» What is pH Monitoring?
This is a special procedure to test for any acid reflux (stomach contents backing up) into the esophagus. It is a non-painful procedure which involves placement of a thin rubber coated wire (called a probe) through the nose into the distal end of the esophagus just above the stomach. This probe stays in place approximately 16-20 hours, and records all the reflux periods. It requires the child to be admitted for a 23 hour overnight stay in the hospital.
» What will happen?
Shortly after admission, the GI nurse will come to the child’s room with the equipment. Insertion of the probe does not hurt, but it may cause some temporary gagging and discomfort as it passes through the throat. This will pass after approximately 20-30 minutes. The child can help by drinking some juice during insertion to help the tube pass. The child will then go to radiology where an x-ray will be done to check that the probe is in proper place. They will then return to the room where they will be hooked up to the pH machine by the pH wire and also a ground wire. These will stay attached for the remainder of the test. The child is able to eat, drink and play as usual, in the bed. Movement about the room is limited due to the length of the wires. You may bring toys or games to occupy them during the test, or the child life department at the hospital will supply you with some things to do. Smaller children may require some restraint to keep them from pulling the probe out.
After completion of the test, the probe will be pulled out. This is very quick and totally painless (except for tape removal). There may be some slight irritation of nose or throat for the next day or two, but this is to be expected.
We will contact you with the results.
» What is an Endoscopy?
This is a special examination for the diagnosing of problems like acid-related disease, finding causes of pain and bleeding, and removing foreign objects.
It is performed with a long, flexible tube called an endoscope, which transmits light and images to the doctor. The doctor passes the tube through the mouth, and since the tube is thinner than most food we swallow, this is surprisingly easy.
» How to prepare
NO FOOD OR DRINK AFTER MIDNIGHT FOR CHILDREN, OR FOR 6 HOURS BEFORE THE EXAMINATION FOR INFANTS.
» Where to go
All Children's Hospital: someone from the Special Procedures Unit will call you with the time you are to be at the hospital. If you have not heard from anyone by the day before your procedure, call 892-8954 between 1:00 and 2:00 pm. If no contact has been made about arrival time, then please be there by 7:00 am. Go to the admitting Desk at All Children's Hospital, 801 6 th Street So.
St. Joseph's: someone will call the day before your procedure. If you have not heard from the staff by 2:30 PM you may call 813-554-8511 Option 1. If no contact has been made arrive at 6:30 AM.
Tampa General Hospital: someone will call the day before. You may call 813-844-1803 if you have not heard from the staff.
Surgikid: someone will call the day before to confirm. Please call 813-631-5050 if you have not heard from the staff.
» Time needed?
The procedure takes 10-30 minutes. Please don't leave the waiting area during this time. Your doctor will come out and speak with you when the procedure is over.
» What will happen?
Upon arrival at the unit, a nurse will ask you a few questions, get a brief history, and weigh your child. An IV will be started (only clear fluids will be in the bag). For younger children, mask anesthesia may be given first and then an IV started once they are asleep. The doctor or anesthesiologist will order sedation appropriate for your child when he/she arrives and is ready to start. You will be directed to the waiting room prior to sedation being given.
Once asleep, the scope is passed via the mouth. For children with teeth, a bite block is inserted to prevent the scope from being bitten. The scope looks at the esophagus, stomach and first portion of the small bowel. Biopsies are generally taken using a small pair of tweezers which pass through the scope and take pieces of tissue the size of the head of a straight pin. The child sleeps through the examination and feels no discomfort .
Since air is inserted into the stomach during the procedure to view the GI tract, this may cause a bloated feeling in some patients. We try to remove as much of the air as possible as the procedure ends, but some will remain. Burping will relieve this bloating and help remove the air.
» Afterwards
When the procedure is finished, the doctor will come out to speak to you and let you know how everything went, follow any special instructions given by the doctor. The nurse will give you written instructions prior to going home
Immediately after the endoscopy procedure, your child may still be sleeping and will be drowsy.
Your child will rest and be monitored in a recovery area until the sedation wears off. Typically, patients are offered something to drink when they are alert and awake if appropriate.
If your doctor did any biopsies, these will take approximately 3-5 working days for results to return. Keep in mind that the scope takes pictures to the level of a TV camera while biopsies are looked at to the level of a microscope. The report of the biopsies is needed to fully confirm the cause of your child's symptoms.
» Please note
1. No food or drink is allowed in the holding and recovery areas.
2. Only two adults may be in the holding and recovery areas with the patient.
3. Arrangements for siblings should be made; they are not allowed in the holding and recovery areas.
» What is a Colonoscopy?
This is a special examination for examining of the lining of the large intestine or colon. It allows a detailed study of areas suspected of having abnormalities.
It is performed with a long, flexible tube called a colonoscope, which transmits light and images to the doctor. The colonoscope is about the diameter of a small finger and is inserted through the rectum into the large intestine. The patient is generally lying on their side in a comfortable position. Through this procedure, the doctor can determine the causes of such problems as rectal bleeding, inflammation or changes in bowel habits. By inserting an instrument through the colonoscope tube, he can also remove polyps or take tissue sample (biopsy) when necessary.
