By Harry R. Dalton, H.R. Dalton, S.H. Hussaini, I.A. Murray, J.L.H. Wong
Clinic instruction manual: Gastroenterology offers functional guidance at the scientific and administrative concerns linked to operating a gastroenterology-based outpatient clinic.
Written with all participants of the outpatient crew in brain, the booklet presents key info on prognosis; making plans and implementation of therapy; sufferer schooling and source management.
Clinic guide: Gastroenterology is key examining for an individual taking into account constructing, or at present all in favour of, an outpatient medical institution during this box
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Patients undergo gastroscopy with small bowel biopsy followed by colonoscopy. Alternatives to colonoscopy are a combination of flexible sigmoidoscopy with carbon dioxide insufflation followed by double-contrast barium enema or CT of the colon. CT of the colon is performed for patients over 80 years old, those few patients who are too frail to undergo colonoscopy or those who have incomplete colonoscopic investigation. Colonoscopy is preferred to barium contrast studies since angiodysplastic lesions can be visualized and colonic biopsies can be taken.
Senior staff should review all patients before decisions are made on further investigation (such as endoscopic retrograde cholangiopancreatography; ERCP), admission, discharge or follow-up. In our experience such a service can be an important part of the ongoing education of junior medical staff. Skilled nursing staff can take on many aspects of the workload of an acute jaundice service, from venesection up to proforma-guided history taking. Integration of paramedical and nursing staff into the day-to-day running of the jaundice clinic will facilitate a high quality, multidisciplinary service.
It is important to differentiate the patients with acute onset of jaundice from those with chronically deranged liver function tests (LFTs). This latter group can be more effectively investigated in a conventional outpatient setting and are covered in Chapter 7. Traditionally, the acutely jaundiced patient has often been admitted directly to hospital as an emergency. This is often unnecessary as most can be safely assessed and managed on an outpatient basis. Depending on the local availability of outpatient clinics, radiology and endoscopy, it may be necessary to establish ‘open-access’ services where these patients can be rapidly assessed and appropriate management can be instigated without delay.