FAQs on TIPSS(Transjugular Intrahepatic Portasystemic Stent Shunt)

Q- What Is TIPSS?

Ans- TIPSS

TIPSS stands for Transjugular Intrahepatic Portasystemic Stent Shunt. This procedure

 is used to treat a condition called portal hypertension.

What is portal hypertension ?

Sometimes with liver disease, blood flow through the liver is restricted causing an

 increase in the blood pressure in and around the liver. This is called Portal Hypertension. 

This back pressure of blood can cause a network of enlarged, weak varicose veins to 

develop in the gullet or stomach. These are called varices. If one of these veins

 ruptures severe bleeding can occur resulting in vomiting of blood or passing blood in

 the form of black stools.In patients who have fluid retention due to their liver disease,

 portal hypertension can result in a build up of fluid in the abdomen. This is called ascites.

How does t.i.p.s.s. work?

TIPSS is just one way to treat portal hypertension. It involves inserting a metal mesh 

tube (stent) through the liver which joins two large veins (the portal vein and 

hepatic vein). This allows blood to flow through the liver and relieves the portal

 hypertension which causes the varices. This stent remains in place permanently.

Prior to the procedure

• A TIPSS is sometimes inserted as an 'emergency' when other forms of treatment 
• are unable to stop severe bleeding of varices. In this situation the patient is taken
• straight to the Xray department soon after their admission to hospital.
• However sometimes the procedure can be planned ahead of time. In this case, a 
• few days before the procedure you will have various blood tests, and an ultrasound 
• scan of the liver as an in-patient. Sometimes a tracing of the heart is taken.
• The medical staff will explain the procedure and potential complications and
• you will be asked to sign a consent form.
• Before the procedure, you will be asked to eat nothing for at least 4 hours although
•  you will be allowed to drink, unless a general anaesthetic is being carried out. If this is
•  the case, you will have to fast.
• On the day of the TIPSS procedure you will be asked to change into a hospital gown.
•  A needle will be inserted into a vein in your arm through which you will be given
•  antibiotics. This is to prevent infection during or after the procedure.

How is the T.I.P.S.S. inserted?

• This procedure is carried out in the X-ray department and can take between 1-2 hours.
•  You will be asked to lie on a special Xray bed where you will be attached to monitors to
•  measure your heart rate and blood pressure. Sometimes patients are required to wear 
• oxygen masks.
• You will be given sedation through the needle in your arm which will make you drowsy
•  and relaxed. Only under special circumstances is a general anaesthetic required.
• Local anaesthetic is injected around the right side of your neck (or occasionally the
•  left side) to numb the area. A thin tube, called a central line, is inserted into the neck 
• vein. The TIPSS is passed into the central line and through the veins which lead to
•  the liver under X-ray guidance. The stent is then positioned in the liver. Blood 
• pressure readings of the liver are taken to check they have returned to normal.
• Once the procedure is complete, the monitors are removed and you will be transferred
•  back to the ward. The central line in your neck may be kept in place for use on the ward.

After the procedure

Once back in the ward you should remain on bed rest until the sedation has worn

 off. During this time nurses will monitor your blood pressure and pulse at regular 

intervals. You will be able to eat and drink once you are fully awake. If the central 

line has been removed, the needle in your hand may be kept in place in order for 

a second dose of antibiotics to be given 24 hours after the procedure.

Are there any possible complications ?

TIPSS procedure is a safe procedure with a very low frequency of complications,

 but occasionally the following can occur:

• Bruising around the injection site on the neck can occur following the procedure.
• This will clear after a few days. Occasionally this can be more severe, or the site
•  can actually bleed. Very rarely the blood can collect in the neck and can interfere
•  with breathing. The nursing staff will regularly check the neck site for this reason
•  when you return to the ward.
• Occasionally the injection site or more rarely the blood can become infected.
•  To reduce this risk, antibiotics are given. • There is a small risk of some bleeding
•  in or around the liver where the stent has been inserted. You will be monitored closely
•  for signs of this following the procedure.
• Over time the TIPSS can become narrowed or even block off. This could result in 
• bleeding again. If this happens, the TIPSS can be widened or a second stent 
• inserted if necessary. For this reason regular follow-up is important.