» How to prepare
For the best possible examination, the colon must be completely empty of waste material. You will know your child is thoroughly cleaned out when only clear liquid is coming from below. To accomplish this, please carefully follow all the directions on your instruction sheet. Your child may be required to have lab work done to check clotting studies if they have never had surgery or any type of operative procedure. This will be done at the initial office visit.
» Where to go
All Childrens Hospital: someone from the Special Procedures Unit will call you with the time you are to be at the hospital. If you have not heard from anyone by the day before your procedure, call 892-8954 between 1:00 and 2:00 pm. If no contact has been made about arrival time, then please be there by 7:00 am. Go to the admitting Desk at All Children’s Hospital, 801 6 th Street So.
St. Joseph's: someone will call the day before your procedure. If you have not heard from the staff by 2:30 you may call 813-554-8511 Option 1. If no contact has been made arrive at 6:30 AM.
Tampa General Hospital: someone will call the day before. You may call 813-844-1803 if you have not heard from the staff.
Surgikid: someone will call the day before to confirm. Please call 813-631-5050 if you have not heard from the staff.
» Time needed?
Allow 30-60 minutes for the colonoscopy procedure, and another 30 minutes for rest and recovery following the procedure.
» What will happen?
Upon arrival at the unit, a nurse will ask you a few questions, get a family history, and weigh your child. An IV will be started (only clear fluids will be in the bag). The doctor will order sedation when he/she arrives and is ready to start. You will be directed to the waiting room prior to sedation being given. Once the child is sedated, the colonscope is inserted into the rectum and slowly advanced through the colon. When the intestinal lining has been thoroughly examined, the colonoscope is slowly withdrawn. When the colonoscopy is completed, the child will rest until the sedation wears off. Please do not leave the waiting room during the procedure; the doctor will be out to speak with you when the procedure is done.
» Afterwards
After the examination, follow any special instructions given by your doctor. If a biopsy or a polypectomy was done, allow 5-7 days for results. The office will call you as soon as the results come in. Immediately after the colonoscopy procedure, your child will be drowsy because of the sedation that was given, But, within the next several hours, she/he should be able to resume normal diet activity. A discharge sheet with instructions will be given to you prior to going home.
ERCP stands for Endoscopic Retrograde CholangioPancreatography. An ERCP is a special procedure used to study the ducts (drainage routes) of the liver, gallbladder, and pancreas. The test is preformed in the X-Ray Department and takes about 30-90 minutes to complete.
During this procedure an endoscope (a narrow flexible tube with a light and camera on the end) is passed through the mouth, esophagus (throat) and stomach into the duodenum (small intestine). A narrow plastic tube is passed through the endoscope into the ducts and x-rays are taken.
» Liver, Gallbladder & Pancreas
The liver produces bile, which is needed to digest food. The bile flows from the liver through ducts (or tubes), into the gallbladder, and enters the duodenum (small intestine) just beyond the stomach.
The pancreas secretes enzymes also used for digestion. The enzymes flow through the pancreatic duct into the duodenum (small intestine).
» Purpose
The test is used to help diagnose and treat a variety of disease and/ or symptoms involving the liver, gallbladder and pancreas. These may include:
Gallstones which are trapped in the main bile duct
Blockage or narrowing of the bile duct
Yellow jaundice, which turns the skin yellow and the urine dark
Upper abdominal pain
Inflammation of the pancreas
An ERCP can be used to diagnose a problem and in some cases treat the problem. This may be used to determine whether or not surgery is necessary and is helpful in providing the doctor with detailed information. For example, this test can be used to open the end of the bile duct, remove stones, or place drainage tubes into a closed or narrow duct to allow drainage of bile or enzymes.
» Before the test
An empty stomach is needed for the best results. You should have nothing to eat or drink, including water, after midnight or 6 hours before the test.
Before the test begins you will be asked to put on a hospital gown.
» Medicine, Allergies & Precautions
Be sure to discuss with the doctor whether you should adjust any of your usual medicines. In most cases, medicines may be continued as usual, but some may interfere with the test. Aspirin products, arthritis medicines, anticoagulants (blood thinners), insulin, and iron products are examples of medicines that should be discussed.
Also, you need to tell your doctor if you have allergies to any drugs or anesthetics, if you have any heart or lung problems, or if you are pregnant.
» During the test
You will be asked to lie on the X-Ray table so that films can be taken. You will lie on your left side or abdomen. A doctor, nurse and technician will be there with you.
You will receive sedation medication through a vein to help you relax. Also, your throat may be sprayed with a medication to make it numb.
The endoscope is then gently passed through the mouth, esophagus, and stomach into the duodenum. The instrument does not interfere with breathing.
A contrast dye is injected into the main bile duct and/or the pancreatic duct through the endoscope. X-rays are taken.
If a stone is found, it may be removed. If a duct has become narrowed, an incision may be made to relieve the blockage.
