20 to 30 minutes. Because you
will be sedated, you will need to rest at the endoscopy facility for 1
to 2 hours until the medication wears off.
Your stomach and duodenum must be empty for the
procedure to be thorough and safe, so you will not be able to eat or
drink anything for at least 6 hours beforehand. Also, you must arrange
for someone to take you home--you will not be allowed to drive because
of the sedatives. Your physician may give you other special
instructions. |
Esophageal Strictures
The esophagus is a relatively simple tubular structure connecting the
throat to the stomach. The major functions of the stomach are to transport
ingested food from the oropharynx to the stomach and to prevent
regurgitation of food and gastric contents from the stomach back up into the
esophagus. At the same time it allows air to be vented out of the stomach
thus relieving abdominal bloating. On occasion, a narrowed area will occur
in the esophagus resulting in an interruption in the normal swallowing
mechanism. This may result in dysphagia or difficulty swallowing. Passage of
food or liquid may be impaired through the esophagus with a sensation of a
fullness in the chest, pressure-like sensation, shortness of breath and
inability to swallow food, liquids or saliva. In many cases this is
transient in nature and may only last a short time but on occasion may be
prolonged requiring emergent intervention.
This narrowing of the esophagus can be caused by many different
conditions. The most common of which is a benign stricture. This is the
result of peptic esophagitis or gastroesophageal reflux disease and can
occur at any age but is more common after the age of 40. The fundamental
abnormality is excessive acid reflux from the stomach up into the esophagus
resulting in an inflammatory reaction in the lower esophagus that leads to
scarring after repeated injury and healing. Eventually, scar tissue is
formed and a benign stricture develops which is in the form of a concentric
ring that narrows the opening of the esophagus. A hiatal hernia is often
present in association with the reflux. This concentric lower esophageal
ring sometimes called a Schatzki's ring often occurs at the junction between
the esophagus and the stomach and sometimes can be present for years. When
diagnosed, it can be easily treated by passage of a dilator through the area
to break open the scar tissue and relieve the narrowed area.
Other causes of benign esophageal strictures may be congenital in nature
such as a membranous diaphragm or web that can occur anywhere in the
esophagus but frequently occurs in the upper portion. This is also treated
by dilation either through an endoscope or by passage of Bougie dilator.
Other conditions leading to benign strictures include corrosive injury to
the esophagus from ingestion of a toxic substance (i.e. cleaning solutions,
radiation injury to the esophagus, post surgical strictures, or achalasia,
which is a gradual thickening of the musculature at the lower end of the
esophagus).
Other conditions could cause dysphagia (difficulty swallowing), even
though no stricture is present. In that case, various neurological
conditions, vascular abnormalities, diverticulum, spastic motility
disorders, or skeletal muscle disorders like muscular dystrophy and
myasthenia gravis are possibilities.
In addition to the above, a malignant condition may develop causing a
stricture or narrowing of the esophagus. There are about 11,000 new cases of
cancer of the esophagus diagnosed yearly and is correlated with smoking or
excessive alcohol ingestion, particularly in young adulthood. It is more
frequent in men than women and also more frequent in blacks than whites.
Esophageal cancer can develop anywhere along the esophagus but is more
frequent in the lower portion. A condition called Barrett's esophagus may
occur in the lower esophagus due to chronic gastroesophageal reflux disease.
This condition is diagnosed by esophageal biopsy and is reflected by a
change in the cellular structure of the lower esophagus. Patients who have
this condition are at higher risk for developing adenocarcinoma of the lower
esophagus and must be screened by performing upper endoscopy on a regular
basis.
Treatment of a benign esophageal stricture consists of esophageal
dilation. This is most commonly done at the time of an upper endoscopy. The
upper endoscopy is where a video endoscope is placed through the mouth into
the esophagus while the patient is under an IV sedation. The esophagus is
then examined and if a benign stricture is present it can be dilated in
various ways. A balloon dilator passed through the endoscope is often
inflated within the confines of the stricture, thus opening the area and
relieving the patient's symptoms. Other types of dilators may also be passed
although not through the endoscope. These are called Mallony or savory
dilators in increasing sizes in order to break open the stricture. In either
case, the patients are sedated and should not feel anything during the
procedure. The risks of a dilation include potential bleeding, infection or
a tear. If a tear is deep enough, on rare occasion, it might require
surgical repair.
Treatment of a malignant stricture of the esophagus is available but can
often be disappointing. If the malignancy is determined to be small and
localized without any spread beyond the esophagus then a surgical repair is
often opted for and may, on rare occasion cure the cancer. If the tumor is
not curable, then often, palliative treatments are employed which include
chemotherapy, radiation therapy, esophageal dilation, laser treatments,
injections, tumor probes or placement of an esophageal stent (wire mesh
tube) to keep the esophagus open. In any situation the patient must work
closely with his or her physician to decide what is the best approach for
that individual since it varies from patient to patient.
