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Southern DHB Gastroenterology Services

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    Southern DHB (SDHB) Gastroenterology is a districtwide service that specialises in disorders of the digestive tract (oesophagus, stomach, small intestine and colon) and related organs such as the liver.

    Full diagnostic endoscopy services, including the National Bowel Screening Programme colonoscopies, are delivered in Dunedin Hospital by gastroenterologists and general surgeons, with an acute service available at all times.  To maintain privacy and confidentiality for all patients and the safety of vulnerable patients, visitors or relatives are not routinely allowed into clinical areas.  Exceptions will be considered on an individual basis.

    Gastroenterology services at Southland Hospital consist of outpatient appointments and endoscopy sessions, including National Bowel Screening Programme colonoscopies, provided by a consultant gastroenterologist or the general surgical team.  However, patients that require urgent gastroenterology intervention may be referred to specialists based in Dunedin Hospital.  To maintain privacy and confidentiality for all patients and the safety of vulnerable patients, visitors or relatives are not routinely allowed into the procedural area.  Access to the day surgery area is at the discretion of the nursing staff.

    An endoscopy service is provided at Dunstan Hospital at a regular clinic for planned patients.  Urgent interventions will be referred to Dunedin Hospital.  To maintain privacy and confidentiality for all patients and the safety of vulnerable patients, visitors or relatives are not routinely allowed into the procedural area.  Access to the patient preparation area is at the discretion of the nursing staff

    Rural specialist clinics are provided at Queenstown, Balclutha and Oamaru.

    Southern DHB participates in the training of new endoscopists from medical, surgical and nursing backgrounds, with training lists allocated to each trainee to develop safe and thorough technical skills and recognition of disease.  Patients should be told if they are allocated to a training list when they attend for the procedure and have the option to opt out of having a trainee do their procedure.  The consultant supervising the trainee will then complete the procedure and the report.  Patients are also able to decline to have student doctors and nurses observe their procedure.  Please let the nursing staff know on arrival if you don’t want students present during your admission.


    What is Gastroenterology?

    Gastroenterology is the branch of medicine that looks at diseases of the oesophagus (gullet), stomach, small and large intestines (bowel), liver, gallbladder and pancreas. 

    The oesophagus is the tube that joins your mouth with your stomach. It is a muscular tube that contracts to push the food through when you swallow.

    The stomach is where food is broken down by acid and emptied into your intestines. The stomach has special cells lining its wall to protect it from these acids.

    The intestines consist of the small intestine (duodenum, jejunum and ileum – different sections of small intestine) and the large intestine (colon).  As food passes through the small intestine, nutrients are broken down and absorbed.  When it passes into the colon, water is absorbed.  The waste that is left is passed as faeces (poo).

    The liver is the largest internal organ and is on your right side just under your ribs. It stores vitamins, sugar and iron, which are used by cells in the body for energy. It also clears the body of waste products and drugs, produces substances that are used to help blood clot and aid the immune system, and produces bile to aid digestion.

    The pancreas is an elongated organ that lies in the back of the mid-abdomen. It is responsible for producing digestive juices and certain hormones, including insulin, the main hormone responsible for regulating blood sugar.

     

    A gastroenterologist is a doctor specialising in the field of medicine which involves these closely related organs.

    Practitioners

    • Dr Jason Hill

      Gastroenterologist - Clinical Leader
    • Dr Srikantaiah Manjunatha

      Gastroenterologist
    • Prof. Michael Schultz

      Prof. Michael Schultz

      Gastroenterologist
    • Dr Paddy O'Connor

      Gastroenterologist
    • Dr Steven Johnson

      Gastroenterologist
    • Dr Kyle Hendry

      Dr Kyle Hendry

      Gastroenterologist
    Procedures

    Gastroscopy

    This is a procedure which allows the endoscopist to see inside your oesophagus, stomach, and the first part of the small intestine (duodenum) and examine the lining directly.   The gastroscope is a flexible soft coated tube about as thick as a marker pen.  It has a tiny camera attached that sends images to a viewing screen.  During the test you will swallow the tube but the back of your throat is usually sprayed with local anaesthetic so you don’t feel this.  You will be offered a sedative (medicine that will make you sleepy but is not a general anaesthetic) but you can choose to have no sedation.  If the endoscopist sees any abnormalities they can take a biopsy (a small piece of tissue) to send to the laboratory for testing.  This is not a painful procedure and will usually be performed as a day stay patient by a specialist endoscopist with nurses assisting. Complications from this procedure are very rare but can occur. They include bleeding after a biopsy, allergic reaction to the sedative or throat spray and perforation (tearing) of the stomach with the instrument (this is a serious but extremely rare complication). 

    Before the procedure you will be asked not to eat anything for six hours and not to take any of your medications on the day of the appointment. 

    Afterwards you will stay in the post procedure area until you have recovered and are safe to send home and you have been given your discharge instructions.  Time in this area is between 15 minutes and 2 hours, depending on sedation effect and how you are feeling.  You will be given something to eat or drink before you go home unless you have had throat spray.  If you have had sedation, you are not to drive until the following day. If biopsies are taken these will be sent for analysis and results are available within one week.  All information will be sent to your GP.

    Endoscopic Retrograde Cholangio Pancreatography (ERCP)

    A flexible tube with a tiny video camera attached (endoscope) is inserted through the mouth into the stomach and small intestine while you are under sedation (you have been given medication to make you drowsy). A smaller tube is then moved through the first tube into the bile duct (the tube that connects your gallbladder to your intestines) through which dye is injected and an x-ray is taken to visualise the ducts. This procedure also enables the removal of stones from the ducts without the need for surgery.