» Possible Side Effects or Complications
During the procedure, air is introduced through the instrument and may cause temporary bloating during and after the test. This my be relieved by burping. A sore throat may occur and last 24-36 hours after the test. Sucking on hard candy or gargling with mouthwash may help.
» After the test
When the test is completed, you will rest in a recovery area until the sedation wears off. Your heart rate and blood pressure will be monitored.
» Results
Your doctor will inform you of the test results as soon as he has the report from the radiologist and/or pathologist. Results of any biopsies (tissues samples) may take 3-5 days to be available.
Based on test results, other tests or treatment may be recommended.
» What is a PEG/ G tube?
PEG stands for Percutaneous (through the skin) Endoscopic (use of a flexible lighted tube to visualize tube placement) Gastrostomy (surgical opening into the stomach from the abdomen). PEG tubes are used to give nutrition and medications to children who are unable to take sufficient amounts by mouth. PEG tubes have an internal disc holding them in place. They have to be removed by endoscopy. Other types of G tubes which may be placed several weeks after the initial PEG tube have a balloon that can be deflated and changed at home or in the office.
» How is the PEG placed?
The PEG is place by endoscopy. It is performed with a long flexible tube called an endoscope, which transmits light and images to the doctor to ensure the proper placement. One doctor passes the tube through the mouth, and since the tube is thinner than most food we swallow, this is surprisingly easy. Another doctor makes a small incision in the skin to place the tube into the stomach.
» How to prepare
NO FOOD OR DRINK AFTER MIDNIGHT THE NIGHT BEFORE THE PROCEDURE.
» Where to go
All Children's Hospital: someone from the Special Procedures Unit will call you with the time you are to be at the hospital. If you have not heard form anyone by the day before your procedure, call 892-8954 between 1:00-2:00 pm. If no contact has been made about arrival time, then please be there by 7:00 am. Go to the Admitting Desk at All Children's Hospital, 801 7th St. S..
St. Joseph's: someone will call the day before your procedure. If you have not heard from the staff by 2:30 you may call 813-554-8511 Option 1. If no contact has been made arrive at 6:30 AM.
Tampa General Hospital: someone will call the day before. You may call 813-844-1803 if you have not heard from the staff.
Surgikid: someone will call the day before to confirm. Please call 813-631-5050 if you have not heard from the staff.
» Time Needed
The procedure takes 10-30 minutes. Please don't leave the waiting area during this time. Your doctor will come out and speak with you when the procedure is over.
» What will happen
Upon arrival at the unit, a nurse will ask you a few questions, get a brief history, and weigh your child. An IV will be started (unless one has already been placed). For younger children, mask anesthesia may be given first and then an IV started once they are asleep. The doctor or anesthesiologist will order sedation and antibiotics appropriate for your child when he/she arrives and is ready to start. You will be directed to the waiting room prior to sedation being given.
Once the child is sedated and asleep, the endoscope is passed through the mouth and into the stomach. The doctors will then look for a good location to place the PEG tube where the stomach and abdominal wall touch one another. Rarely, an appropriate place can not be found to safely place the tube, the procedure will be stopped and your child referred to a surgeon to place a surgical G tube if this is the case. When the doctors find a good location, the skin will be numbed and a very small incision will be made approximately 1/8th of an inch long on the abdomen to allow passage of the tube. A needle is placed via this small incision through the abdominal wall and into the stomach, then a string is passed via the needle into the stomach and grasped by the scope. This string is pulled out the mouth and the PEG tube tide to this string. The string is then pulled from the abdomen side and with it the PEG tube goes down the esophagus, into the stomach and ultimately out the abdominal wall. There is a disc on the end of the tube that stays in the stomach and keeps the tube from being pulled out.
» Afterwards
When the procedure is finished, the doctor will come out to speak to you and let you know how everything went. You will then be transferred to another room in the hospital. The child will be admitted for approximately 48 to 72 hours.
When the procedure is completed, the child will rest until the sedation wears off. Pain medication will be ordered for any discomfort and antibiotics will be given as well to help the area heal. Your child will not have anything to eat for the first 24 hours to allow the stomach and new G tube site the chance to heal. He/she will be given IV fluids so he/she will not get dehydrated. He/she may have a mild sore throat and discomfort at the PEG tube site. Pain medicine will be ordered for the nurses to give as needed. Once it is appropriate for your child to eat, formula will be ordered to go slowly through the tube. It may be slowly increased as your child tolerates it. Once he/she tolerates the prescribed amount and you are properly taught how to give the feedings and operate any equipment, you will be allowed to go home. During your stay in the hospital, the nurses will teach you how to clean and use the PEG tube and operate any equipment such as feeding pumps, etc. You will need to follow up in the office approximately 2 weeks after being sent home from the hospital.
» Please Note:
1. No food or drink is allowed in the holding and recovery area.
2. Only two adults may be in the holding areas with the patient.
3. Arrangements for siblings should be made; they are not allowed in the holding and recovery areas.