Endoscopic retrograde cholangiopancreatography
(en-doh-SKAH-pik REH-troh-grayd koh-LAN-jee-oh-PANG-kree-uh-TAH-gruh-fee)
(ERCP) enables the physician to diagnose problems in the liver, gallbladder,
bile ducts, and pancreas. The liver is a large organ that, among other
things, makes a liquid called bile that helps with digestion. The
gallbladder is a small, pear-shaped organ that stores bile until it is
needed for digestion. The bile ducts are tubes that carry bile from the
liver to the gallbladder and small intestine. These ducts are sometimes
called the biliary tree. The pancreas is a large gland that produces
chemicals that help with digestion and hormones such as insulin.
ERCP is used primarily to diagnose and treat conditions
of the bile ducts including gallstones, inflammatory strictures (scars),
leaks(from trauma and surgery), and cancer. ERCP combines the use of x rays
and an endoscope, which is a long, flexible, lighted tube. Through it, the
physician can see the inside of the stomach and duodenum, and inject dyes
into the ducts in the biliary tree and pancreas so they can be seen on x
rays.
For the procedure, you will lie on your left side on an
examining table in an x ray room. You will be given medication to help numb
the back of your throat and a sedative to help you relax during the exam.
You will swallow the endoscope, and the physician will then guide the scope
through your esophagus, stomach, and duodenum until it reaches the spot
where the ducts of the biliary tree and pancreas open into the duodenum. At
this time, you will be turned to lie flat on your stomach, and the physician
will pass a small plastic tube through the scope. Through the tube, the
physician will inject a dye into the ducts to make them show up clearly on x
rays. X rays are taken as soon as the dye is injected.
If the exam shows a gallstone or narrowing of the
ducts, the physician can insert instruments into the scope to remove or
relieve the obstruction. Also, tissue samples (biopsy) can be taken for
further testing.
Possible complications of ERCP include pancreatitis
(inflammation of the pancreas), infection, bleeding, and perforation of the
duodenum. Except for pancreatitis, such problems are uncommon. You may have
tenderness or a lump where the sedative was injected, but that should go
away in a few days.
ERCP takes 30 minutes to 2 hours. You may have some
discomfort when the physician blows air into the duodenum and injects the
dye into the ducts. However, the pain medicine and sedative should keep you
from feeling too much discomfort. After the procedure, you will need to stay
at the hospital for 1 to 2 hours until the sedative wears off. The physician
will make sure you do not have signs of complications before you leave. If
any kind of treatment is done during ERCP, such as removing a gallstone, you
may need to stay in the hospital overnight.
Your stomach and duodenum must be empty for the
procedure to be accurate and safe. You will not be able to eat or drink
anything after midnight the night before the procedure, or for 6 to 8 hours
beforehand, depending on the time of your procedure. Also, the physician
will need to know whether you have any allergies, especially to iodine,
which is in the dye. You must also arrange for someone to take you home--you
will not be allowed to drive because of the sedatives. The physician may
give you other special instructions. |
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Sclerotherapy for esophageal varices (also called
endoscopic sclerotherapy)
Author/s: Lori De Milto
Definition
Sclerotherapy for esophageal varices (also called
endoscopic sclerotherapy) is a treatment for esophageal bleeding that
involves the use of an endoscope and the injection of a sclerosing
solution into veins.
Purpose
In most hospitals, sclerotherapy for esophageal
varices is the treatment of choice to stop esophageal bleeding during
acute episodes, and to prevent further incidences of bleeding. Emergency
sclerotherapy is often followed by preventive treatments to eradicate
distended esophageal veins.
Precautions
Sclerotherapy for esophageal varices cannot be
performed on an uncooperative patient, since movement during the
procedure could cause the vein to tear or the esophagus to perforate and
bleed. It should not be performed on a patient with a perforated
gastrointestinal tract.
Description
Esophageal varices are enlarged or swollen veins on
the lining of the esophagus which are prone to bleeding. They are
life-threatening, and can be fatal in up to 50% of patients. They
usually appear in patients with severe liver disease. Sclerotherapy for
esophageal varices involves injecting a strong and irritating solution
(a sclerosant) into the veins and/or the area beside the distended vein.
The sclerosant injected into the vein causes blood clots to form and
stops the bleeding. The sclerosant injected into the area beside the
distended vein stops the bleeding by thickening and swelling the vein to
compress the blood vessel. Most physicians inject the sclerosant
directly into the vein, although injections into the vein and the
surrounding area are both effective. Once bleeding has been stopped, the
treatment can be used to significantly reduce or destroy the varices.
