Screening Colonoscopy

PROCEDURE:  Colonoscopy.

INDICATION:  Screening

PROCEDURE IN DETAIL:  Indications, risks, benefits, alternatives, and limitations were explained to the patient in the office.  Risk of anesthesia, perforation, bleeding, infection, colitis, cardiopulmonary risk, morbidity, and mortality were discussed.  Possibility of missing a lesion, a polyp, a growth, a mass, and cancer was discussed.  Risk of cold biopsy, hot biopsy, and polypectomy was discussed.  Risk of the prep was discussed.  All these discussions were done in the office.  She understood all of the above.  All her questions were answered.  She agreed to the procedure.  She came to the endoscopy unit today.  She had no further questions or concerns.  She said she is prepped well.  Physical exam was grossly negative.  She was given informed consent.  She was then taken to the endoscopy room.  Anesthesia provided sedation.  Scope was advanced into the rectum all the way to the cecum.  Tortuous colon application of pressure was required to get to the cecum.  Cecum was identified by the ileocecal valve and appendix.  Photographs were taken for documentation.  Small bowel could not be intubated.  Mucosa was then examined on withdrawal.  There was some liquid and pasty stool throughout the colon, as much as possible was cleaned out.  Small lesions or flat lesions could have been missed.  The cecum, the ascending colon, transverse colon, descending colon, sigmoid colon, and rectum were carefully examined.  Retroflexion was done in the rectum.  Over 6 minutes was taken to evaluate the colon on withdrawal.  Findings were that of grossly negative colonoscopy.  Small-to-moderate internal hemorrhoids.  Procedure was completed.  The patient tolerated the procedure well.

IMPRESSION:  Screening colonoscopy grossly negative, small-to-moderate internal hemorrhoids.

PLAN:  Fiber supplement.  Hemorrhoid suppositories.  She can buy OTC.  The patient to do annual Hemoccult screening with primary care doctor.  Colonoscopy in 5 to 10 years, unless otherwise indicated.  Follow up in my office.  Follow up with PCP