Follow up appointments

You will be routinely followed up in a hospital out-patients clinic. As well as this it is

 important that the TIPSS is checked regularly (usually every 6 months) to make sure 

it is still functioning. This ensures the pressure does not build up within the liver causing 

the problems you experienced previously. A TIPSS check involves a similar procedure 

to the TIPSS insertion and a small tube is inserted through the neck and passed into

 the liver. Dye is injected though this tube and x-rays are taken to see if the TIPSS is

 working. Blood pressures of the liver are also taken. If the flow through the shunt is not 

sufficient and the pressures are high, the TIPSS will be widened or a new TIPSS may 

be inserted. This usually involves an overnight stay in the ward before and sometimes

 after the procedure.It is very important to inform your doctor if you have any signs

 of bleeding after your TIPSS, such as dark stools or vomiting blood. This 

could be an indication that the TIPSS is not working.

FAQs on Oesophageal Dilatation

Q- What Is Oesophageal Dilatation?

Ans- Oesophageal Dilatation

The oesophagus is a muscular tube that pushes the food from the mouth

to the stomach. If the gullet gets narrowed, swallowing becomes difficult

and food intake can be severely impaired. Then the narrow part has to be

stretched up to allow proper swallowing. The procedure to stretch the gullet is

called oesophageal dilatation.

Who needs an oesophageal dilatation?

Usually prior to stretching of your gullet other tests such as a diagnostic

endoscopy (camera test) or a barium swallow (x-ray of the gullet) have shown

that your gullet has become narrowed. Usually this is the result of severe acid 

reflux from the stomach into the gullet causing acid burn and scarring, although in

some cases it can be due to a growth in the gullet or the result of previous surgery

in the oesophagus. Such individuals could be advised oesophageal dilatation.

Who will be doing the procedure and where?

A specialist Gastroenterologist with expertise in the procedure will be doing your test. 

The procedure is usually done in the Endoscopy Unit like any other camera test.

What is the preparation for the procedure?

• You need to be in hospital a few hours prior to the procedure to have a routine 
• clinical examination and some blood investigations done.
• You will be asked to fast for four to six hours prior to the procedure.
• A sedative and a painkiller will be given intravenously just before the procedure 
• to ensure that you are kept comfortable throughout the test.
• You will be asked to put on a hospital gown and sign the concent form.
• You should continue all your medications but if you take any medications
• that make your blood thinner (anticoagulants) such as warfarin, or if you're diabetic
• on insulin you must let your doctor know at least 3 days in advance.
• If you have any allergies you must let the nursing staff and doctors know.

What happens during the procedure?

You will lie on your back or on your left side. You need to have a needle put into a

 vein in your arm, so that the doctor can give you the sedative and the painkillers. 

Once in place, this needle should not cause any pain. You will also have a device attached

to your finger to monitor your pulse and the amount of oxygen in your blood. You will also

receive oxygen through small nasal prongs.The doctor may spray the back of your throat

with local anaesthetic and an endoscopy (camera test) will be performed. A fine wire will

then be passed through the endoscope down the gullet, and through the blockage, 

if necessary under x-ray control. The endoscope will be withdrawn and some special

dilating tubes will be slid down the throat into the gullet to open up the narrowed area. 

Finally the fine wire will be withdrawn. The procedure usually lasts 20 to 30min and you

will be taken back to the ward on a trolley. There your pulse and blood pressure will be

monitored for a few hours to make sure that there are no problems. Most patients will be

able to return home the next day.

Will it hurt?

Unfortunately, it may hurt a little as the gullet opens up, but in the majority of cases the 

discomfort resolves within 24-48 hours. Any pain you may experience should be reported

promptly and will be controlled with painkillers given orally.

FAQs on Sigmoidoscopy

Q- What Is Flexible Sigmoidoscopy?

Ans- Lower Gi Endoscopy Flexible Sigmoidoscopy

Flexible sigmoidoscopy is a procedure that enables your doctor to examine the lining

 of the rectum and a portion of the colon (large bowel) by inserting a flexible tube

 that is about the thickness of your finger into the anus and advancing it slowly into

 the rectum and lower part of the colon.

What preparation is required?

The rectum and lower colon must be completely empty of waste material for the

 procedure to be accurate and complete. In general, preparation consists of one or

 two enemas prior to the procedure but may include laxatives or dietary modifications.

What about my current medications?

• Most medications can be continued as usual. You should inform your doctor of all 
• current medications as well as any allergies to medications several days prior to
•  the examination.
• However, drugs such as aspirin or anticoagulants (blood thinners) are examples
•  of medications whose use should be discussed with your doctor.

What can be expected during flexible sigmoidoscopy?

Flexible sigmoidoscopy is usually well tolerated and rarely causes much pain. 

There is often a feeling of pressure, bloating, or cramping at various times during

 the procedure. You will be lying on your side while the sigmoidoscope is advanced

 through the rectum and colon. As the instrument is withdrawn, the lining of the

 intestine is carefully examined. The procedure usually takes anywhere from 5 to 15 minutes.