Sclerotherapy for esophageal varices is performed by a
physician in a hospital, with the patient awake but sedated. Hyoscine
butylbromide (Buscopan) may be administered to freeze the esophagus,
making injection of the sclerosant easier. During the procedure, an
endoscope is passed through the patient's mouth to the esophagus to view
the inside. The branches of the blood vessels at or just above where the
stomach and esophagus come together, the usual site of variceal
bleeding, are located. After the bleeding vein is identified, a long,
flexible sclerotherapy needle is passed through the endoscope. When the
tip of the needle's sheath is in place, the needle is advanced, and the
sclerosant is injected into the vein or the surrounding area. The most
commonly used sclerosants are ethanolamine and sodium tetradecyl
sulfate. The needle is withdrawn. The procedure is repeated as many
times as necessary to eradicate all distended veins.
Sclerotherapy for esophageal varices controls acute
bleeding in about 90% of patients, but it may have to be repeated within
the first 48 hours to achieve this success rate. During the initial
hospitalization, sclerotherapy is usually performed two or three times.
Preventive treatments are scheduled every few weeks or so, depending on
the patient's risk level and healing rate. Several studies have shown
that the risk of recurrent bleeding is much lower in patients treated
with sclerotherapy: 30-50%, as opposed to 70-80% for patients not
treated with sclerotherapy.
Preparation
Before sclerotherapy for esophageal varices, the
patient's vital signs and other pertinent data are recorded, an
intravenous line is inserted to administer fluid or blood, and a
sedative is prescribed.
Aftercare
After sclerotherapy for esophageal varices, the
patient will be observed for signs of blood loss, lung complications,
fever, a perforated esophagus, or other complications. Vital signs are
monitored, and the intravenous line maintained. Pain medication is
usually prescribed. After leaving the hospital, the patient follows a
diet prescribed by the physician, and, if appropriate, can take mild
pain relievers.
Risks
Sclerotherapy for esophageal varices has a 20-40%
incidence of complications, and a one to two percent mortality rate.
Complications can arise from the sclerosant or the endoscopic procedure.
Minor complications, which are uncomfortable but do not require active
treatment or prolonged hospitalization, include transient chest pain,
difficulty swallowing, and fever, which usually go away after a few
days. Some people have allergic reactions to the solution. Infection
occurs in up to 50% of cases. In 2-10% of patients, the esophagus
tightens, but this can usually be treated with dilatation. More serious
complications may occur in 10-15% of patients treated with sclerotherapy.
These include perforation or bleeding of the esophagus and lung
problems, such as aspiration pneumonia. Long-term sclerotherapy can
damage the esophagus, and increase the patient's risk of developing
cancer.
Patients with advanced liver disease complicated by
bleeding are very poor risks for this procedure. The surgery,
premedications, and anesthesia may be sufficient to tip the patient into
protein intoxication and hepatic coma. The blood in the bowels acts like
a high protein meal; therefore, protein intoxication may be induced.
Key Terms
- Endoscope
- An instrument used to examine the inside of a
canal or hollow organ. Endoscopic surgery is less invasive than
traditional surgery.
- Esophagus
- The part of the digestive canal located between
the pharynx (part of the digestive tube) and the stomach.
- Sclerosant
- An irritating solution that stops bleeding by
hardening the blood or vein it is injected into.
- Varices
- Swollen or enlarged veins, in this case on the
lining of the esophagus.
Esophageal Varices
Varicose Veins in Esophagus
Varicose veins in the esophagus (known as varices) are similar to the
varicose veins often seen in the legs. In short, they are twisted, dilated
veins that develop because of increased pressure in the venous system.
In the esophagus, varices often stem from high pressures in the portal
venous system, which are veins that normally drain into the liver from the
intestinal tract. Increased pressure in the portal venous system is most
often the result of cirrhosis in the liver. As the portal venous pressure
goes up, the blood must be diverted to other veins, and is then channeled
most commonly to varices in the esophagus.
Varices can also occur in the stomach and in the rectum, although less
commonly. The problem that is often encountered with varices is their
propensity to bleed. Bleeding occurs because of increased tension in the
wall of the varices, leading to rupture. Bleeding varices are a dreaded
complication of cirrhosis, with the death rate approaching 30 to 50 percent.
Patients with bleeding varices usually vomit blood and/or pass black
stools. By the time they get medical help, they often have lost significant
amounts of blood and have low blood pressure requiring resuscitation. The
therapy for bleeding varices involves an upper endoscopy to pinpoint the
site of bleeding, followed by injection of a solution to destroy the varices
or, as you mentioned, variceal banding.
