Gastrointestinal Tract

Enteroscopy is a procedure used to examine the small intestine (small bowel).

Small bowel biopsy; Push enteroscopy; Double-balloon enteroscopy; Capsule enteroscopy; Sonde enteroscopy

A thin, flexible tube (endoscope) is inserted through the mouth or nose and into the upper gastrointestinal tract. During a double-balloon enteroscopy, balloons attached to the endoscope can be inflated to allow the doctor to view a large part of the small intestine.

In a colonoscopy, a flexible tube is inserted through your rectum and colon. The tube usually can reach into the end part of the small intestine (ileum). See also: Colonoscopy

Tissue samples removed during enteroscopy are sent to the laboratory for examination.

Do not take products containing aspirin for 1 week before the procedure. Tell your doctor if you take blood thinners such as warfarin (Coumadin) or clopidogrel (Plavix), because these may interfere with the test. Do NOT stop taking any medication unless told to do so by your health care provider.

Do not eat any solid foods or milk products after midnight the day of your procedure. You may have clear liquids until 4 hours before your exam.

You must sign a consent form.

When the tube is put into your mouth and down your esophagus (food pipe), you may feel like gagging. You will get a numbing medicine to reduce this feeling.

You may get a mild sedative, but only in small doses because you must stay alert enough to help with the procedure (by doing such things as swallowing and turning). The biopsy sampling causes little or no pain, although you may have some mild cramping.

This test is most often performed to help diagnose diseases of the small intestines. It may be done if you have:

• Abnormal x-ray results
• Tumors in the small intestines
• Unexplained diarrhea
• Unexplained gastrointestinal bleeding

In a normal test result, the health care provider will not find sources of bleeding in the small bowel, and will not find any tumors or other abnormal tissue.

Abnormal findings may include:

• Abnormalities of the tissue lining the small intestine (mucosa) or the tiny, finger-like projections on the surface of the small intestine (villi)
• Immune cells called PAS-positive macrophages
• Polyps or cancer
• Radiation enteritis
• Swollen or enlarged lymph nodes or lymphatic vessels
• Ulcers

Changes found on enteroscopy may be signs of disorders and conditions including:

• Amyloidosis
• Celiac sprue
• Crohn's disease
• Folate or vitamin B12deficiency
• Giardiasis
• Infectious gastroenteritis
• Lymphangiectasia
• Lymphoma
• Tropical sprue
• Whipple's disease

Complications are rare but may include:

• Excessive bleeding from the biopsy site
• Hole in the bowel (bowel perforation)
• Infection of the biopsy site leading to bacteremia
• Vomiting, followed by aspiration into the lungs

Factors that prohibit use of this test may include:

• Uncooperative or confused patients
• Untreated blood clotting (coagulation) disorders
• Use of aspirin or other medicines that prevent the blood from clotting normally (anticoagulants)

The greatest risk is bleeding. Signs include:

• Abdominal pain
• Blood in the stools
• Vomiting blood

Bjorkman DJ. Gastrointestinal hemorrhage and occult gastrointestinal bleeding. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 137.

Sidhu R, Sanders DS, Morris AJ, McAlindon ME. Guidelines on small bowel enteroscopy and capsule endoscopy in adults. Gut. 2008;57:125-136.

Ammonia is a strong, colorless gas. If the gas is dissolved in water, it is called liquid ammonia. Poisoning may occur if you breathe in ammonia. Poisoning may also occur if you swallow or touch products that contain very large amounts of ammonia.

This is for information only and not for use in the treatment or management of an actual poison exposure. If you have an exposure, you should call your local emergency number (such as 911) or the National Poison Control Center at 1-800-222-1222.

• Ammonia

• Ammonia gas
• Some household cleaners
• Some linaments
• Some fertilizers

Note: This list may not be all inclusive.

• Airways, lungs, and chest
  • Cough
  • Chest pain (severe)
  • Chest tightness
  • Difficulty breathing
  • Wheezing
• Eyes, ears, nose, mouth, and throat
  • Tearing and burning of eyes
  • Temporary blindness
  • Throat pain (severe)
  • Mouth pain
  • Lip swelling
• Heart and blood
  • Rapid, weak pulse
  • Collapse and shock
• Nervous system
  • Altered mental state
  • Fever
  • Restlessness
• Skin
  • Bluish-colored lips and fingernails
  • Severe burns if contact is longer than a few minutes
• Stomach and gastrointestinal tract
  • Severe stomach pain
  • Vomiting

Do NOT make a person throw up unless told to do so by poison control or a health care professional. Seek immediate medical help.