    Colonoscopy

    This is a procedure which allows the endoscopist to see inside your large bowel and examine the surfaces directly and take biopsies (samples of tissue) if needed.  Treatment of conditions can also be undertaken.   The colonoscope is a flexible  soft coated tube a little thicker than a marker pen which has a tiny camera attached that sends images to a viewing screen. You will be given a sedative (medicine that will make you sleepy but is not a general anaesthetic). The tube is passed into the rectum (bottom) and gently moved along the large bowel.  The procedure takes from 10 minutes to 1 hour and your oxygen levels and heart rhythm are monitored throughout. The procedure is performed in a day procedure environment.    Before the procedure you will need to follow a special diet and take some laxative drinks to empty your bowel just prior to the appointment.  Risks of a colonoscopy are rare but include bleeding, allergic reaction to the sedative and perforation (tearing) of the bowel wall.

    Capsule Endoscopy or PillCam™

    This procedure involves the patient swallowing a camera the size of a large medication pill in order to view the small intestine.  An external belt is worn that holds the equipment to record the images taken. Captured images are made into a movie that is reviewed later by a clinician.  The procedure is non-invasive and the camera passes out in the toilet within 48 hours. 

    To prepare for a capsule endoscopy requires fasting for a few hours before the procedure and drinking some liquids to clean out the bowel.  Once the camera has been swallowed you can leave the unit and go to work or home for a few hours before returning to have the external equipment removed. There is a small risk of the camera not passing out in to the toilet and needing surgery to remove the capsule to prevent injury to the small intestine. 

    Liver Biopsy

    The best way to establish what type of liver disease is present, and the extent of the disease, is a biopsy. It is usually performed by inserting a needle into the liver through the skin and taking a small sample of liver tissue. Examination of the sample under the microscope can demonstrate what damage or what type of disease is present. Before your doctor does this procedure, they will check whether or not you are at increased risk of bleeding by doing blood tests. Following the procedure, you will need to be monitored for several hours before you are discharged to go home.

    Hepatitis

    This name refers to inflammation of the liver. The most common causes are fatty liver, alcohol, drug injuries and viruses.  Hepatitis B and C are viruses that can cause chronic (long term) inflammation and damage to the liver. These viruses are passed from person to person through body fluids.  For more information about Hepatitis B and C see www.hepfoundation.org.nz 

    Cirrhosis

    Cirrhosis is the term used to describe a diseased liver that has been badly scarred, usually due to many years of injury. Many people who have developed cirrhosis have no symptoms or have only fatigue, which is very common. However, as the cirrhosis progresses, symptoms often develop as the liver is no longer able to perform its normal functions. Symptoms include swollen legs and an enlarged abdomen, easy bruising and bleeding, frequent bacterial infections, malnutrition, especially muscle wasting in the temples and upper arms and jaundice (a yellow tinge to the skin and eyes). 

    Cirrhosis is diagnosed using a number of tests including: blood tests, ultrasound scans and liver elastography.

    Treatment options depend on the severity of damage to the liver and include dietary changes and avoidance of substances such as alcohol that can further damage the liver. Medication may be given to prevent complications and treat symptoms of liver failure.

    Peptic Ulcers

    Peptic ulcers are sores or eroded areas that form in the lining of the digestive tract. They usually occur in the stomach (gastric ulcer) or in the duodenum (duodenal ulcer), which is the first part of the small intestine. People with peptic ulcers can have a wide variety of symptoms and signs, can be completely symptom-free or, much less commonly, can develop potentially life-threatening complications such as bleeding.

    Signs and symptoms of ulcers include pain / burning or discomfort (usually in the upper abdomen), bloating, an early sense of fullness with eating, lack of appetite, nausea, vomiting and bleeding, which is made apparent by blood in the stool, either in noticeable or microscopic amounts (very brisk bleeding will result in black and tarry stools that smell bad).

    Smoking, alcohol, anti-inflammatory medication and aspirin increase the risk of developing ulcers. Psychological stress and dietary factors (once thought to be the cause of ulcers) do not appear to have a major role in their development.

    Helicobacter pylori, a bacteria that is found in the stomach is a major cause of stomach ulcers.  If this is found you will be given a course of antibiotics. Diagnosis is made by the history, examination and sometimes blood tests.  You may be asked to have a gastroscopy (see above) to clarify the diagnosis and aid with treatment.

    Treatment consists of lifestyle modification like losing weight, eating smaller meals, smoking cessation, reducing caffeinated, carbonated and alcoholic drink intake.  Medication can be prescribed in the short term to reduce the amount of acid in the stomach which aids in the healing of active ulcers.

    Inflammatory Bowel Disease (IBD)

    There are many types of IBD, the most common are ulcerative colitis and Crohn’s Disease.  In these conditions, the immune system attacks the lining of the colon causing inflammation and ulceration, bleeding and diarrhoea.  In ulcerative colitis this only involves the large intestine, whereas in Crohn’s areas within the entire intestine and outside the intestine can be involved.  Both diseases are chronic (long term) with symptoms coming (relapse) and going (remission) over a number of years.

    Symptoms depend on what part of the intestine is involved but include abdominal pain, diarrhoea with bleeding, tiredness, fevers, infections around the anus (bottom), weight loss can occur if the condition has been present for some time.

    Diagnosis is made when the symptoms, examination and blood tests suggest inflammatory bowel disease, infection is ruled out, and you undergo a colonoscopy with biopsy.

    Treatment depends on the severity of the symptoms and what part of the intestine is affected.  Medication is aimed at suppressing the immune system, which is harming the lining of the bowel.  This is done via oral or subcutaneous or intravenous medication as well as medication given as an enema (via the bottom). 

    Other treatments include changes in the diet to optimise nutrition and health.  Treatment in some cases requires surgery to remove affected parts of the bowel.  For more information see  www.crohnsandcolitis.org.nz