Banding involves using an endoscope to place a small, rubber band around
a varicose vein. This effectively cuts off the blood flow, and, over the
next several days, the rubber band and the tissue within it will
spontaneously fall off. The esophagus lining at the site will slowly heal.
Banding is very effective in eradicating varices, and it often is repeated
at set intervals over weeks until all the varices have been obliterated.
The most common side effect after banding is difficulty swallowing. Some
patients feel that food is becoming stuck in their esophagus. The reason for
this is that the bands (as many as 12 may be placed at one session) take up
space in the esophagus. Thus, food that passes by them may get held up
temporarily. The gastroenterologist that performs the banding will usually
inform the patient about the possibility of this occurring. Avoiding solid
foods such as meat and chicken for the first couple of days after banding
will help avoid this side effect.
On the other hand, pain is uncommon after a banding procedure, and
medications for pain are not given routinely.
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Normal |

Abnormal |
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- The esophagus is the tube in the chest that carries food from the
mouth to the stomach. It has a system of veins that take blood from
the esophagus back to the heart. This system is connected to the same
venous system as the liver (called the portal veins). When the liver
is damaged (most commonly by
Cirrhosis), fluid backs up in the portal veins, blocking
the veins of the esophagus. The esophageal veins then dilate
(distended much beyond their normal size); the walls weaken and burst
like a balloon. When this occurs, there may be massive bleeding in
the esophagus.
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| Symptoms |
- Vomiting bright red blood or coffee-ground material
- Individual may pass tar/black stool or blood in the stool
- Usually, there are signs of
Cirrhosis
- Swollen abdomen, red hands, enlarged breasts in males, yellow eyes
or skin
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| Cause |
- Liver Cirrhosis
(any type may be the cause, including alcohol or
Hepatitis B or C)
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Lower GI Series
A lower gastrointestinal (GI) series uses x rays to
diagnose problems in the large intestine, which includes the colon and
rectum. The lower GI series may show problems like abnormal growths, ulcers,
polyps, and diverticuli, and colon cancer.
Before taking x rays of your colon and rectum, the
radiologist will put a thick liquid called barium into your colon. This is
why a lower GI series is sometimes called a barium enema. The barium coats
the lining of the colon and rectum and makes these organs, and any signs of
disease in them, show up more clearly on x rays. It also helps the
radiologist see the size and shape of the colon and rectum.
You may be uncomfortable during the lower GI series.
The barium will cause fullness and pressure in your abdomen and will make
you feel the urge to have a bowel movement. However, that rarely happens
because the tube used to inject the barium has a balloon on the end of it
that prevents the liquid from coming back out.
You may be asked to change positions while x rays are
taken. Different positions give different views of the intestines. After the
radiologist is finished taking x rays, you will be able to go to the
bathroom. The radiologist may also take an x ray of the empty colon
afterwards.
A lower GI series takes about 1 to 2 hours. The barium
may cause constipation and make your stool turn gray or white for a few days
after the procedure.
Your colon must be empty for the procedure to be
accurate. To prepare for the procedure you will have to restrict your diet
for a few days beforehand. For example, you might be able to drink only
liquids and eat only nonsugar, nondairy foods for 2 days before the
procedure; only clear liquids the day before; and nothing after midnight the
night before. A liquid diet means fat-free bouillon or broth, gelatin,
strained fruit juice, water, plain coffee, plain tea, or diet soda. To make
sure your colon is empty, you will be given a laxative or an enema before
the procedure. Your physician may give you other special instructions.
Colonoscopy
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The digestive system |
Colonoscopy (koh-luh-NAH-skuh-pee) lets the physician look inside your
entire large intestine, from the lowest part, the rectum, all the way up
through the colon to the lower end of the small intestine. The procedure is
used to look for early signs of cancer in the colon and rectum. It is also
used to diagnose the causes of unexplained changes in bowel habits.
Colonoscopy enables the physician to see inflamed tissue, abnormal growths,
ulcers, and bleeding.
For the procedure, you will lie on your left side on the examining table.
You will probably be given pain medication and a mild sedative to keep you
comfortable and to help you relax during the exam. The physician will insert
a long, flexible, lighted tube into your rectum and slowly guide it into
your colon. The tube is called a colonoscope (koh-LON-oh-skope). The scope
transmits an image of the inside of the colon, so the physician can
carefully examine the lining of the colon. The scope bends, so the physician
can move it around the curves of your colon. You may be asked to change
position occasionally to help the physician move the scope. The scope also
blows air into your colon, which inflates the colon and helps the physician
see better.
