Proctoscopy is a common medical procedure in which an instrument called a proctoscope (also known as a rectoscope, although the latter may be a bit longer) is used to examine the anal cavity, rectum, or sigmoid colon. A proctoscope is a short, straight, rigid, hollow metal tube, and usually has a small light bulb mounted at the end. It is approximately 5 inches or 15 cm long, while a rectoscope is approximately 10 inches or 25 cm long. During proctoscopy, the proctoscope is lubricated and inserted into the rectum, and then the obturator is removed, allowing an unobstructed view of the interior of the rectal cavity. This procedure is normally done to inspect for hemorrhoids or rectal polyps and might be mildly uncomfortable as the proctoscope is inserted further into the rectum. Modern fibre-optic proctoscopes allow more extensive observation with less discomfort.
An anoscope, a proctoscope and a rectoscope, and their approximate lengths.
A proctoscope is a hollow, tube-like speculum that is used for visual inspection of the rectum. Both disposable and non-disposable proctoscopes are available for use. Out of these, the non-disposable Kelly's rectal speculum, named after the American gynecologist Howard Atwood Kelly, is the most commonly used speculum for proctoscopy. Some proctoscopes have a light source for better visibility. The proctoscope is inserted into the anal canal with the patient in Sims' position. Fibre optic proctoscopes are now available which cause less discomfort to the patient.
The proctoscope is used in the diagnosis of hemorrhoids, carcinoma of anal canal or rectum and rectal polyp. It is used therapeutically for polypectomy and rectal biopsy.
Disposable proctoscopes without light are also available. The proctoscope also has a hollow channel through which other instruments may be inserted. For example, another instrument may be used to take a biopsy of a small amount of tissue for examination under a microscope. Also, air may be injected through the proctoscope to help make viewing easier. Similar instruments, the sigmoidoscope and colonoscope may be used to visualize more proximal parts of the bowels..
An anoscopy is an examination using a small, rigid, tubular instrument called an anoscope (also called an anal speculum). This is inserted a few inches into the anus in order to evaluate problems of the anal canal. Anoscopy is used to diagnose hemorrhoids, anal fissures (tears in the lining of the anus), and some cancers.Billroth II
Billroth II, more formally Billroth's operation II, is an operation in which the greater curvature of the stomach is connected to the first part of the jejunum in end-to-side anastomosis. This often follows resection of the lower part of the stomach (antrum). The antrectomy (resection of the antrum) is not part of the originally described procedure. The surgical procedure is called gastrojejunostomy.The Billroth II is often indicated in refractory peptic ulcer disease and gastric adenocarcinoma.
It was first described by Theodor Billroth.Cervical cancer staging
Cervical cancer staging is the assessment of cervical cancer to decide how far the disease has progressed. Cancer staging generally runs from stage 0, which is pre-cancerous or non-invasive, to stage IV, in which the cancer has spread throughout a significant part of the body.Cervical cancer is staged by the International Federation of Gynecology and Obstetrics (FIGO) staging system, which is based on clinical examination, rather than surgical findings. It allows only the following diagnostic tests to be used in determining the stage: palpation (feeling with the fingers), inspection, colposcopy, endocervical curettage, hysteroscopy, cystoscopy, proctoscopy, intravenous urography, and X-ray examination of the lungs and skeleton, and cervical conization.Cholangiography
Cholangiography is the imaging of the bile duct (also known as the biliary tree) by x-rays.Cholecystostomy
A cholecystostomy or cholecystotomy is a procedure where a stoma is created in the gallbladder, which can facilitate placement of a tube for drainage, first performed by American surgeon, Dr. John Stough Bobbs, in 1867. It is sometimes used in cases of cholecystitis where the person is ill, and there is a need to delay or defer cholecystectomy. The first endoscopic cholecystostomy was performed by Drs. Todd Baron and Mark Topazian in 2007 using ultrasound guidance to puncture the stomach wall and place a plastic biliary catheter for gallbladder drainage.Collis gastroplasty
A Collis gastroplasty is a surgical procedure performed when the surgeon desires to create a Nissen fundoplication, but the portion of esophagus inferior to the diaphragm is too short. Thus, there is not enough esophagus to wrap. A vertical incision is made in the stomach parallel to the left border of the esophagus. This effectively lengthens the esophagus. The stomach fundus can then be wrapped around the neo-esophagus, thus reducing reflux of stomach acid into the esophagus.