What if the flexible sigmoidoscopy shows something abnormal?

If the doctor sees an area that needs evaluation in greater detail, a biopsy

 (sample of the colon lining) may be obtained and submitted to a laboratory

 for greater analysis. If polyps (growths from the lining of the colon which vary in size) 

are found, they can be biopsied, but usually are not removed at the time of

 the sigmoidoscopy. Polyps are of varying types; certain benign polyps, known

 as "adenomas," are potentially precancerous. Certain other polyps ("hyper plastic" 

by biopsy analysis) may not require removal. Your doctor will likely request that 

you have a colonoscopy (a complete examination of the colon) to remove any

 large polyp that is found, or any small polyp that is adenomatous after biopsy analysis.

What happens after a flexible sigmoidoscopy?

• After sigmoidoscopy, the doctor will explain the results to you.
• You may have some mild cramping or bloating sensation because of the air that
•  has been passed into the colon during the examination. This will disappear quickly
•  with the passage of gas.
• You should be able to eat and resume your normal activities after leaving the hospital.

What are possible complications of flexible sigmoidoscopy?

Possible complications after flexible sigmoidoscopy are rare but few complications may occur—

• Severe abdominal pain,
• Fevers and chills, or
• Rectal bleeding .It is important to note that rectal bleeding can occur even several days after 
• the biopsy.

FAQs on Endoscopic retrograde cholangiopancreatography ( ERCP)

Q- What Is ERCP?

Ans- Endoscopic retrograde cholangiopancreatography ( ercp)

ERCP is a technique used to study the ducts (drainage routes) of the gallbladder, pancreas,

 and liver (the drainage channels from the liver are called bile ducts). An endoscope

 (flexible thin tube that allows the doctor to see inside the bowel) is passed through

 the mouth, oesophagus, and stomach into the duodenum (first part of the small intestine). 

After the common opening to ducts from the liver and pancreas is visually identified, a 

catheter (narrow plastic tube) is passed through the endoscope into the ducts. Contrast

 material ("dye") is then injected gently into the ducts (pancreatic or biliary) and x-ray

 films are taken. ERCP may be useful in diagnosing and treating problems causing jaundice

 (yellowing of the whites of the eyes) or pain in the abdomen, for example, blockage 

of the bile ducts by gallstones, tumours or scarring.

What preparation is required?

• It is necessary to have a completely empty stomach. You should therefore fast for 
• at least 6 hours before the procedure.
• If you are allergic to iodine- containing drugs (contrast material or "dye") you should
•  discuss this with your doctor prior to the procedure.
• The doctor performing the procedure should be informed of any medications that you 
• take regularly, any heart or lung conditions (or any other major diseases), and whether
•  you are allergic to any medications.
• Someone must accompany you home from the procedure because of the sedation
•  used during the examination. Even if you feel alert after the procedure, your judgement 
• and reflexes may be impaired by the sedation for the rest of the day, making it unsafe for 
• you to drive or operate any machinery. If a complication occurs, you may need to stay in
•  hospital until it resolves.

What can be expected during ERCP?

An intravenous sedative will be given to make you more comfortable during the test.

 Some patients also receive antibiotics before the procedure. The endoscope

 is passed through the mouth, oesophagus, and stomach into the duodenum. 

The instrument does not interfere with breathing.

What are possible complications of ERCP?

• Localised irritation of the vein into which medications were given may rarely cause 
• a tender lump that may last several days.
• Major complications requiring hospitalisation can occur but are uncommon during 
• diagnostic ERCP. They include serious inflammation of the pancreas ('pancreatitis') and 
• even more rarely infections, bowel perforation, and bleeding. Another potential risk of 
• ERCP is an adverse reaction to the sedative used. The risks of the procedure vary with the
• reasons for the test, what is found during the procedure, whether any therapy is undertaken,
• and the presence of other major medical problems, e.g., heart or lung diseases. Your doctor
• will tell you what is your likelihood of complications before undergoing the test.
• If therapeutic ERCP is performed (cutting an opening in the bile duct, stone removal, 
• dilation of a stricture (narrowing), stent or drain placement, etc), the possibility of 
• complications is higher than with diagnostic ERCP; complications include pancreatitis, 
• bleeding, and bowel perforation. These risks must be balanced against the potential 
• benefits of the procedure and the risks of alternative surgical treatment of the condition.
• Often these complications can be managed without surgery, but occasionally they do require
• corrective surgery.
• 
  

What can be expected following ERCP?