If anything abnormal is seen in your colon, like a polyp or inflamed
tissue, the physician can remove all or part of it using tiny instruments
passed through the scope. That tissue (biopsy) is then sent to a lab for
testing. If there is bleeding in the colon, the physician can pass a laser,
heater probe, or electrical probe, or inject special medicines through the
scope and use it to stop the bleeding.
Bleeding and puncture of the colon are possible complications of
colonoscopy. However, such complications are uncommon.
Colonoscopy takes 30 to 60 minutes. The sedative and pain medicine should
keep you from feeling much discomfort during the exam. You will need to
remain at the endoscopy facility for 1 to 2 hours until the sedative wears
off.
Preparation
Your colon must be completely empty for the colonoscopy to be thorough
and safe. To prepare for the procedure you may have to follow a liquid diet
for 1 to 3 days beforehand. A liquid diet means fat-free bouillon or broth,
strained fruit juice, water, plain coffee, plain tea, or diet soda. Gelatin
or popsicles in any color but red may also be eaten. You will also take one
of several types of laxatives the night before the procedure. Also, you must
arrange for someone to take you home afterward--you will not be allowed to
drive because of the sedatives. Your physician may give you other special
instructions. Inform your physician of any medical conditions or medications
that you take before the colonscopy.
Upper GI Series
The upper gastrointestinal (GI) series uses x rays to
diagnose problems in the esophagus, stomach, and duodenum (first part of the
small intestine). It may also be used to examine the small intestine. The
upper GI series can show a blockage, abnormal growth, ulcer, or a problem
with the way an organ is working.
During the procedure, you will drink barium, a thick,
white, milkshake-like liquid. Barium coats the inside lining of the
esophagus, stomach, and duodenum and makes them show up more clearly on x
rays. The radiologist can also see ulcers, scar tissue, abnormal growths,
hernias, or areas where something is blocking the normal path of food
through the digestive system. Using a machine called a fluoroscope, the
radiologist is also able to watch your digestive system work as the barium
moves through it. This part of the procedure shows any problems in how the
digestive system functions, for example, whether the muscles that control
swallowing are working properly. As the barium moves into the small
intestine, the radiologist can take x rays of it as well.
An upper GI series takes 1 to 2 hours. X rays of the
small intestine may take 3 to 5 hours. It is not uncomfortable. The barium
may cause constipation and white-colored stool for a few days after the
procedure.
Your stomach and small intestine must be empty for the
procedure to be accurate, so the night before you will not be able to eat or
drink anything after midnight. Your physician may give you other specific
instructions.
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MRI Scan |
What is
MRI ?
Magnetic Resonance Imaging (MRI) is a
painless way to look inside a patient's body without using X-ray.
Instead, a large magnet, radio waves and a computer are used to scan the
patient's body and produce detailed pictures that cannot be seen on
conventional x-rays.
How does an MRI scanner work?
The human body is composed of small particles called atoms. Hydrogen
atoms, or water make up about 95 percent of the body. Normally, the
hydrogen atoms within the patient's body spin around at random. However
when a patient is placed inside a strong magnetic field, the hydrogen
atoms line up and spin in the same direction. When a radio wave is
passed through the body, the hydrogen atoms give off a signal. That
signal, with the aid of a computer, becomes the source of MRI
information. It produces the images that will assist a physician in
making a diagnosis and planning a treatment.
Why is MRI important?
MRI offers a non-invasive way to obtain information about a
patient's body that may otherwise not be as easily seen. It can lead to
early detection and treatment of disease and has no known side effects.
MRI makes it possible to see certain types of tissue and can provide
important information about the brain, spine, joints and internal
organs.
What can I expect?
When your physician refers you for an MRI exam, make sure you
discuss with your physician all your questions and concerns. It's
important to tell your physician if you have a pacemaker, think you may
be pregnant or other medical conditions (such as Parkinson's Disease,
claustrophobia, severe pain, etc) that could interfere with the
procedure.
If you have a history of claustrophobia (fear of
closed-in places) or severe painful medical condition, it may be
necessary for your physician to prescribe a mild sedative or analgesic.
Also, it is very important to let your physician know if you even
suspect you have anything metallic within your body, such as surgical
clips, joint or bone pins, metal plates or unremoved bullets, shrapnel
or BB shot. These materials may interfere with the examination.
When you arrive, a technologist or nurse will ask you
questions to screen you for certain contraindications for MRI imaging.
They will ask you to remove excessive metallic/glittery type make-up.
They will provide you with a gown, if needed, and instruct you which
articles of clothing needs to be removed. They will also provide you
with a safe and secure place to put your valuables. All credit cards,
watches, coins and keys must be removed and put away before scanning.