It was devised by John Leigh Collis (1911–2003), a British cardiothoracic surgeon, in 1957.Endoanal ultrasound
Endoanal ultrasound is a type of medical investigation which images the structures of the anal canal.It is used in the investigation of some anorectal symptoms, e.g. fecal incontinence or obstructed defecation.Fecal pH test
A fecal pH test is one where a specimen of feces is tested for acidity in order to diagnose a medical condition. Human feces is normally acidic. An acidic stool can indicate a digestive problem such as lactose intolerance or a contagion such as E. coli or rotavirus, or overgrowth of the acid producing bacteria (such as lactic acid bacteria for instance).
The average pH for a healthy person is a pH of 6.6.Frey's procedure
Frey's procedure is a surgical technique used in the treatment of chronic pancreatitis in which the diseased portions of the pancreas head are cored out. A lateral pancreaticojejunostomy (LRLPJ) is then performed in which a loop of the jejunum is then mobilized and attached over the exposed pancreatic duct to allow better drainage of the pancreas, including its head.Gastropexy
Gastropexy is a surgical operation in which the stomach is sutured to the abdominal wall or the diaphragm. Gastropexys in which the stomach is sutured to the diaphragm are sometimes performed as a treatment of GERD to prevent the stomach from moving up into the chest.Hill repair
A Hill repair is an anti-acid reflux procedure. It is similar to the Nissen fundoplication. Though far less common owing to a greater degree of difficulty, studies indicate a similar rate of efficacy. It is performed almost exclusively in the Pacific Northwest.Intraperitoneal injection
Intraperitoneal injection or IP injection is the injection of a substance into the peritoneum (body cavity). It is more often applied to animals than to humans. In general, it is preferred when large amounts of blood replacement fluids are needed or when low blood pressure or other problems prevent the use of a suitable blood vessel for intravenous injection.In animals, it is used predominantly in veterinary medicine and animal testing for the administration of systemic drugs and fluids because of the ease of administration compared with other parenteral methods.In humans, the method is widely used to administer chemotherapy drugs to treat some cancers, particularly ovarian cancer. Fluids are injected intraperitoneally in infants, also used for peritoneal dialysis. Although controversial, that specific use has been recommended as a standard of care.Magnetic resonance cholangiopancreatography
Magnetic resonance cholangiopancreatography (MRCP) is a medical imaging technique that uses magnetic resonance imaging to visualize the biliary and pancreatic ducts in a non-invasive manner. This procedure can be used to determine if gallstones are lodged in any of the ducts surrounding the gallbladder.
It was introduced in 1991.Portography
Portography is a radiography of the portal vein after injection of radioopaque contrast material.Pyloromyotomy
A pyloromyotomy is a surgical procedure in which an incision is made in the longitudinal and circular muscles of the pylorus. It is used to treat hypertrophic pyloric stenosis. Hypertrophied muscle is cut along the whole length until the mucosa bulges out. If the mucosa is injured, it is sutured horizontally using interrupted vicryl or silk sutures. It is also known as Ramstedt's Operation, after Conrad Ramstedt who performed the procedure in 1911. However, Harold Stiles performed the procedure first, in 1910.Ranson criteria
The Ranson criteria form a clinical prediction rule for predicting the prognosis and mortality risk of acute pancreatitis. They were introduced in 1974 by the English-American Pancreatic Expert and Surgeon, Dr. John Ranson (1938–1995).Rapid urease test
Rapid urease test, also known as the CLO test (Campylobacter-like organism test), is a rapid diagnostic test for diagnosis of Helicobacter pylori. The basis of the test is the ability of H. pylori to secrete the urease enzyme, which catalyzes the conversion of urea to ammonia and carbon dioxide.Rectal bleeding
Rectal bleeding refers to bleeding in the rectum. There are many causes of rectal hemorrhage, including inflamed hemorrhoids (which are dilated vessels in the perianal fat pads), rectal varices, proctitis (of various causes), stercal ulcers and infections. Diagnosis is usually made by proctoscopy, which is an endoscopic test. Bleeding from the anus is termed anal hemorrhage and is usually superficial in nature.Transrectal ultrasonography
Transrectal ultrasonography, or TRUS in short, is a method of creating an image of organs in the pelvis. The most common indication for transrectal ultrasonography is necessity of evaluation of the prostate gland in men with elevated prostate specific antigen or prostatic nodules on digital rectal exam. TRUS may reveal prostate cancer, benign prostatic hypertrophy, or prostatitis. It may also be used to help guide a biopsy of the prostate.
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