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Gastroscopy is used in the diagnosis and treatment of diseases of the gastrointestinal tract. This examination allows you to carry out a number of medical manipulations. Thus, gastroscopy is performed to assess the degree of damage to the organs of the gastrointestinal tract by a malignant tumor and to select the correct method of treatment. In domestic medicine, gastroscopy is used to remove tumors and to localize their foci.

What can a gastroscopy achieve?

Gastroscopy before surgery is performed to clarify the location of tumors, their localization to assess the degree of damage to the organs of the gastrointestinal tract. Before the operation, this procedure is also performed to detect bleeding vessels. Bleeding inside the organs can lead to the death of the patient, in order to avoid this, gastroscopy is performed using an endoscope. The doctor in the process of research performs the following actions:

1) examines the condition of the organs and assesses the degree of damage;

2) based on the information received and the picture of the disease, makes a conclusion about the need for emergency surgical intervention;

3) performs surgical manipulations in order to save the life of the patient.

The advantage of gastroscopy over surgery is that the surgeon gets the opportunity to choose the right treatment method and, based on a complete picture of the disease, performs the operation and eliminates the threat to the patient's life. In a modern medical center, gastroscopy before surgery is mandatory in order for the doctor to determine the risks and possibilities of complete removal of malignant tumors, choose the right technique for performing the operation, and thus reduce the risks for the patient to zero.

Nature of the Study

Gastroscopy can be performed using a disposable capsule or endoscope, depending on the severity of the patient's condition and his desire. Gastroscopy using a capsule is carried out as follows:

. the patient swallows the tablet and drinks it with water;

During the time the capsule is inside the gastrointestinal tract, it passes through all parts, starting from the esophagus;

During the study, pictures are taken;

The received information is processed by a computer, a preliminary diagnosis is made;

The doctor makes the final diagnosis and chooses the method of treatment.

Gastroscopy using an endoscope is necessary to collect materials that are necessary for biopsy. During this analysis, the number and influence of bacteria in the gastrointestinal tract is assessed. Also, this analysis is necessary for accurate diagnosis of cancer. The fact is that tumors can be benign or malignant. The first type of tumor is potentially harmless to the patient and does not lead to risks. The second type of tumor is dangerous and requires immediate treatment in order to save the patient's life.

Gastroscopy is carried out by a highly qualified doctor and his assistant on the basis of a medical center. In order for the patient not to feel pain during the study, anesthetics can be used, and special antiemetic drugs can be used to suppress the gag reflex. Gastroscopy is of great importance for the diagnosis and treatment of diseases of the gastrointestinal tract.

This examination is carried out in the presence of symptoms indicating the presence of problems with the gastrointestinal tract. Gastroscopy is widely used in world medicine along with the diagnosis of gastrointestinal diseases by other methods.

Laparoscopy does not require complex preparation. Before the operation, the doctor must check the patient's condition to make sure that there is no possible risk of complications. The patient needs to pass tests for which the doctor gives directions. Without them, the patient will not receive admission to.

The main tests before laparoscopy, the results of which are needed for admission to the operation:

1. General blood test (CBC).
2. Biochemical analysis.
3. General urine analysis (OAM).
4. General swab for flora.
5. Coagulogram.
6. Analysis for HIV, hepatitis B and C.
7. Wasserman's reaction (analysis for syphilis).
8. Oncocytology.
9. Electrocardiogram.
10. Blood type, Rh factor (to exclude errors and reinsurance during laparoscopy).

Depending on the presence of other diseases or the purpose of laparoscopic surgery, the doctor decides which tests and studies need to be done additionally.

Preoperative preparation may include visits to other specialists to evaluate contraindications. In case of diseases of the cardiovascular, respiratory, endocrine systems and gastrointestinal tract, the patient is previously sent to an appointment with other doctors in order to confirm or refute contraindications.

Additional research:

• Fluorography.
• Examination of feces for the presence of helminths.

Each general analysis (blood, urine, smear) is valid for 2 weeks. After the expiration of the period, the patient must be tested again. A smear for oncocytology and feces for helminths are valid for a year. Wasserman reaction, blood for HIV and hepatitis are valid for 3 months. Validity of ECG is 1 month, fluorography is 11 months.

Particular attention is paid to the number of platelets and the content of prothrombin, fibrinogen, bilirubin, urea, glucose, and total protein in the blood.

General blood analysis

Clinical analysis (CLA) is a diagnostic method in which blood is taken from the ring finger. The goal is to detect anemia or inflammatory disease.

The main indicators that are given close attention before laparoscopy (including diagnostic):

• leukocytes. A decrease in indicators indicates leukopenia, an increase indicates any inflammatory disease in the body.
• hemoglobin. A decrease in indicators indicates an insufficient supply of oxygen to the body, an increase indicates heart defects, smoking and dehydration.
• erythrocytes. A decrease indicates pregnancy, anemia, blood loss, destruction of red blood cells, and an increase is observed with neoplasms, polycystosis, and hormonal disorders.
• platelets. A decrease in indicators indicates a diseased liver, bacterial infections, anemia, hemolytic disease, immune and hormonal diseases. An increase is observed after operations, with oncological diseases, benign tumors, and inflammations.
• ESR. A decrease in indicators indicates an increase in albumins (a group of proteins), bile acids, and circulatory failure. An increase is observed with a decrease in albumin, erythrocytes, an increase in fibrinogen, as well as in infectious and inflammatory diseases, liver and kidney damage, fractures, postoperative periods, endocrine disorders. If a woman has an increase in ESR, it is necessary to undergo a gynecological examination and check the gastrointestinal system.
• hematocrit. Low rates indicate a deterioration in blood viscosity, anemia. An increase is observed with dehydration, lack of oxygen, congenital heart defects.

The doctor evaluates all indicators and discrepancies from the norm. For example, if leukocytes, erythrocytes, ESR and platelets are elevated, and the rest of the indicators are within the normal range, then we will talk about the presence of an inflammatory process and neoplasms, because of which laparoscopic methods of treatment are planned. If the erythrocytes, platelets, hematocrit are lowered, and the rest of the indicators are within the normal range, then the patient most likely has anemia.