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Must I do
anything to prepare for the exam?
There is no required preparation for the examination unless you are
going to be sedated for claustrophobia/pain or having a special liver
imaging procedure with Feridex intravenous contrast agent.
If you are having any of the above you will be
asked to be fasting and off certain medications before the procedure.
Otherwise, you may go about your normal routine.
What happens during the
examination?
Before the scan, a technologist will assist you onto an automatic
scanning table. You will lie on your back, relaxed, with your arms in a
comfortable position, and your head on a pillow or headrest. It is
important that you move as little a possible during the exam.
The table will then slide you very smoothly into
the opening. You will not feel anything, but you may hear a sort of
bumping noise and the hum of the machine. This is normal.
A speaker is installed in the magnet to allow you
to communicate with the technologist during the procedure if you wish.
The technologist can always hear you, see you, and will always be only a
couple of steps away from you.
When a contrast agent is
needed.
In some cases, the Radiologist may order an IV contrast (imaging
enhancement) agent. This is a fluid injected into a vein in your arm. It
helps to make the details in MRI images clearer and is standard for some
types of MRI scans.
How long does it take?
Depending on the type of exam, the total amount of time typically
30-60 minutes. It is over before you know it! Some people even go to
sleep.
When the exam is completed, the technologist and or
nurse will help you off the table and direct you to collect your
personal belongings.
How will I find out the
results.
Your scan will be read by the Radiologist on staff after it is
completed by the technologist. The final report will be available for
your physician within 24-72 hours. |
Schering AG (SHR)
Release: New MRI Liver Contrast Agent Primovist(TM) Approved In
Sweden
BERLIN, Germany, April 5 /PRNewswire-FirstCall/ -- Schering AG
Group, Germany (FSE: SCH, NYSE: SHR) announced today that the
Swedish health authority MPA has granted marketing approval
for its innovative liver
imaging product Primovist(TM) (gadoxetic acid disodium).
Primovist(TM) is designed for the detection and
characterization of liver lesions by
magnetic resonance imaging ( MRI)
including liver tumors, metastases as
well as other malignant and
benign lesions. Based on the Swedish
registration Schering will start a mutual recognition
procedure for the European Union with Sweden acting as
reference member state. EU registration is expected in most
countries within 2004. "Primovist(TM) is a new
gadolinium based contrast medium that
offers the possibility to simultaneously detect, locate and
distinguish various types of liver lesions, thus providing a
powerful tool for radiologists that increases the diagnostic
confidence", said Michael Rook, Head of Diagnostics &
Radioparmaceuticals at Schering AG. "Furthermore, an
examination with Primovist(TM) - requiring only one single
contrast media injection - improves patient convenience and
may have a positive impact on healthcare costs. By adding
Primovist(TM) to our imaging portfolio, Schering further
strengthens its position as true innovator and as the world's
leading company in the field of MRI contrast media."
The clinical development of Primovist(TM) has taken place
globally and has proven distinct diagnostic
efficacy and an excellent safety profile. Submission for
approval in Japan and other Asian countries, where liver
examinations are particularly frequent, is planned within this
year.
Additional information
Primovist(TM) is chemically related to Schering's
Magnevist(r) (Gd-DTPA) which has been the world's leading MRI
contrast agent for more than 15 years. Like Magnevist(r) it
brightens the signal of T1-weighted MR images.
Owing to its structural properties, Primovist(TM) is
specifically taken up by liver cells (hepatocytes),
thus enhancing healthy liver tissue (parenchymal
enhancement). Lesions with no or minimal
hepatocyte function (cysts, metastases, the majority of
hepatocellular carcinomas) will remain unenhanced and will
therefore be more readily detected and localized. Primovist(TM)
furthermore provides useful diagnostic information at the time
immediately after contrast administration (dynamic imaging)
and thus also supports lesion
characterization (i.e. distinction of different types of liver
lesions).
Schering AG is a research-based pharmaceutical company. Its
activities are focused on four business areas: Gynecology&Andrology,
Diagnostics&Radiopharmaceuticals,
Dermatology as well as Specialized Therapeutics for
disabling diseases in the fields of the
central nervous system, oncology and
cardiovascular system. As a global
player with innovative products Schering AG aims for leading
positions in specialized markets worldwide. With in-house R&D
and supported by an excellent global network of external
partners, Schering AG is securing a promising product
pipeline. Using new ideas, Schering AG aims to make a
recognized contribution to medical progress and strives to
improve the quality of life: making medicine work
This press release has been published by Corporate
Communication of Schering AG, Berlin, Germany.
