GI Scopes, Occult Blood Testing, and Urologic Assessment

GI Endoscopic Scopes

• Sigmoidoscope ("sigmoid scope")
• Inserted through anus → inspects rectum + sigmoid colon only.
• Shorter instrument; outpatient, minimal prep.
• Colonoscope
• Travels entire large intestine up to ileocecal valve (junction with small bowel).
• Longer, requires full bowel prep.
• Upper endoscope (EGD)
• Introduced orally → oesophagus → stomach → proximal small bowel.
• Needed to visualise small-intestinal bleeds.
• Quick scope-mapping hierarchy
• Digital rectal exam < proctoscope < sigmoidoscope < colonoscope.
• Disposable, clear-walled scopes now preferred; some equipped with density-sensing cameras that halt advancement until suspicious mucosa is acknowledged.

Visible vs Occult GI Bleeding

• Two descriptive terms for blood in urine or stool
• Gross = visible to naked eye.
• Micro = occult; detected only by chemical tests.
• Patient complaints that may suggest hidden blood
• Abdominal pain, constipation, diarrhoea, alternating diarrhoea/constipation, “stringy” stool (faecal matter squeezing past an impaction).

Stool Appearance & Bristol Chart

• Seven Bristol classes (Type 11–77)
• Ideal stool should neither sink instantly nor float; represents balanced fibre/water.
• Colour clues
• Black, tarry, sticky (melena) → old/upper GI bleed.
• Bright-red streaks on outside of stool → haemorrhoid or distal anal lesion.
• “Coffee-ground” emesis or stool → active upper GI bleed; emergency.
• Use Bristol chart if patient is a poor historian; point to diagram to pick closest description.

Occult Blood Tests

Guaiac-based faecal occult blood test (gFOBT / Hemoccult, Glyc-Slide)

• Kit contains 33 slide cards + 33 wooden applicator sticks.
• Patient instructions
• Collect on three separate days (e.g., Mon-Wed-Fri).
• Defecate into clean container; avoid urine mixing.
• Using fresh stick: smear thin sample on area “A”, fresh portion on “B”; close flap; allow to dry.
• Fill in name, DOB, collection date before handling stool.
• Return cards personally or mail in biohazard pouch.
• In-clinic processing
• Open rear flap; note two orange control circles.
• Apply one developer drop between controls first (establishes colour change reference).
• Wait 60 s60\text{ s}; positive control = blue/green ring.
• Then place one drop on back of each specimen window.
• Read at 6060–120 s120\text{ s}.
• Interpretation: any blue coloration matching control = positive.
• Documentation format: “Slide 1 – neg; Slide 2 – pos; Slide 3 – pos”. ≥2/32/3 positives → refer for colonoscopy.

Immunochemical test (FIT / QuickVue, OC-Auto)

• Uses antibodies specific to human globin; no dietary/medication restrictions.
• Quantitative laboratory analyser; fewer false positives → fewer unnecessary colonoscopies.

Patient Prep: gFOBT-Specific

• Diet 33 days prior
• High-fibre foods (lettuce, spinach, corn, celery) to provoke potential bleeding.
• Eliminate red meat (animal haemoglobin may trigger false +).
• Avoid horseradish, turnips, broccoli, cauliflower, radish, cantaloupe.
• Medication hold 7 days7\text{ days} prior
• Aspirin, NSAIDs, iron, vitamin C >250 mg/day250\,\text{mg/day}.
• Anticoagulants: require written cardiology clearance; may perform Lovenox bridge.

Endoscopic Polypectomy

• Snare/basket loop passes through colonoscope.
• Assistant (MA) manages retrieval cup, labels specimen, sends to pathology.
• Cold-cut devices open/close to excise polyp; risk of perforation in diverticulitis.

Male Reproductive & Urologic Topics

Testicular Self-Examination (TSE)

• Perform monthly, ideally during/after warm shower to relax scrotum.
• Steps

  1. Stand before mirror; inspect for scrotal swelling, skin puckering (“orange-peel”).
  2. Support testicle with index & middle fingers beneath, thumbs on top.
  3. Roll gently front–back & side–side; identify epididymis (soft cord at back) & vas deferens.
  4. Repeat on other side; note differences but recognise natural asymmetry.
  5. Report immediately:
    • New lump (even rice-grain size), enlargement, heaviness, pain, change in consistency.
    • Hydrocele = fluid accumulation; often treated with antibiotics or further imaging.

Vasectomy Basics

• Surgeon isolates vas deferens, clamps, cuts segments widely apart, cauterises ends.
• Possibility of recanalisation (tubes “find” each other, like starfish regrowth) – emphasise follow-up semen analyses.

Radiology & Contrast Medium Considerations

• “Contrast medium” or “with dye” exams (CT, IVP, hysterosalpingogram).
• Pre-check
• Allergies (iodine, shellfish, previous contrast reaction).
• Renal function: hold metformin; resume only when serum creatinine returns to baseline.
• Some GI studies require patient positioning knowledge (supine, prone, left lateral decubitus, Trendelenburg, Sims). Review list for exam.

CLIA, QC & Lab Environment

• Most FOBT kits are CLIA-waived qualitative assays; positives often reflex to quantitative laboratory tests.
• Store kits at manufacturer-specified temperature; record lot #, expiry, control results.
• External liquid controls run with each new lot/shipment.

Practical Workflow Tips

• Provide disposable “hat” or clean Tupperware for stool collection; caution against stained containers (colour interferes with evaluation).
• Give extra gloves + written instructions to increase compliance.
• If black/tarry stool is reported before testing, escalate to provider immediately; may bypass FOBT.
• Expect to teach Bristol chart and TSE repeatedly; keep laminated copies in exam rooms.

Ethical & Communication Points

• Normalise discussion of anorectal & genital symptoms to reduce stigma.
• Use correct but patient-friendly language (“poop”, “stringy”, “ball”), then document in clinical terminology.
• Provide printed prep instructions; never rely on verbal memory alone.