Deciphering a biochemical blood test. Click to enlarge

Blood chemistry

This diagnostic method before laparoscopy allows you to judge the functioning of all organs. The main goal is to check the condition of the heart, endocrine system, liver and kidneys. It reveals:

1. total protein. The decrease indicates starvation, liver disease and serious bleeding of an acute and chronic nature. The increase is about dehydration, oncology, acute infections.
2. Bilirubin. A decrease indicates the intake of certain groups of drugs, alcohol and coffee, coronary heart disease. Increase - about hepatitis, acute infections and viruses, tumors and cirrhosis of the liver, anemia, inflammatory diseases.
3. Urea. The decrease indicates starvation or strict vegetarianism, pregnancy, poisoning with toxic substances, impaired liver function. Increase - kidney disease, cardiovascular insufficiency, severe blood loss, excessive protein intake.
4. fibrinogen. A decrease indicates the formation of microthrombi, toxicosis, hypovitaminosis, poisoning with poisons, cirrhosis of the liver. Increase - about pregnancy, heart attack, diabetes, pneumonia, tuberculosis, oncology and infectious diseases.
5. Glucose. The decrease indicates malnutrition, starvation, excessive exercise, bad habits, malignant tumors, excessive consumption of bakery products, fast food and sweets. An increase occurs with diabetes mellitus, pancreatitis, cancerous tumors, diseases of the endocrine system, metal poisoning.

Analysis of the results of biochemistry gives an almost accurate picture of the state of the patient's body.

General urine analysis

Normal urinalysis. Click to enlarge

OAM is the simplest and most painless diagnostic method before laparoscopy, with the help of which acute and chronic pathologies of the genitourinary system and other inflammatory diseases are determined. Together with blood tests, the overall picture will allow you to better understand the functionality of the body.

The main values ​​of OAM, which are given attention before the operation "laparoscopy":

1. The amount of urine. A decrease is observed in the initial stages of acute renal failure, chronic kidney disease. Increase - with diabetes mellitus, acute renal failure, heavy drinking.
2. Color. A specific change in color, depending on shades, is caused by urolithiasis, tumor decay, red blood cells in the urine, liver disease, and eating coloring foods.
3. Transparency. Turbid urine is characteristic of cystitis and pyelonephritis.
4. Smell. Sharpness or a specific smell are observed with hereditary diseases, increased acidity or diabetes.
5. Reaction. High acidity speaks of experienced infectious diseases.
6. Protein. An increase in the amount is observed with inflammation and kidney disease.
7. Glucose. The presence in the urine indicates diabetes mellitus.
8. Leukocytes. They indicate an inflammatory process in the body.

The delivery of a general urine test is necessary to assess the functioning of the genitourinary system and kidneys.

General smear

A flora smear is a method for diagnosing diseases and assessing the state of the microflora of the vagina, urethra and cervical canal. The goal is to detect infections and inflammations. The analysis shows:

1. Leukocytes. An increase is a sign of inflammation or pregnancy.
2. Lactobacilli. A decrease in their number is a symptom of bacterial vaginosis.
3. Yeast. A high score indicates thrush.
4. key cells. An increase is a sign of gardnerellosis.
5. Leptothrix. Occur when mixing infections: bacterial vaginosis, candidiasis, chlamydia and trichomoniasis.
6. Mobilunkus. The appearance in the results is a sign of candidiasis or bacterial vaginosis.
7. Trichomonas. The appearance is a symptom of inflammatory diseases of the genitourinary system.
8. Gonococcus. The appearance is a sign of gonorrhea.
9. Escherichia coli. An increase in the number indicates the onset of bacterial vaginosis, neglect of intimate hygiene, feces getting into the smear.
10. Staphylococci, streptococci, enterococci. An increase is a sign of infection.

A smear on the flora assesses the general condition of the reproductive organs.

Deciphering the coagulogram. Click to enlarge

Coagulogram

This analysis prior to laparoscopy examines the blood clotting system regulated by the endocrine and nervous systems. The goal is to determine how the operation will go, whether the surgeon will be able to stop the blood in an unforeseen situation and save the patient. Particular attention before the operation is given to the following indicators:

1. PV and MNO. Decrease in indicators - may be a sign of thrombosis. An increase in liver diseases, intestinal dysbacteriosis, amyloidosis, nephrotic syndrome, etc.
2. APTT. Shortening the value is a sign of increased coagulability. Lengthening - insufficient clotting, severe liver disease, etc.
3. PTI. A decrease is observed with increased coagulability during pregnancy, thrombosis, cirrhosis, hepatitis. Increase - deficiency of blood factors, vitamin K, etc.
4. fibrinogen. A reduced amount is a symptom of congenital deficiency, liver disease, bone marrow damage, prostate cancer, etc. An increased amount is observed with infections, injuries, stress, menstruation, heart attacks, pregnancy, lung cancer, and also in the postoperative period.
5. RFMK. An increase occurs with sepsis, thrombosis, shock, complicated pregnancy, etc.

Not all doctors are able to decipher this analysis.

Cytological smear analysis

Oncocytology is a method for diagnosing oncology in the reproductive organs. The goal is to detect the presence of cancer cells or other viral diseases.

Abnormalities in the analysis do not always imply the presence of cancer. A positive result may be due to pathologies:

• chlamydia;
• trichomoniasis;
• gonorrhea;
• fungal diseases.

When infections are found, therapy is prescribed, after which the analysis is repeated to monitor the dynamics.

Electrocardiogram and ultrasound

An ECG is assigned to study the work of the heart in order to assess the degree of readiness of the patient for laparoscopy. Contraindications to laparoscopic surgery are diseases of the heart, respiratory system, liver and kidneys.

No matter how many studies the doctor prescribes, they are carried out as soon as possible. UAC, coagulogram, Wasserman reaction, analysis for Rh factor, blood group, HIV and hepatitis - the material is taken from a vein once, checked for all necessary indicators, which already means that half of the tests have been passed.