If you are having ERCP as an outpatient, you will be kept under observation until most

of the effects of the medications have worn off. Evidence of any complications of the

procedure will be looked for and hospitalization may be advised if further 

observation is necessary. You may experience bloating or pass gas because of the

air introduced during the examination. You may resume your usual diet unless you are

instructed otherwise.

FAQs on Colonoscopy and its Preparation

Q- What Is Colonoscopy?

Ans- Colonoscopy

Colonoscopy is a procedure that enables your doctor to examine the lining of the colon

 (large bowel) by inserting a flexible tube that is about the thickness of your finger into

 the anus and advancing it slowly into the rectum and colon.Colonoscopy is a procedure

 that enables your doctor to examine the lining of the colon (large bowel) by inserting a

 flexible tube that is about the thickness of your finger into the anus and advancing it slowly 

into the rectum and colon.

What preparation is required?

The colon must be completely clean for the procedure to be accurate and complete. The

 hospital will give you detailed instructions regarding the dietary restrictions to be followed 

and the cleansing routine to be used. Preparation consists of either drinking a large volume

 of a special cleansing solution or several days of clear liquids, laxatives, and enemas prior

 to the examination. Follow your doctor's instructions carefully. If you do not, the procedure

 may have to be cancelled and repeated later.

What about my current medications?

Most medications may be continued as usual, but some can interfere with the preparation

 or the examination. Please inform your doctor of your current medications as well as any 

allergies to medications several days prior to the examination. Aspirin products, anticoagulants

 (blood thinners), insulin, and iron products are examples whose use should be discussed with 

your doctor prior to the examination. You should alert your doctor if you require antibiotics prior

 to undergoing dental procedures, since you may need antibiotics prior to colonoscopy as well.

What can be expected during colonoscopy?

Colonoscopy is usually well tolerated and rarely causes much pain. There is often a feeling of 

pressure, bloating, or cramping at times during the procedure. Your doctor will give you medication

 through a vein to help you relax and better tolerate any discomfort. The colonoscopy is advanced 

slowly through the large intestine and the lining is carefully examined. The procedure usually takes

 15 to 60 minutes. In some cases, passage of the colonoscopy through the entire colon cannot be

 achieved. The doctor will decide if the limited examination is sufficient or if other examinations are

 necessary.

What if the colonoscopy shows something abnormal?

If your doctor thinks an area of the bowel needs to be evaluated in greater detail, a forceps

 instrument is passed through the colonoscopy to obtain a biopsy (a sample of the colon lining).

 If colonoscopy is being performed to identify sites of bleeding, the areas of bleeding may be 

controlled through the colonoscopy by injecting certain medications or by coagulation (sealing

 off bleeding vessels with heat treatment). If polyps are found, they are generally removed.

 None of these additional procedures typically produce pain. Remember, the biopsies are

 taken for many reasons and do not necessarily mean that cancer is suspected.

What are polyps and why are they removed?

Polyps are abnormal growths from the lining of the colon which vary in size from a tiny dot to

 several inches. The majority of polyps are benign (noncancerous) but the doctor cannot

 always tell a benign from a malignant (cancerous) polyp by its outer appearance alone. 

For this reason, removed polyps are sent for tissue analysis. Removal of colon polyps is 

an important means of preventing colorectal cancer.

How are polyps removed?

Tiny polyps may be totally destroyed by fulguration (burning), but larger polyps are removed

 by a technique called snare polypectomy. The doctor passes a wire loop (snare) through

 the colonoscopy and severs the attachment of the polyp from the intestinal wall by means 

of an electrical current. You should feel no pain during the polypectomy. There is a small

 risk that removing a polyp will cause bleeding or result in a burn to the wall of the colon, 

which could require emergency surgery.

What happens after a colonoscopy?

After colonoscopy, your doctor will explain the results to you. If you have been given

 medications during the procedure, someone must accompany you home from the

 procedure because of the sedation used during the examination. Even if you feel alert

 after the procedure, your judgment and reflexes may be impaired by the sedation for

 the rest of the day, making it unsafe for you to drive or operate any machinery.

What are the possible complications of colonoscopy?

• Colonoscopy and polypectomy are generally safe. One possible complication is a perforation
•  or tear through the bowel wall that could require surgery, although this is very uncommon.
• Bleeding may occur from the site of biopsy or polypectomy. It is usually minor and stops on
•  its own or can be controlled through the colonoscopy. Rarely, blood transfusions or surgery
•  may be required.
• Other potential risks include a reaction to the sedatives used and complications from heart
•  or lung disease.
• Localized irritation of the vein where medications were injected may rarely cause a tender
•  lump lasting for several weeks, but this will go away eventually. Applying hot packs or hot
•  moist towels may help relieve discomfort.