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Pah.nhs.ukInformation for Patients
An appointment for your gastroscopy (OGD) has been arranged at: The Alexandra Day Unit, Princess Alexandra Hospital Harlow Telephone: 079 87880 PLEASE BRING THIS BOOKLET AND THE CONSENT FORM WITH YOU TO THE APPOINTMENT.
Please telephone the endoscopy department on the above number if this appointment is not convenient or you would like to discuss any aspect of the procedure before your appointment.
On the day of your appointment, please bring your dressing gown, slippers and, if you are diabetic, your normal tablets or insulin.
Please write your relative’s or friend’s name and telephone number below.
You have been advised by your GP or hospital doctor to have an investigation known as a gastroscopy (OGD).
This procedure requires your formal consent.
If you are unable to keep your appointment, please notify the department as soon as possible. This will enable the staff to give your appointment to someone else and they will be able to arrange another date and time for you.
This booklet has been written to enable you to make an informed decision in relation to agreeing to the investigation and whether you wish sedation to be used. Enclosed is the consent form.
The consent form is a legal document, therefore please
read it carefully. Once you have read and understood all the
information including the possibility of complications and
you agree to undergo the investigation, please sign and date
the consent form. You will notice that the consent form is
carbonised, allowing you to keep a copy for your records.
If however there is anything you do not understand or wish to discuss further but still wish to attend do not sign the form, but bring it with you and you can sign it after you have spoken to a health care professional.
A space is provided at the end of this leaflet for you to note down any questions you may wish to ask. Please bring this leaflet with you to your next hospital appointment. The procedure you will be having is called an oesophago-gastro-duodenoscopy (OGD) sometimes known more simply as a gastroscopy or endoscopy. This is an examination of your oesophagus (gullet), stomach and the first part of your small bowel called the duodenum. The instrument used in this investigation is called a gastroscope. It is flexible and has a diameter less than that of a little finger. Within each gastroscope is a channel which enables light to be directed onto the lining of your upper digestive tract and another which relays pictures back to the endoscopist onto a television screen.
During the investigation, the doctor may need to take some tissue samples (biopsies) from the lining of your upper digestive tract for analysis; this is painless. These samples will be retained. A video recording and/or photographs may be taken for your medical records.
The procedure will be performed by or under the supervision of a trained doctor or nurse endoscopist, and we will make the investigation as comfortable as possible for you. Some patients have sedation injected into a vein for this procedure, although others prefer to remain awake and have local anaesthetic throat spray.
You have been advised to undergo this investigation to try and find the cause for your symptoms, help with treatment and if necessary, to decide on further investigation.
There are many reasons for this investigation including: indigestion; anaemia; weight loss; vomiting; passing black motions, vomiting blood or difficulty swallowing.
A barium meal x-ray examination is an alternative investigation. It is not as informative as an endoscopy and has the added disadvantage that tissue samples cannot be taken.
Eating and Drinking
It is necessary to have clear views and for this the stomach must
be empty. Therefore please do not have anything to eat for at
least six hours before the test. Water and other clear fluids are
safe up until two hours before your appointment.
If your appointment is in the morning have nothing to eat after midnight but you should continue to have water and/or other clear fluids as required up until two hours before your appointment. From then onwards, until you arrive at the department for your test, you are allowed sips of water only. If your appointment is in the afternoon you may have a light breakfast no later than 8am but you may continue to drink water and/or other clear fluids until two hours before your test. From then onwards, until you arrive at the department your test, you are allowed sips of water only. Your routine medication should be taken. NB: DIaBETIcs If your appointment is in the morning your
medication should be taken at 6am with a little water, however
if your appointment is in the afternoon your medication should be taken by 8am.
If you are presently taking tablets to reduce the acid in your
stomach please discontinue them two weeks before your
If you are having a follow-up OGD to check for healing of an ulcer found during the last two–three months, then please continue your acid reducing medications right up to the day before your repeat endoscopy. This also applies if you have a definite diagnosis of Barrett’s disease or of GORD (gastro-oesophageal reflux disease).
If unsure please telephone the unit.
If you are a diabetic controlled on insulin or medication
please ensure the endoscopy department is aware so that the
appointment can be made at the beginning of the list. Please
see guidelines printed in the back of the book on page .
Please telephone the unit if you are taking anticoagulants such
as warfarin or clopidogrel (Plavix).
Please telephone for information if you have a latex allergy.
How long will I be in the Endoscopy department?This largely depends upon whether you have sedation and also how busy the department is. You should expect to be in the department for approximately one–three hours. The department also looks after emergencies and these can take priority over outpatient lists.
When you arrive in the department you will be met by a qualified nurse who will ask you a few questions, one of which concerns your arrangements for getting home. You will also be able to ask further questions about the investigation. The nurse will ensure you understand the procedure and discuss any outstanding concerns or questions you may have.
You will be offered the choice of sedation or local anaesthetic throat spray (this is dealt with in more detail in the next section of this booklet).