If the chemical is on the skin or in the eyes, flush with lots of water for at least 15 minutes.

If the chemical was swallowed, immediately give the person water or milk, unless instructed otherwise by a health care provider. Do NOT give water or milk if the patient is having symptoms (such as vomiting, convulsions, or a decreased level of alertness) that make it hard to swallow.

If the person breathed in the poison, immediately move him or her to fresh air.

Determine the following information:

• Patient's age, weight, and condition
• Name of product (as well as the ingredients and strength, if known)
• Time it was swallowed
• Amount swallowed

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Take the container with you to the hospital, if possible.

See: Poison control center - emergency number

The health care provider will measure and monitor the patient's vital signs, including temperature, pulse, breathing rate, and blood pressure. Bloood and urine tests will be done. The patient may receive:

• Breathing support
• Continued flushing of the eyes and skin
• Fluids through a vein (IV)
• Endoscopy -- camera down the throat to see burns to the esophagus and the stomach
• Medicines to treat the symptoms

Damage is related to the amount and strength (concentration) of the ammonia. Most household cleaners are relatively weak and cause little or mild damage. Industrial strength cleaners can cause severe burns and injury.

Survival past 48 hours usually indicates recovery will occur. Chemical burns that occurred in the eye frequently heal; however, permanent blindness may result.

White SR, Eitzen EM Jr, Klein KR. Toxicology of hazardous chemicals. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:chap 185.

Mesenteric arteriography is an x-ray exam of the blood vessels that supply the abdominal area, including the small and large intestines.

Abdominal arteriogram; Arteriogram - abdomen

This test uses x-rays and a special dye (contrast material) to make blood vessels show up on the images.

This test is done in a hospital. You will lie on an x-ray table. You may ask for a sedative if you are anxious about the test.

The health care provider will shave and clean the groin area. A numbing medicine (anesthetic) is applied, and a needle inserted into an artery. A thin flexible tube called a catheter is passed through the needle, into the artery, and up through the main vessels of the belly area and chest until it is properly placed into a mesenteric artery. The doctor can see live images of the area on a TV-like monitor, and uses them as a guide.

Contrast dye flows through the catheter into the blood vessels. X-ray images are taken. The catheter is occasionally flushed with saline solution containing a drug called heparin to help keep blood in the tube from clotting.

Your pulse, blood pressure, and breathing are monitored during the procedure. After the x-rays are taken, the needle and catheter are withdrawn.

Pressure is immediately applied to the puncture site for 10-15 minutes to stop the bleeding. After that time the area is checked and a tight bandage is applied. The leg should be kept straight for an additional 4 hours after the procedure.

You should not eat or drink anything for 8 hours before the test.

You will be asked to wear a hospital gown and sign a consent form for the procedure. Jewlery should be removed from the area being imaged.

Tell your health care provider:

• If you are pregnant
• If you have ever had any allergic reactions to x-ray contrast material or iodine substances
• If you are allergic to any medications
• Which medications you are taking (including any herbal preparations)
• If you have ever had any bleeding problems

The x-ray table is hard and cold, but you may ask for a blanket or pillow. You may feel a brief sting when the numbing medication (anesthetic) is given. You will feel a brief sharp pain as the catheter is inserted into the artery, and some pressure as it is moved into place.

As the dye is injected, you will feel a warm, flushing sensation. You may have tenderness and bruising at the site of the injection after the test.

This test is done:

• When endoscopycannot locate the source of bleeding in the gastrointestinal tract
• When other studies fail to provide enough information about abnormal growths along the intestinal tract
• To possibly look at blood vessel damage after an abdominal injury

A mesenteric arteriogram may be performed after more sensitive nuclear medicine scans have identified active bleeding. The radiologist can then pinpoint and treat the source. See: Endovascular embolization.

Results are considered normal if the arteries being examined are normal in appearance.

Abnormal results may be due to

• Angiodysplasia of the colon
• Bleeding in the upper or lower gastrointestinal track
• Blood vessel rupture from injury
• Cirrhosis
• Growth of abnormal cells

There is some risk of the catheter damaging the artery or knocking loose a piece of the artery wall, which can reduce or block blood flow and lead to tissue death. This is a rare complication.

Other risks include:

• Bleeding
• Blood clot
• Infection
• Reaction to the contrast dye