Examination before the operation involves the following tests:

• Clinical blood test. To obtain reliable results, it is recommended to stop eating for 6-8 hours before the procedure. The study is carried out 2-3 days before surgical treatment, so that the doctor can assess the presence and stage of inflammatory processes. With chronic inflammation, the erythrocyte sedimentation rate increases (more than 30 mmol per liter). During infectious diseases or in the presence of purulent wounds, the number of leukocytes is increased. With a reduced level of hemoglobin, one should expect various complications in the postoperative period. Therefore, the patient needs a special diet, taking iron supplements. It is important to determine the number of platelets that are involved in the processes of blood clotting, wound healing;
• Biochemical study of blood. Allows you to determine the functionality of internal organs and systems, to detect serious diseases. The analysis helps to determine the level of total protein in the bloodstream, ALT and AST, creatinine, sugar, bilirubin and other vital compounds;
• Clinical study of urine. Allows you to assess the state of the urinary system. For analysis, an average portion of morning urine is required. If proteins or a large number of red blood cells are found in the urine, it is recommended to postpone surgery. In case of urgent need, the operation is performed against the background of the use of drugs to improve the functionality of the kidneys. If salts and sand are found in the urine, then additional preventive measures will need to be taken to prevent the movement of stones;
• Determination of blood group and Rh factor. This information allows you to prepare donated blood in advance in order to provide emergency assistance in the event of bleeding. The study is carried out once in a lifetime;
• Analysis for syphilis, hepatitis B and C, HIV infection. A blood test for the listed infections allows you to determine how dangerous the patient is to other patients and medical personnel;
• Coagulogram. The test is a blood clotting test to determine the risk of bleeding during or after surgery. If a low prothrombin index (PTI) level is detected, the blood clot will take too long to form. In such a case, the patient is prescribed drugs that can increase the level of coagulation. If the PTI is high, then the risk of developing blood clots increases. In such cases, blood-thinning drugs are prescribed;
• ECG. The study allows you to evaluate the functionality of the heart, to find out the presence of contraindications or restrictions to surgical procedures. The results of the ECG help the surgeon determine the tactics of the operation, and the anesthesiologist - the optimal dose and nature of anesthesia;
• Fluorography or X-ray of the chest. Allows to exclude the development of tuberculosis, inflammatory processes in the lungs.

Important! The duration of the analyzes varies significantly. Clinical and biochemical blood tests, coagulogram, ECG are valid for 10 days. Fluoroscopy is carried out once a year. The validity of tests for infections is not more than 3 months.

Additional tests before surgery

Before some surgical procedures, it is not enough to conduct a standard examination of the patient. If there is an operation on the veins, then duplex scanning (ultrasound dopplerography) is additionally prescribed. Before laparoscopy, it will be necessary to perform fibrogastroscopy to exclude pathologies of the digestive organs, a blood test for hormones to exclude diseases of the endocrine system.

Important! If deviations were found during the examination, then the patient is referred for an additional consultation with narrow specialists: an endocrinologist, a cardiologist, an otolaryngologist.

Often, before surgery, a dental examination and sanitation of the oral cavity are prescribed. The absence of inflammatory processes in the oral cavity reduces the risk of developing infectious diseases after surgery. An examination by a dentist is an obligatory stage of preoperative preparation before installing metal implants.

In male patients over 50 years of age, it is recommended to determine the prostate-specific antigen PSA. The study allows to establish the presence of inflammatory processes that can lead to the development of severe complications in the postoperative period. Patients with ischemic heart disease, cardiac arrhythmias are shown Holter monitoring with ECG recording. This is necessary to determine the presence of contraindications to surgery, dosage and type of anesthesia.

Specialized tests before gynecological operations

Examination before surgery on the uterus or appendages involves standard tests and additional studies. The latter include such manipulations:

• Taking a smear on the flora from the vagina. The analysis allows you to identify some bacterial infections, inflammatory processes in which gynecological operations are not performed. The duration of the smear is not more than 2 weeks;
• Cytological analysis of the cervix and cervical canal. The study is carried out to determine malignant changes in tissues, before any surgical procedures. The results of the study are valid for 6 months;
• Taking an aspirate from the uterine cavity. The analysis is carried out to exclude oncopathology in the uterus. Validity - 6 months;
• Blood test for oncomarkers CA 125, CA 19.9. The analysis is prescribed in the presence of cysts or tumors in the uterine appendages. The results are valid for 3 months;
• Conducting magnetic resonance imaging with contrast in the presence of a tumor helps to determine the degree of damage to the uterus and appendages, the involvement of healthy neighboring tissues in the pathological process. The study is valid for 3 months.

Preoperative examination is an important stage of preparation for surgical treatment. It allows you to minimize the risk of complications, determine the tactics of therapy, and choose the optimal type of anesthesia.

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Shelf life of gastroscopy before surgery

Examination before the operation always raises no less questions than the operation itself. Despite the same laws and requirements, we still have different requirements for analysis in different clinics.

Quite often I am asked the following questions about the examination before the operation:

• What examinations are necessary before the operation? (download list)
• Why do different clinics have different lists of examinations before surgery?
• Why do tests have different expiration dates?
• Why do I not require everyone to conduct gastroscopy and colonoscopy?

In order to answer them, it is necessary to refer to regulatory documents. To date, the activities of any medical institution in the Russian Federation should not contradict the order of the Ministry of Health of Russia dated November 12, 2012 No. 572n (“On approval of the Procedure for the provision of medical care in the field of obstetrics and gynecology”).

This order contains a complete list of examinations, medical and rehabilitation measures necessary in the treatment of a particular gynecological pathology.

The examination for the operation in this order is divided into 3 headings:

• mandatory minimum examination of gynecological patients
• preoperative preparation of patients with gynecological diseases
• examination associated with the presence of a specific pathology - in our case, these are benign ovarian tumors

I. Mandatory minimum examination of gynecological patients.

These are the examinations that should be carried out by every woman who has applied to a gynecologist, regardless of the presence of gynecological diseases. In addition to taking anamnesis and examination, such examinations include:

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1. Colposcopy (examination of the cervix)
2. Microscopic examination of the discharge of the female genital organs for aerobic and facultative anaerobic microorganisms (this is a common Sami smear from the vagina)
3. Cytology of smears (PAP test)
4. Ultrasound examination (ultrasound) of the genitals (1 time per year, then - according to indications)
5. Examination of the mammary glands: Ultrasound of the mammary glands (1 time per year, then - according to indications). Mammography (first mammography, entry - 1 time in 2 years, over 50 years old - 1 time per year).