If you have sedation, the nurse or doctor will insert a small cannula (small plastic tube) into a vein (usually on the back of your hand) through which the sedation will be administered later.
If you have sedation you will not be permitted to drive home or use public transport alone, so you must arrange for a family member or friend to collect you. The nurse will need to be given their telephone number so that she can contact them when you are ready for discharge.
You will have a brief medical assessment with a qualified endoscopy nurse who will ask you some questions regarding your medical condition and any past surgery or illness you have had to confirm that you are sufficiently fit to undergo the investigation.
Your blood pressure and heart rate will be recorded and if you are diabetic, your blood glucose level will also be recorded. Should you suffer from breathing problems a recording of your oxygen levels will be taken.
If you have not already done so, and you are happy to proceed, you will be asked to sign your consent form at this point.
Intravenous sedation or topical local anaesthetic throat spray can improve your comfort during the procedure so that the endoscopist can perform the procedure successfully.
The sedation will be administered into a vein in your hand or
arm which will make you lightly drowsy and relaxed but not
unconscious. You will be in a state called co-operative sedation:
this means that, although drowsy, you will still hear what is said
to you and therefore will be able to follow simple instructions
during the investigation.
If you have sedation you may or may not remember anything about the procedure.
Whilst you are sedated we will check your breathing and heart rate so changes will be noted and dealt with accordingly. For this reason you will be connected by a finger probe to a pulse oximeter which measures your oxygen levels and heart rate during the procedure. Your blood pressure may also be recorded.
Please note that if you decide to have sedation you must not drive, take alcohol, operate machinery or sign any legal documents for hours following the procedure. You will also need someone to accompany you home.
anaesthetic throat spray
With this method sedation is not used, but the throat is
numbed with a local anaesthetic spray.
As gastroscopes have become thinner, many patients are happy for the procedure to be carried out without sedation and to have throat spray instead. The throat spray has an effect very much like a dental injection in that it numbs the area that is sprayed with anaesthetic.
The benefit of choosing throat spray is that you are fully conscious and aware, and can go home unaccompanied almost immediately after the procedure. You are permitted to drive and carry on life as normal.
The only precaution you will need to take is that you must not have anything to eat or drink for about an hour after the procedure, until the sensation in your mouth and throat has returned to normal.
It is strongly advised that when having your first drink after the procedure, it should be a cold drink and should be sipped to ensure you do not choke.
When it is your turn you will be escorted into the procedure room where the endoscopist and the nurses will introduce themselves and you will have the opportunity to ask any final questions.
If you have any dentures you will be asked to remove them at this point, any remaining teeth will be protected by a small plastic mouth guard which will be inserted immediately before the examination begins.
If you are having local anaesthetic throat spray this will be sprayed onto the back of your throat whilst you are sitting up and swallowing: the effect is rapid and you will notice loss of sensation to your tongue and throat.
The nurse looking after you will ask you to lie on your left side and will then place the oxygen monitoring probe on your finger. If you have decided to have sedation, the drug will be administered into a cannula (tube) in your vein and you will quickly become sleepy.
Any saliva or other secretions produced during the investigation will be removed using a small suction tube, rather like the one used at the dentist.
The endoscopist will introduce the gastroscope into your mouth, down your oesophagus into your stomach and then into your duodenum. Your windpipe is deliberately avoided and you will still be able to breathe easily.
During the procedure samples (biopsies) may be taken from the lining of your digestive tract for analysis in our laboratories. These will be retained. A video recording and/or photographs may be taken for your medical records.
Upper gastrointestinal endoscopy is classified as an invasive investigation and because of that it has the possibility of associated complications. These occur extremely infrequently; however, we would wish to draw your attention to them and so with this information you can make your decision.
The doctor who has requested the test will have considered this. The risks must be compared to the benefit of having the procedure carried out.
The risks can be associated with the procedure itself and with administration of the sedation.
The endoscopic examination
The main risk is of perforation or tear of the lining of the
stomach or oesophagus (risk approximately one in 000 cases)
which may entail you being admitted to hospital. This will be
treated with antibiotics and intravenous fluids and may require
surgery to repair the hole.
Very rarely, severe bleeding may occur which may entail you being admitted to hospital.
Mechanical damage to teeth or bridgework occurs rarely.
Sedation can occasionally cause problems with breathing, heart
rate and blood pressure. If any of these problems do occur, they
are normally short lived. Careful monitoring by a fully trained
endoscopy nurse ensures that any potential problems can be
identified and treated rapidly.
Older patients and those who have significant health problem (for example, people with significant breathing difficulties due to a bad chest) may be assessed by a doctor before being treated.
You will be allowed to rest for as long as is necessary. Your blood pressure and heart rate will be recorded and if you are diabetic, your blood glucose will be monitored. Should you have underlying difficulties or if your oxygen levels were low during the procedure, we will continue to monitor your breathing and can administer additional oxygen. Once you have recovered from the initial effects of any sedation (which normally takes 0 minutes) you will be offered a snack and moved into a comfortable chair.
