Objective methods of diagnostics part 2

in the beginning

Sigmoidoscopy

Sigmoidoscopy is intended for objective examination of the rectum and distal Sigma.
In our country, widespread rectoromanoscopy produced by the plant "red guard" (model R-50 and R-60).
Rectoromanoscopy must be preceded by a digital examination of the rectum. It is not only for diagnostics, but also to prepare the anal canal to the introduction of rectoromanoscopy. Thanks to lubricate the anus and anal canal, and some stretching sphincter during finger study subsequent introduction proctoscope is easy and does not cause pain to the patient.
Sigmoidoscopy, usually held in the knee-shoulder position (the patient comes to the table left shoulder). This situation allows for multiple straighten rectosigmoid angle. In the mucous becomes the most accessible inspection and requires almost no insufflation (air flow in the gut). In some cases (severe condition of the patient) study is performed with the patient on the left side of the belly and his feet. In such conditions to make sigmoidoscopy is much more difficult, because the intestine squeezed the side of the abdominal cavity and to promote rectoromanoscopy need constant insufflate intestine.
Sigmoidoscopy requires careful preparation: the presence of feces even in some parts of the intestine may cause polyp, for example, will not be detected. Rectoromanoscopy the study begins with the fact that abundantly greased with vaseline ointment rectoromanoscopy is introduced into the rectum to a depth of 5 cm Then taken out of the rod, the opening is closed with the protection cover with glass. Further promotion of rectoromanoscopy performed at lit field of view and under the control of the eyes.
First of all looks ampulla of the rectum. The device is moving forward and slightly upwards towards the inner surface of the sacrum. At a depth of 12 cm from the anus rectoromanoscopy translates into a horizontal position, and the distal end of the instrument is rotated to the right, which corresponds to the anatomical bending intraperitoneal cut rectum. Overcoming rectosigmoid Department with a small insufflation, rectoromanoscopy turned in the direction of the distal Sigma. Next tool is generally freely moving through the lumen of the sigmoid colon.
Full rectoromanoscopy the study can be considered only in those cases when rectoromanoscopy manage to hold on depth not less than 30 cm In some cases, with additional loops Sigma, a tube of rectoromanoscopy, resting in a bend in the wall stretches the intestine. The false impression that rectoromanoscopy introduced on all depth. Therefore, you should use the following method. Rectoromanoscopy given back to 8-10 cm, then moving again. This is repeated until then, until achieved straightening loop sigmoid colon and smoothing her crotch. Often by using this technique can achieve full disclosure of the intestinal lumen and then to review revealed not only the scope of the study, according to length of rectoromanoscopy, but also part of the intestine length 5-10 cm above.
During rectoromanoscopy studies have examined the state of the mucous membrane. Special attention is paid to the sites located in the district of folds, because, as shown by numerous observations, during the advance of rectoromanoscopy these folds are able to cover a small tumors.
Here is an example. If additional loop sigmoid colon, resulting in a bend of the latter, at the height of 20-22 cm from the anal canal is often found transversely located fold, which is a tube of rectoromanoscopy given up and densely adjoins to the wall of the intestine. The result may be overlooked covered fold a small nodule. In these cases need to be especially careful inspection of the specified area when removing rectoromanoscopy, seeking pulling folds down in order to fully disclose its pocket. In General it should be noted that a thorough examination of all of the walls is possible in the process of extraction of rectoromanoscopy. Moreover, if output tool slowly, avoiding slipping it from the anus become a well available to the inspection nizhneamudarya Department of the rectum and the anal canal. These departments, as a rule, the introduction of the tube rectoromanoscopy remain neosmaslenne.

Colonoscopy

The logical development of the method of rectoromanoscopy was the creation of flexible colonoscopy on fiber optics that allow you to penetrate into all departments of the colon and identify the defeat mucous membrane of the smallest sizes. Extensive clinical material suggests that if, for example, if rectoromanoscopy detected 2 or more polyps, a significant percentage (33%) polyps are found in the colon. Thus, this group of patients should be subjected to preventive colonoscopy.
Colonoscopy first established in the late 60-ies in Japan. The principle of the device is based on the transmission of images on a flexible beam fiberglass total reflection.
Preparation of the patient to the study is the appointment of a sick for 3 days prior to the study, bessekeevaa diet. A day before colonoscopy patient takes a laxative, 12 and 2 h before the examination - cleansing enema.
The conduct of the colonoscope on the colon is sometimes accompanied by pain. The cause of the pain may be stretching a colonoscopy bowel or air that is introduced into the rectum for disclosure of her crotch. However, experience shows that colonoscopy should begin without prior anaesthesia. Analgesic and spasmolytic tools should be introduced parenteral during the colonoscope at increased painful reaction or excessive bowel spasms.
The study begins with the patient on their left sides with their legs bent at the knee and hip joints feet. The distal end of the colonoscope, greased with a thin layer of paraffin oil is injected into the rectum via the anus dilator. At this time the distal end is not fixed and is in the rectum until rectosigmoid Department, as a rule, freely. If the bowel lumen disappears from view, it is necessary to delay the colonoscope ago before the advent of ground clearance and re-enter it during the intestine. The entrance to rectosigmoid Department (14-16 cm from the anus) found turns the distal end of the device. Finding the entrance to the sigmoid colon (which is often to be done using insufflation), the distal end of the record. Further promotion of it occurs at a constant manipulation of controls. The only way to ensure that the distal end of the device installed in the centre of the colonic lumen, following all her curves.



Biopsy

This method is used to diagnose many diseases of the colon: polyps, cancer, etc. are Often the results of biopsy depends on the further course of all remedial measures. It is important to take a piece of tissue, which is then subjected to histological analysis.
Biopsy through rectoromanoscopy is held with the long tongs, with the tips in the form of acute round of cups. If the biopsy is performed from the distal intestine, usually used short rectoromanoscopy and small forceps, because to manipulate long, much harder.
The biopsy does not require anesthesia, for they do not cause patients much pain.
Much more difficult is the method of kolonovits. It requires special skills. The high qualifications of the researcher is all the more necessary that colonise often used in such dangerous conditions, as a malignant tumor and ulcerative colitis.

Microbiological studies

In the diagnosis of diseases of the colon microbiological methods is essential.
In this study, the authors describe the main associative forms of dysbacteriosis that broadened the diagnosis of the disease, allow a more differentiated approach to the issues of therapy.