II. Preoperative preparation of patients with gynecological diseases

When the question of surgical treatment arises, an additional examination is necessary for surgical intervention. To date, this list includes:

1. Clinical blood test.
2. Biochemical blood test: study of the level of total blood protein, creatinine, ALT, ACT, urea, total bilirubin, direct bilirubin, blood glucose, cholesterol, sodium, blood potassium.
3. Coagulogram.
4. Clinical analysis of urine
5. Determination of blood group and Rh factor.
6. Determination of antibodies to pale treponema (Treponema pallidum) in the blood, HIV, HBsAg, HCV.
7. X-ray examination of the chest organs (fluorography) - 1 time per year

III. And finally, the examinations that need to be carried out in connection with the presence of a cyst or other benign tumors of the ovary.

1. Ultrasound of the kidneys, bladder, urinary tract (with symptomatic tumors, i.e. if there are signs of a malfunction of these organs)
2. With the rapid growth of the tumor and the inability to exclude the oncoprocess:
   • Ultrasound + TsDK;
   • study of the level of CA19-9, Ca 125 in the blood
   • rheoencephalography (according to indications)
   • colonoscopy / irrigoscopy (according to indications)
   • esophagogastroduodenoscopy (according to indications)
3. Ultrasound of the retroperitoneal space (with intraligamentary location of the tumor).

As you can see, all additional examinations are marked “according to indications” or taking into account clinical manifestations. That is, they do not need to be done to absolutely all patients with ovarian cysts.

In my opinion, there is only one indication for gastroscopy and colonoscopy. This is a suspicion that the formation on the ovary is a metastasis of a malignant tumor from the stomach or intestines (the so-called Krukenberg metastasis). Luckily, they don't happen very often. And before conducting these unpleasant examinations, the doctor should think about whether there really are indications for them?

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This is the minimum indicated by the order of the Ministry of Health. But some important studies were not included in the list. In some unclear situations, it is important to conduct examinations such as MRI and a study of the level of HE4 (tumor marker). They allow you to make a more accurate diagnosis even before surgery and, accordingly, conduct it properly.

Expiration date of analyzes

In order 572n there is no indication of the expiration date of most examinations. They are meant to be up to date.

Often, patients come with tests that she took 1-2 months ago (and sometimes more). In these cases, I proceed from the following principle: if I have no reason to believe that the analyzes have changed during this time, I do not repeat them.

But in most medical institutions, artificial deadlines have been adopted, after which the tests are considered invalid and they are forced to retake. To avoid trouble, always specify these terms exactly where you are going to carry out the operation.

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How often can a gastroscopy procedure be performed?

Gastroscopy is one of the most informative methods for studying the state of the gastrointestinal tract (its upper section), since this procedure allows you to visually assess the presence of damage to the gastric mucosa, the presence of polyps, erosions, ulcers, bleeding and other pathologies of the walls of the stomach and duodenum. Many patients are interested in the question of how safe this, in general, unpleasant procedure is, and how often gastroscopy can be done in the presence of various pathologies of the digestive tract.

The frequency of gastroscopy is determined by the attending physician.

However, this study is prescribed for many other diseases. For example, cardiovascular: before coronography, an endovascular cardiologist must make sure that there are no gastric erosions or ulcers. Otherwise, the operation will be postponed, since the patient must take strong antithrombotic drugs on the eve of the operation, which thin the blood and promote bleeding.

Indications for the appointment of gastroscopy

Such general symptoms as nausea, diarrhea, vomiting do not always indicate the presence of diseases of the digestive tract, but if the patient complains, he will most likely be prescribed a series of studies that should confirm or refute suspicions of gastritis, duodenitis or other gastric pathologies.

Among other indications for the appointment of gastroscopy, the following should be noted:

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• suspicion of the presence of malignant neoplasms in the stomach / esophagus;
• the need for constant monitoring of the state of the epithelium of the stomach in the treatment of diseases of the gastrointestinal tract;
• symptoms of stomach bleeding;
• when a foreign object enters the stomach;
• if the patient often experiences pain in the epigastric region;
• Difficulties experienced by the patient when eating;
• to clarify the diagnosis in a number of diseases that are not related to the pathologies of the gastrointestinal tract.

With caution, FGDS should be prescribed to children under six years of age, with a history of severe mental disorders, if the patient is diagnosed with an exacerbation of chronic gastritis or gastric ulcer, when there is a respiratory tract infection. In any case, the appointment of this procedure can occur repeatedly, and not knowing in what cases and how often gastroscopy of the stomach can be done is very disturbing for many patients.

As for contraindications to the appointment of esophagogastroduodenoscopy (the official medical name for gastroscopy), there are few of them:

• some heart diseases;
• narrow in comparison with the standard entrance to the stomach;
• obesity 2 - 3 degrees;
• hypertension;
• kyphosis/scoliosis;
• a history of stroke / heart attack;
• congenital/acquired blood diseases.

How is a gastroscopy performed?

An instrument that allows you to examine the condition of the internal walls of the stomach (and, if necessary, the duodenum 12), is a kind of endoscope. The gastroscope consists of a hollow elastic tube containing a fiber optic cable with optical and illuminating devices at the end. Through the mouth opening and the esophagus, the hose is inserted into the stomach cavity for a thorough examination. Through the cable, the image is transmitted to the eyepiece or monitor screen, and the doctor conducting the study has the opportunity to study the state of the epithelium in different parts of the stomach, turning and moving the tube in the right direction.

Is gastroscopy harmful in terms of the condition of the esophagus and stomach walls in contact with a solid foreign object? Before the procedure, the gastroscope is thoroughly disinfected, so the likelihood of introducing an external infection is extremely low (no more than when eating fruits, bread or vegetables). The possibility of damaging the walls of the esophagus, stomach or duodenum is also close to zero, since the device in its basic form does not have sharp protrusions.