Your contacts:
Business: Dr Friedrich von Heyl, T: +49-30-468-152-96;
friedrich.vonheyl@schering.de
Investor Relations: Peter Vogt, T: +49-30-468-128-38,
peter.vogt@schering.de
Pharma: Dr Claudia Schmitt, T: +49-30-468-158-05,
claudia.schmitt@schering.de
Your contacts in the US:
Media Relations: Kimberley Jordan, T:+1-973-487-2592,
kimberley_jordan@berlex.com
Investor Relations: Joanne Marion, T: +1-973-487-2164,
joanne_marion@berlex.com
Find additional information at: www.schering.de/eng
Certain statements in this press release that are neither
reported financial results nor other historical information
are forward-looking statements, including but not limited to,
statements that are predictions of or indicate future events,
trends, plans or objectives. Undue reliance should not be
placed on such statements because, by their nature, they are
subject to known and unknown risks and uncertainties and can
be affected by other factors that could cause actual results
and Schering AG's plans and objectives to differ materially
from those expressed or implied in the forward-looking
statements. Certain factors that may cause such differences
are discussed in our Form 20-F and Form 6-K reports filed with
the U.S. Securities and Exchange Commission.
Schering AG undertakes no obligation to update publicly or
revise any of these forward-looking statements, whether to
reflect new information or future events or circumstances or
otherwise.
Schering AG
CONTACT: Business: Dr Friedrich von Heyl, tel
+49-30-468-152-96;friedrich.vonheyl@schering.de, Investor
Relations: Peter Vogt,tel +49-30-468-128-38, peter.vogt@schering.de,
Pharma: DrClaudia Schmitt, tel
+49-30-468-158-05,claudia.schmitt@schering.de or Your contacts
in the US: MediaRelations: Kimberley Jordan, tel
+1-973-487-2592,kimberley_jordan@berlex.com, Investor
Relations: Joanne Marion,tel +1-973-487-2164, joanne_marion@berlex.com
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CT Scan
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What is a CT Scan?
A CT (Computed Tomography) scan, often
called a CAT (Computed Axial Tomography) scan, is a painless examination
that gives the physician an unobstructed, cross-sectioned look at organs
and structures that cannot be seen clearly on conventional X-rays.
How does CT
scanner work?
The CT scan combines a sophisticated X-ray system with a high-speed
computer. The scanner obtains slices (blocks of image data that can be
viewed on an end to end projection) of information that will assist the
patient's physician in making a diagnosis and planning a treatment. This
combination produces a picture of the body, allowing the physician to
see tissue and bone structures in fine detail. The imaging procedure and
the images are best described thinking of a loaf of bread. The entire
loaf being the part of the body that is scanned. Anywhere in the loaf of
bread a single slice can be picked out and looked at end to end.
Why is CT
important?
CT offers a non-invasive way to obtain information about the
patient's body that may otherwise not be as easily seen. It can lead to
early detection and treatment of disease and pathology by a physician.
CTs can make it possible to see various types of tissue and can provide
important information about the brain, spine, joints and internal
organs. The CT scan is a "window" into the body.
What can I
expect?
When your physician refers you for a CT exam, it is important to
talk to him/her about all of your questions or concerns. It is important
to tell your doctor if there is any chance you could be pregnant or
trying to get pregnant. You also need to inform your doctor if you are
allergic to iodine or presently taking a medication for diabetes called
glucophage. If abdominal imaging is planned, tell your doctor if and
when a previous barium exam was done. A recent barium exam could
interfere with a CT procedure.
When you arrive, a technologist and
or nurse will ask you certain questions pertaining to your medical
history and explain your procedure. You will be asked to change into a
hospital gown and be given a secure place to store your clothing and
valuables. Any metal or plastic objects will need to be removed before
your scan.
Some CT produces require two sets of
scans. The first scan will be without IV contrast and the second scan
will be with IV contrast. This is a normal CT technique that helps
differentiate tissue types. The IV contrast is injected into a vein in
your arm. For abdominal /pale CT procedures, you will also be asked to
drink an oral contrast (liquid barium). The oral contrast will highlight
and abnormal in your digestive tract. |
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Must I do
anything to prepare for the exam?
Yes. All contrast exams require that you do not eat or drink anything 4
hours before the procedure. You can take your prescribed medicines if
needed, under the direction of your physician. This can be discussed
when your exam is scheduled.
What happens
during the examination?
In the scanner room, there is a patient table and a structure with a
big round hole in the middle called a gantry. Before the scan, a
technologist will assist you onto the scanning table. Depending on the
type of CT exam being performed, you will be positioned either head of
feet first and in your back or abdomen.