Before you leave the department, the nurse or doctor will explain the findings and any medication or further investigations required. She or he will also inform you if you require further appointments.
Since sedation can make you forgetful it is a good idea to have a member of your family or a friend with you when you are given this information although there will be a short written report given to you.
If you have had sedation, although you may feel fully alert following the investigation, the drug remains in your blood system for about hours and you can intermittently feel drowsy with lapses of memory. If you live alone, try and arrange for someone to stay with you or, if possible, arrange to stay with your family or a friend for at least hours.
If the person collecting you leaves the department while you are having your procedure done, the nursing staff will telephone them when you are ready for discharge.
If you are unable to keep your appointment please notify the endoscopy unit as soon as possible. This will enable us to give the appointment to someone else.
If you have decided to have the procedure under sedation, please arrange for someone to collect you.
It is our aim for you to be seen and investigated as soon as possible after your arrival. However, the department is very busy and your investigation may be delayed. If emergencies occur as these patients will obviously be given priority over less urgent cases.
The hospital cannot accept any responsibility for the loss or damage to personal property during your time on these premises.
If you have any problems with a persistent sore throat, worsening chest or abdominal pain, please contact your GP immediately informing them that you have had an endoscopy. If you are unable to contact or speak to your doctor, during normal working hours (Monday to Friday, 9am–.0pm), please ring the endoscopy department for advice (079 87880). Outside these hours you are advised to go immediately to your local casualty department.
Guidelines for patients with diabetes
Patients with diabetes controlled by diet and exercise alone
can ignore these instructions
Patients with Type 2 diabetes treated with oral medication
Patients with Type 1 or Type 2 diabetes treated with insulin
PlEasE rEaD INsTrucTIoNs BElow
If you have any concerns about managing your diabetes while preparing for this investigation please contact the diabetes specialist nurses on 079 69867, Monday to Friday, 9am–pm.
Day prior to the investigation
Have your normal diet, tablets and/or insulin.
The following diabetes tablets should be taken as prescribed: Glibenclamide (Daonil or Euglucon)Gliclazide or Gliclazide MR (Diamicron or Diamicron MR)Glimepiride (Amaryl)Glipizide (Glibenese or Minodiab)Gliquidone (Glurenorm)Repaglinide (NovoNorm) or Nateglinide (Starlix)Tolbutamide Rosiglitazone (Avandia or Avandamet)Pioglitazone (Actos)Acarbose (Glucobay) Day of investigation (scheduled for the morning)
Test your blood glucose on rising (if you normally do so). If below mmol, to take three glucose tablets or 0 to 00ml of ordinary lemonade or Lucozade).
No food or drink to be taken within six hours of appointment time. Clear fluids can be drunk up to two hours prior to appointment.
Omit morning insulin (except Lantus or Levemir which should be taken as normal), and/or diabetes tablets (as listed above), and breakfast.
Take along your morning insulin and/or diabetes tablets and some breakfast with you to your hospital appointment, so that you can have your insulin and/or diabetes tablets with some food, following completion of the investigation.
Do not drive to or from the appointment if you are on insulin therapy.
On arrival, remind staff that you have diabetes.
If the district nurse administers your insulin in the morning, please take your diabetes shared care book, your Insulin and a syringe to the appointment with you.
Check blood glucose pre meal for the rest of the day, if you normally self test at home.
Resume insulin at normal times across the rest of the day with your normal diet. Day of the investigation (scheduled for the afternoon)
Patients treated by diabetes tablets only.
Only clear fluids (cordial, water or fizzy drinks), should be taken orally from rising until two hours before the test.
Test blood glucose while oral intake is restricted (if you normally do so). If blood glucose is under mmol to take three glucose tablets or 0 to 00ml of ordinary lemonade or Lucozade).
Take normal diabetes tablets with evening meal after investigation completed.
Check blood glucose pre-meal for the rest of the day, if you normally self test at home.
any other questions?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diabetic instructions written by Dr. Elrishi, Consultant: Diabetes and Endocrinology, Princess Alexandra Hospital NHS Trust, Harlow This leaflet is based upon an original produced by: Dr Hugh Shepherd FRCP MD MB BChir (Consultant Gastroenterologist) Dr David Hewett MSc MFPHM MBCS MHSM (Assistant Medical Director) Meeting your needs
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You can contact us about accessibility by telephoning 079 87.
Princess Alexandra Hospital NHS Trust, Hamstel Road, Harlow, Essex
In de helft van het bloedverlies in de eerste maanden van de zwangerschap is er sprake van een miskraam, een abortus
Wanneer u een miskraam heeft. In de helft van het bloedverlies in de eerste maanden van de zwangerschap is er sprake van een miskraam. De oorzaak van een miskraam is bijna altijd een afwijking in de chromosomen die toevallig is ontstaan bij de bevruchting van de eicel. Dit leidt tot een stoornis in de aanleg van de zwangerschap waardoor de zwangerschap niet verder kan groeien en wordt afge