But the procedure itself requires compliance with certain restrictions on the part of the patient. First of all, it should be done on an empty stomach: the presence of a food mass makes it very difficult to examine the mucous membrane, so it is very important not to eat 10-12 hours before gastroscopy. Approximately 100 - 120 minutes before the procedure, you should drink about 200 grams of liquid (weak tea or boiled water), which will clear the walls of the stomach from food debris and mucus. It is highly recommended to refrain from smoking the day before, as this provokes the secretion of gastric juice.

Immediately before the insertion of the probe, the pharynx and the upper part of the esophagus are anesthetized with a spray, and excessive excitement is stopped by a subcutaneous injection of a mild sedative - the calmness of the patient during manipulation is very important, since fear can lead to involuntary sharp movements, which will make it difficult to examine the walls of the stomach.

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Important: the expiration date of gastroscopy before surgery is one month, after which a second examination will have to be done (significant changes can occur in the stomach cavity in a month that can affect the result of the operation or be a direct contraindication to its implementation).

The gastroscopy itself is performed in the following sequence:

• the patient undresses to the waist, in the presence of glasses, loose dentures, they must also be removed;
• manipulation is carried out only in the supine position with a straight back, usually on the right side;
• a special mouthpiece is inserted into the mouth, which must be held firmly in order to prevent reflex compression of the teeth;
• after the instruction to take a few sips and completely relax the larynx, the endoscope is inserted and lowered until it reaches the entrance to the stomach (the most unpleasant moment is the transition from the oral cavity to the esophagus, during which a natural vomiting urge occurs);
• then the doctor begins to turn the gastroscope, which allows you to examine the condition of the gastric cavities from all sides (the viewing angle of the device, as a rule, does not exceed 150 degrees).

Duration of the procedure

For an experienced doctor, when performing gastroscopy for the purpose of diagnosis, 12-15 minutes are enough to examine the entire inner surface of the stomach, however, in some cases, it may be necessary to perform a biopsy (taking a sample of epithelial tissue for laboratory research) or other therapeutic manipulations (for example, the introduction of medications). Such a comprehensive study can last up to 25 - 40 minutes.

For some time after the manipulation, the patient should be in a supine position, eating during gastroscopy without a biopsy is allowed after 60 minutes. If the procedure was carried out with a biopsy, the first intake of non-hot food is allowed after 180 - 240 minutes. If a child under 6 years of age or a patient with a history of mental disorders is subjected to manipulation, gastroscopy can be performed under general anesthesia.

Deciphering the results

The uninitiated will certainly not be able to interpret the resulting images, since the resulting image will rather resemble some kind of fantastic landscape. But an experienced doctor is able to make an accurate diagnosis, guided by the method of comparison with the mucosa without pathologies.

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It looks like this:

• the color of the mucosa ranges from red to pale pink;
• even with an empty stomach, there is always a little mucus on the surface of the walls;
• the front wall looks smooth and shiny, and the back wall is covered with folds.

With gastritis, ulcers, stomach cancer, deviations from the norm appear, which neither X-ray nor ultrasound can fix. But gastroscopy will definitely reveal them: with gastritis, an increased amount of mucus, swelling and redness of the epithelium will testify to the disease, local minor hemorrhages are possible. With an ulcer, the surface of the walls is covered with red spots, the edges of which have a whitish coating, indicating the presence of pus. With stomach cancer, the back wall of the stomach is smoothed, and the color of the mucosa changes to light gray.

How often can a gastroscopy be done

In life, there are often situations when we do not attach importance to certain symptoms that indicate the presence of a pathology, and when a diagnosis is made, we begin to intensively look for ways to get rid of it, undergoing consultations and examinations with various specialists. In the case of gastritis, no doctor will take up treatment without receiving accurate information about the condition of the mucosa. And there are often cases when, after undergoing a gastroscopy, a new specialist can refer the patient for a second examination to make sure that no significant changes have occurred since then. Therefore, many patients are interested in how long it takes to re-do gastroscopy.

In principle, in the absence of contraindications, the number of such manipulations is not limited, but in practice they try not to prescribe a study more than once a month - this is exactly the expiration date of the results of the previous study. In the chronic course of the disease, in order to prevent complications (peptic ulcer, oncology), this study is prescribed 2-3 times a year. In the process of treating gastritis, if the real effect of drug therapy does not coincide with the expected one, gastroscopy can be performed more often.

Conclusion

FGDS is a generally safe procedure, although quite unpleasant. Complications in this case are extremely rare: minor damage to the walls of the esophagus / stomach, infection, an allergic reaction to medications. Sometimes after the procedure there are painful sensations in the throat, which disappear after 2-3 days. How many times you can do a gastroscopy over a certain period of time - the attending physician decides. If necessary, the procedure is performed with the frequency that is necessary for the successful treatment of pathology.

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Laparoscopy. Analyzes and examinations before surgery.

Question about laparoscopy

half a year is not a period, after a lapara!?

Comments

Katyusha! I'm reading it.. It's scary.. But it's probably necessary to mentally prepare. Who did you do there? Can I take all the tests in a paid clinic and bring them? How much did the operation cost? And how did you negotiate? Doctor's money? Or an agreement? I just know that you had a result .. Let's hand over the SG in July. I'm on vacation in September and after that I'll come and probably do it. A lump stuck in my throat

I think to come to the family clinic for a fee for two days to collect tests there .. And then to 31 GB. Although in the family, too, the girl wrote what she did, everything in the world was done to her. there are some varieties of operations, but the amount is such .. I haven’t read more about the SM Clinic yet.

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And in the hospital there is a kapets direct Soviet Union hospital? Or normal behavior? Conditions?