When you are comfortable, the
technologist conducting the examination will move the table into the
gantry opening until you reach the first scan position. You will be
given specific instruction about how to breath during the scan,
depending on the type of scan you are having. At that point, all you
have to do is relax and remain still while each scan is being taken.
You can think of the CT scanner as a
fancy X-ray machine. Other than a sound like a clothes dryer, you won't
even notice when the system is on and taking pictures. Several scans are
taken while the table is moving; when the table is moving it is allowing
for a different scan location.
How will I
find out the results?
When the exam is complete, you may leave the facility. If IV and or
oral contrast was used, it will be necessary to drink additional
liquids, preferably water, throughout the day of the examination to help
eliminate the contrast from your system.
All procedures will be read by the
Radiologist on staff after the scan is completed by the technologist.
The final report will be available
for your physician within 24-72 hours. |
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Ultrasound
Ultrasound is the use of sound waves to obtain a medical
image of various organs, blood vessels and tissues of the body. It
cannot image bones or anything with air in it like the stomach or bowel.
It does not involve X-rays and is safe enough to image babies before and
after they are born. The test can be called an ultrasound or a sonogram.
Both terms mean the same test. |
What are some common uses of the
procedure?
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Ultrasound: Liver
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Ultrasound imaging is used extensively for evaluating the kidneys,
liver, gallbladder, pancreas, spleen, and blood vessels of the abdomen.
Because it provides real-time images, it can also be used to:
- Guide procedures such as needle biopsies, in
which needles are used to sample cells from organs for laboratory
testing.
- Help a physician determine the source of
many abdominal pains, such as stones in the gall bladder or kidney, or
an inflamed appendix.
- Help identify the cause for enlargement of
an abdominal organ.
Doppler ultrasound is a special type of ultrasound study that
examines major blood vessels. These images can help the physician to see
and evaluate:
- Blockages to blood flow, such as clots.
- Build-up of plaque inside the vessel.
- Congenital malformation.
With knowledge about the speed and volume of blood flow gained from
an ultrasound image, the physician can often determine whether a patient
is a good candidate for a procedure like angioplasty.
What is the exam like?
Most sonograms are easy and painless to have. A water soluble gel is
applied to the area and an imaging transducer will be slowly moved over
the area being imaged. The transducer sends a signal to an on-board
computer which processes the data and produces the ultrasound image. The
patient feels only a light pressure and movement of the transducer over
the part of the body being imaged. It is important to remain still and
relaxed during the procedure. The ultrasound images will appear on a
monitor and are recorded on film for a detailed study. It is from this
image that the diagnosis is made by a physician on staff.
How long will the exam take?
Most exams usually take 30 minutes with a few lasting from 1 to 11/2
hours. Some exams require a full urinary bladder and there could be some
delay if it is not full at the time of the exam.
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Who will perform and
interpret the exam?
All ultrasound exams done at St. Paul Medical Center are performed
by registered diagnostic medical sonographers.
The exams are interpreted by board certified
Radiologists on staff with some of the vascular exams interpreted by a
board certified Cardiologist on staff.
How will I learn the results?
The results will be made available to you from your physician or
health care provider who ordered the exam.
What are the limitations of
Abdominal Ultrasound Imaging?
Ultrasound waves are reflected by air or gas; therefore ultrasound is
not an ideal imaging technique for the bowel. Barium exams and CT
scanning are the methods of choice for bowel-related problems in most
cases.
Ultrasound waves do not pass through air; therefore an evaluation of
the stomach, small intestine and large intestine may be limited.
Intestinal gas may also prevent visualization of deeper structures, such
as the pancreas and aorta. Patients suffering from obesity are more
difficult to image—this is because tissue attenuates (weakens) the sound
waves as they pass deeper into the body.
Ultrasound has difficulty penetrating bone and therefore can only see
the outer surface of bony structures and not what lies within and
beyond. For visualizing bone or internal structures of certain joints,
waves do not reflect clearly from bone or air. For visualization of
bone, other imaging modalities, such as MRI (magnetic resonance
imaging), may be selected.
What are the benefits vs. risks?
Benefits
- Ultrasound scanning is noninvasive (no
needles or injections, in most cases) and is usually painless.
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- Ultrasound is widely available and easy
to use.
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- Ultrasound imaging uses no ionizing
radiation, and is the preferred image modality for diagnosis and
monitoring of pregnant women and their unborn infants.
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- Ultrasound provides real-time
imaging, making it a good tool for guiding minimally invasive
procedures such as needle biopsies.
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- Ultrasound images can visualize
structure, movement and live function in the body's organs and
blood vessels.
- Risks
- standard diagnostic ultrasound there are
no known harmful effects on humans.
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Reviewed May 28 04
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