I’ll write to you in a personal about the doctor and the details) I got it much cheaper than 65 thousand) I don’t advise you to do it commercially, but this is my point of view) And the conditions and attitude are excellent, I was in a double ward with a TV set and a separate shower and toilet )

Hi! So 8 months have passed and now I'm going to the laparotomy. I started my conversation here quite green. I did not know what the phases of the menstrual cycle and ovulation are)))))

Ahahaha)) hello, hello, my good)) Nuuuuu. we all go through ignorance in one way or another) The main thing is that we are moving towards the goal)) Everything will be fine, don’t worry (TTT)

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T e you swallowed a light bulb and the colon was checked?

Crap. Well, this is how much you will have to take time off from work: first for tests, then for a sick leave.

Thanks! I will wait!

(11) Mammologist's consultation

(12) Consultation of the therapist

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(13) Blood for cancer markets CA-125, CA - 19.9

(16) Ultrasound of the arteries of the lower extremities

And if there is a cyst, then the tumor marker c-125 should be increased?

So it's a shortened version. For you, in principle, this is not bad even. There is less unnecessary running around.) These are analyzes for the City Clinical Hospital 31 of Moscow.

A smear for tumor markers? o_O And what should he show?))) It seems to me that you need to clarify - I definitely donated blood. And it’s a good idea to go to a mammologist and on your own initiative to know for sure that everything is fine. As a rule, when all sorts of problems with the female apparatus begin, then all this creeps up.

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Why is the lapar repeated? And the first was for what reason, if not a secret, of course?

Oh, lapar, of course, the operation is not the most difficult, but all the same, it is sad to go to the operating table, as if to work. Can't the pipes be checked during the pipe lapara? I have in the conclusion it is written that they checked.

About tumor markers - donate blood better. And the tests will not be expired if you have not signed up for the lapara yet? They also have an expiration date, as the doctor explained to me.

Calmness, only calmness, as Carlson said))

Blood for oncomarkets CA-125, SA - 19.9

And what kind of emergency happened to you, if not a secret?

It's true. She recovered normally from anesthesia and soon passed B))

Tests required for hospitalization of patients

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All analyzes must be on separate official forms with clearly visible seals of the medical institution.

1. The results of blood tests for syphilis by ELISA, HRsAg and ant - HCV by ELISA (shelf life - 30 days);

2. Chest x-ray (picture and description, expiration date - 12 months).

Tests required during hospitalization in surgical departments:

If necessary, as prescribed by the attending physician, in addition:

1. Gastroscopy (shelf life - 1 month);

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3. Hormonal blood test: free T3, free T4 (shelf life - 10 days).

A. Upon receipt of positive results for hepatitis, the patient must provide data from a biochemical blood test for ALT and AST and the conclusion of an infectious disease specialist.

B. For women of the reproductive period (with a menstrual cycle of 28 days), hospitalization in the surgical department is carried out from the 5th to the 20th day of the menstrual cycle.

C. You also need to have 2 elastic bandages with you (length 3.5 - 5 meters).

When planning a surgical operation, the patient can receive the following document from the attending physician:

To the clinic at the place of residence (work)

In connection with the upcoming surgical operation, I ask you to conduct an examination of the patient

and attach the results of the following studies (analysis):

4. Complete blood count (shelf life - 10 days);

6. Coagulogram (shelf life - 10 days);

7. Biochemical blood test: total protein, total bilirubin, amylase, creatinine, urea, potassium, sodium, calcium, chlorine, ALT, AST, iron, glucose (shelf life - 10 days);

8. ECG (shelf life - 1 month);

9. Consultation with a cardiologist.

If necessary, as prescribed by the attending physician, in addition:

10. Gastroscopy (shelf life - 1 month);

12. Hormonal blood test: free T3, free T4 (shelf life - 10 days).

13. Upon receipt of positive results for hepatitis, the patient is obliged to provide data from a biochemical blood test for ALT and AST and the conclusion of an infectious disease specialist.

Tests required for eye surgery:

1. The results of blood tests for HIV, syphilis by ELISA, HRsAg and ant - HCV by ELISA (shelf life - 30 days);

2. X-ray of the chest (picture and description, expiration date - 12 months);

3. Blood type, Rh factor;

4. Complete blood count - blood formula (shelf life - 10 days);

5. General analysis of urine (shelf life - 10 days);

6. Biochemical blood test: K+, Na+, CI, ALT, ACT, bilirubin, urea, amylase, creatinine, glucose (shelf life - 10 days);

7. Prothrombin index, blood clotting (shelf life - 10 days);

8. ECG with interpretation (shelf life - 1 month);

9. X-ray of the paranasal sinuses (description);

10. Conclusion of the dentist on the sanitation of the oral cavity;

11. Conclusion of an otolaryngologist on the absence of contraindications for eye surgery;

12. Conclusion of the therapist about the absence of contraindications for eye surgery;

13. Conclusion of other specialists on the absence of contraindications to eye surgery (if necessary; agreed with the attending physician).

When planning an eye surgery, the patient can receive the following document from the attending physician at the clinic at the place of residence (work):

FSBI "ENDOCRINOLOGICAL RESEARCH CENTER"

Moscow, st. Dm. Ulyanova, 11 Contact center: (4

To the clinic at the place of residence (work)

In connection with the upcoming eye surgery, I ask you to conduct an examination of the patient

1. Complete blood count (formula), blood sugar;

2. Biochemical blood test (K+, Na+, CI, ALT, ACT, bilirubin, urea, amylase, creatinine);

3. General analysis of urine;

4. The result of the Wasserman reaction, HIV, HBS antibodies, ACV antibodies, blood type;

5. Prothrombin index, blood clotting;

6. Conclusion of the dentist on the sanitation of the oral cavity;

7. The conclusion of the otolaryngologist about the absence of contraindications for eye surgery;

8. X-ray of the paranasal sinuses (description);

9. X-ray (fluorography) of the chest (description);

10 Electrocardiogram with interpretation;

11 The conclusion of the therapist about the absence of contraindications for eye surgery;

12 Conclusion of other specialists on the absence of contraindications for eye surgery (if necessary) _______________________________

Tests required during hospitalization female patients

for IVF treatment:

for both partners;

for both partners;

Blood test for TORCH infection (woman) - indefinitely.

Photocopies of passports of both spouses.

Conclusion of specialists, if there are chronic diseases.

Upon receipt of positive results for hepatitis, the patient is obliged to provide data from a biochemical blood test for ALT and AST and the conclusion of an infectious disease specialist.

When planning IVF treatment, the patient can receive the following document from the attending physician at the clinic at the place of residence (work):

FSBI "ENDOCRINOLOGICAL RESEARCH CENTER"

Moscow, st. Dm. Ulyanova, 11 Contact center: (4

To the clinic at the place of residence (work)

In connection with the upcoming IVF treatment, I ask you to conduct an examination of the patient

and attach the results of the following studies (analyzes):

1. The results of blood tests for AIDS, syphilis by ELISA, HRsAg and anti - HCV by ELISA (shelf life - 30 days) for both partners;

2. X-ray (X-ray) of the chest (image and description, expiration date - 12 months);

3. Blood test for group and Rh factor (indefinitely) for both partners;

4. Clinical blood test (valid for 14 days);

5. Blood biochemistry + electrolytes (valid for 14 days);

6. Coagulogram (valid for 14 days);

7. General urinalysis (valid for 14 days);

8. Smears for flora and art. purity (valid for 21 days);

9. Smears for cytology (valid for 1 year);

10. STI swabs (PCR) (valid for 6 months);

11. ECG (valid for 3 months);

12. Conclusion of the therapist (valid for 1 year).

13. Blood test for TORCH infection (woman) - indefinitely.

14. Conclusion of specialists, if there are chronic diseases.

15. Upon receipt of positive results for hepatitis, the patient is obliged to provide data from a biochemical blood test for ALT and AST and the conclusion of an infectious disease specialist.

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Content

Modern gynecology regularly performs laparoscopic operations, which are already considered simple and common. Many patients, on the advice of doctors, go for this procedure because it is safe for them - the absence of an open process reduces risks, increases the speed of healing and return to normal.

What is laparoscopy

During the polycystic removal procedure, the surgeon makes 3 holes in the abdominal cavity, where he introduces instruments, and sees the direction with the help of a camera. Due to the absence of an autopsy, laparoscopic removal of an ovarian cyst is considered sparing compared to open surgery. There are the following types of techniques in gynecology:

• Diagnostic laparoscopy - the purpose of the method is to study the abdominal organs without incisions along the wall. To increase the field of view after punctures, gas is injected into them and a laparoscope instrument is inserted, which looks like a thin tube with a lens and an eyepiece. Instead of an eyepiece, a video camera can be used: the image received from it can be viewed on the monitor. A manipulator is inserted into the second puncture, the doctor examines the organs with it.
• Operative laparoscopy - always follows the diagnostic. If the doctor has found indications for the operation, then miniature instruments are inserted into the puncture, which are controlled by weight using the same camera. Surgical laparoscopy of an ovarian cyst involves anesthesia, during which an intravenous and urinary catheter is inserted, and then a silicone drainage tube. The advantages of laparoscopy are rapid healing of tissues, the absence of scars, and the possibility of emergency intervention. Due to the minimum size of the instruments, the organs are not severely injured, which preserves their functionality to the maximum. There are no serious complications, so laparoscopy can be performed even during pregnancy.

The success of the operation will depend on diagnostic success and preparation for laparoscopy of the ovarian cyst. If this is a planned procedure, then patients need to follow a special diet, pass the necessary tests, come for an examination to the doctor to identify features. Directly with the laparoscopy itself, special measures also need to be taken. Doctors will tell you in detail about the preparation of a woman and the uterus during the removal of polycystic.

On what day of the cycle do laparoscopy

Before you know what tests are taken before the operation, you need to take care of choosing the day of the operation, which is dependent on the menstrual cycle. It is forbidden to perform the procedure during menstruation and in the period 1-3 days before it. It would be better to choose a day in the first days of the cycle, as soon as menstruation ends. A study on polycystic disease is best done after ovulation - approximately on the 15-25th day of the cycle of 28.

How to prepare for laparoscopy of an ovarian cyst

In order for the operation in the clinic to be successful, you should know the information about its preparation. It includes tests before laparoscopy, a set of ECG studies, x-rays, ultrasound. During the examination, you should inform the doctor about the drugs you are taking, and start preparing in terms of diet a week in advance. Treatment with Aspirin, Ibuprofen and similar drugs should be stopped within a week. On the day of the operation, they take a shower, plus they need to shave off the hair on the entire lower abdomen and perineum.

Doctors recommend starting taking sedative drugs for psycho-emotional preparation a couple of days before surgery. Only herbal sedatives are suitable - tincture of valerian, motherwort, Persen. When a cycle suitable for surgery comes, it is recommended to refrain from taking oral contraceptives so as not to knock down the hormonal background.

Necessary examinations and tests before surgery

In addition to conducting a complex of examinations, the patient should know what tests need to be taken before the operation. Their results will help the attending physician to carry out the operation safely and without pain. Mandatory tests to be taken:

• general blood tests, urine, feces;
• blood group with Rh factor;
• ECG, fluorography;
• biochemical data: glucose, protein, bilirubin levels;
• determination of HIV, hepatitis B, C, syphilis;
• smear for microflora, oncocytology;
• on the degree of blood clotting.

Taking laxatives or a cleansing enema before surgery

Preparation for laparoscopy of an ovarian cyst necessarily includes several cleansing enemas up to 2 liters the night before. Another enema from water with a decoction of chamomile or the addition of glycerin is carried out in the morning, strictly on the day of the operation. If bowel cleansing is neglected, the surgeon will be forced to insert a tube to remove feces, which is an unpleasant procedure. Instead of an enema, you can take the following laxatives to prepare.

The term "laparoscopy" in literal translation from Greek means "to examine the womb." This is not a specific operation, but a way for the doctor to access the organs of the pelvic and abdominal cavities, which differs from the traditional laparotomy. Laparoscopy is considered the least traumatic way of performing surgical procedures, however, in any case, this is a serious intervention in the structure of the body. Laparoscopic operations require careful preparation, the patient must pass tests and undergo a series of studies.

Access to the body cavity is carried out using a modern device - a laparoscope connected to a video camera. Its design allows the doctor to examine the organs, assess the severity of the patient's condition on the spot, confirm or refute the preliminary diagnosis, and, if necessary, immediately perform surgical manipulations. This makes laparoscopy an indispensable therapeutic and diagnostic tool for a number of diseases.

Technique of laparoscopic surgery

Laparoscopy allows you to perform almost all those operations that can be performed through an incision (open method): separation of adhesions, removal of ovarian cysts and uterine myoma nodes, various gynecological and urological operations. In some conditions, laparoscopy is the only way to treat (genital endometriosis, obstruction of the fallopian tubes).

Immediately before the start of the operation, carbon dioxide is injected into the patient's body cavity, which raises the abdominal wall. This measure is necessary to create a working space for the movement of tools. The gas is harmless to the body, after a few days it is completely absorbed by the tissues.

In the wall of the abdomen, the surgeon makes small incisions (punctures) with a special thin tube (trocar). Usually there are three: 10 mm above the navel and two 5 mm on the sides.

For comparison: the length of the abdominal wall incision during laparotomy is 15-20 cm.

Through the punctures, the surgeon's working instruments are inserted, as well as a telescopic tube with a lens system and a video camera equipped with a cold light source (halogen lamp). The image is displayed on the monitor, allowing the doctor to control the progress of the operation.

Before the operation, the patient is given general anesthesia. Diagnostic laparoscopy can be performed under local anesthesia. The duration depends on the complexity of the pathology and the qualifications of the surgeon, it can range from 40 minutes (separation of postoperative adhesions) to 2 hours (removal of multiple myomatous nodes).

Application of the laparoscopic method

Why is laparoscopy necessary? In fact, it can replace almost any laparotomy operation, while being less traumatic for the patient. At the same time, laparoscopic intervention can be both planned and emergency (in critical conditions requiring urgent action).

Planned therapeutic and diagnostic laparoscopy is performed with:

• infertility treatment;
• suspected neoplasms of the uterus and appendages (cysts, fibroids, tumors);
• chronic pain in the small pelvis, not amenable to conservative treatment.

An emergency laparotomy is performed if you suspect:

• rupture (apoplexy) of the ovary;
• perforation of the uterine wall;
• ectopic (tubal) pregnancy;
• rupture of the cystic bladder or torsion of the tumor pedicle;
• acute inflammatory process in the appendages;
• loss of the intrauterine device.

Necessary tests and preparation for laparoscopic surgery

Laparoscopy is a relatively gentle operation. But it is also accompanied by a violation of the structures of the body, interference in its anatomical and functional integrity. There are contraindications for laparoscopy, and the operation itself requires special preparation. If the doctor considers it necessary to prescribe a surgical treatment for the patient, he, first of all, gives him a referral for a series of tests.

What tests need to be done?

Before the operation, you should make sure that the patient will tolerate it well. The attending physician determines which tests need to be taken:

• clinical and biochemical blood tests;
• general urine analysis;
• mandatory before any operation, blood tests for coagulability (coagulogram), determination of clotting time, blood platelet and prothrombin levels;
• determination of the blood group and Rh factor of the patient;
• a blood test for the presence of the causative agent of syphilis (Wasserman reaction), hepatitis B and C, HIV;
• a smear from the vagina to study the degree of purity and microbial flora;
• cytological analysis of a smear for the presence of oncological processes.

The patient also needs to undergo an electrocardiography procedure to detect pathologies of cardiac activity and a therapeutic consultation to establish other systemic diseases.

If necessary, the attending physician may prescribe other studies. Most of the tests are valid only for a certain time (2 weeks), so they must be done immediately before laparoscopy. In addition, the patient should tell the doctor what medications he is taking. Some medications may need to be temporarily interrupted before surgery.

Contraindications for laparoscopy

It should be borne in mind that during laparoscopy, the cavity of the patient's body area is filled with gas, which creates pressure on the diaphragm from below. In this regard, the lungs cannot work independently, breathing during the operation is carried out using a special apparatus. In addition, decompensation of cardiac activity is possible. Thus, contraindications to laparoscopy are any conditions that during surgery may pose a threat to the life and health of the patient:

• cardiovascular diseases;
• decompensated diseases of the respiratory system;
• any bleeding disorder (hemophilia);
• insufficiency of liver or kidney function;
• gynecological and urological infectious diseases, including those transferred less than 2 months ago;
• chronic and acute colds;
• inflammation of the appendages;
• any abnormalities in blood and urine tests;
• microbial contamination of the vagina;
• developed adhesive process;
• metabolic disorders.

Metabolic disorders accompanied by obesity are relative contraindications to surgery. The fact is that a thick layer of adipose tissue can significantly complicate the implementation of surgical procedures. The success of laparoscopy in this case largely depends on the skill of the surgeon.

Preparation for laparoscopic surgery

Preparation for laparoscopy is practically the same as preparation for traditional operations. The necessary measures are primarily due to the fact that the intervention is performed under general anesthesia.

• On the day of the operation, it is necessary to refrain from eating and drinking from midnight.
• 1 week before the scheduled intervention, a light diet should be followed, excluding foods that contribute to intestinal gas formation (legumes, bread, vegetables and fruits).
• Before the operation, the intestines are cleansed with enemas.
• It is necessary to temporarily stop the use of certain drugs, for example, Aspirin, Ibuprofen.

Laparoscopy is performed on any day of the cycle, except, directly, menstruation and a few days before it (due to increased bleeding). In this cycle, the woman must be protected from pregnancy using barrier contraceptives.

After operation

The laparoscopic method promotes rapid recovery after surgery. The very next day the patient can move, lead a moderately active lifestyle; after 7-10 days, the sutures are removed, which are much smaller than with laparotomy. Sick leave is usually issued for 1 week. Complications are rare; moderate pain and discomfort, which disturb patients in the first days after surgery, quickly pass.

Laparoscopy is the most modern surgical method. It gives the surgeon the opportunity to conveniently access the affected organ and perform precise manipulations. Laparoscopy is in many cases the best replacement for traditional surgical methods.