Dr. Martin Salazar Ongkeko, MD

Enteroscopies may be used alone or in combination with other procedures. For example, if a doctor suspects malignancy (cancer) in the small bowel, she may use an enteroscope to take a sample of tissue from the small bowel and have it examined in a laboratory. If there is a blockage in the small intestine that cannot be surgically removed, an enteroscopy-guided stent placement may help relieve some of the symptoms associated with the obstruction. Enteroscopes may also be used to treat intestinal bleeding and remove abnormal growths like tumors and polyps, as well as foreign objects that might have found their way into the small bowel.

There are several ways to perform an enteroscopy:

• Push enteroscopy involves the use of a long tube with a camera, called an enteroscope. Depending on the location of the problem, the enteroscope is either passed through the mouth or rectum. This technique is often used to detect and stop bleeding in the upper small intestine.
• Balloon enteroscopy uses scopes that have tiny balloons at the tip. The balloons inflate and deflate to help make the passage of the scope into the small bowel easier. This method is used when there is a need to access and treat certain parts of the small intestine that push enteroscopy cannot reach.
• Capsule enteroscopy involves swallowing a capsule with a tiny camera inside it. As the capsule travels through the small intestine, the camera records and sends images that are then downloaded and analyzed by the doctor. The capsule eventually leaves the body during bowel movement. If the doctor needs to visualize the entire small intestine, capsule enteroscopy is the only option. The only drawback to this technique is that it cannot be combined with any treatment.

Enteroscopy is typically performed at the doctor's office and takes about 20 to 30 minutes, but may take longer if combined with another procedure. Patients may have a sore throat for a few hours if the scope was inserted through the mouth. Normal activities may be resumed about 24 hours following enteroscopy.

Today, most gallbladder surgeries are done laparoscopically. Four tiny incisions are made in the abdomen, and small tools are inserted through these tiny incisions to perform the surgery. Because the incisions are much smaller, recovery time is much faster with this type of surgery. Patients are usually discharged from the hospital the same day. Sometimes, open surgery is used to remove a gallbladder. In this type of surgery, a cut about six inches long is made in the upper right abdomen. After the gallbladder is removed, it is sutured or stapled closed. With open surgery, patients usually stay in the hospital for two to three days to recover before they are discharged.

Gallbladder removal, like any surgery, carries some risks, such as bleeding, infection, or the development of blood clots. Doctors will tell patients how to minimize their risk for complications. After surgery, patients are advised to avoid strenuous activity for several days. They should not soak in a bath until their sutures or staples have been removed. Patients should wash hands before touching the area around the incision. It will take a couple of days until patients feel like themselves again and a few weeks until their scar has healed and faded.

Hashimoto's is the leading cause of hypothyroidism, which is when the thyroid does not produce enough hormones to stimulate adequate metabolism. The condition is diagnosed by blood tests that measure TSH (thyroid stimulating hormone) and detect Hashimoto's antibodies. Symptoms of hypothyroidism include sluggish metabolism, inflammation, fatigue, weight gain, brittle hair, dry skin, and sensitivity to cold. To supplement impaired thyroid function, patients with Hashimoto's are typically prescribed synthetic thyroid hormone pills. Such patients may need to consume synthetic thyroids for the rest of their lives. Other treatments may include dietary changes, such as the avoidance of certain foods and medication to reduce inflammation. Frequent blood tests can inform patients if their TSH levels are within a normal range.

Grave's disease is most frequently the cause of hyperthyroidism, which is when the thyroid produces too many hormones, overstimulating one's metabolism. The condition is also diagnosed by blood tests that measure TSH and detect Grave's antibodies. Elevated heart rate, high blood pressure, sweating, bulging eyes, and weight loss are common symptoms of hyperthyroidism. Treatments for hyperthyroidism include oral radioactive iodine, which slowly shrinks the thyroid, slowing the production of excess thyroid hormone. Other anti-thyroid medications such as methimazole (Tapazole) also reduce the production of thyroid hormones. Blood pressure medications known as beta blockers can ease the increased heart rate caused by hyperthyroidism. If treatments are unsuccessful, patients may be prescribed a thyroidectomy, or surgery to remove part or all of the thyroid. Some patients with hyperthyroidism may require ophthalmological (eye medicine) treatments such as eye drops, prednisone, and surgery to reduce eye swelling and bulging.

Untreated thyroid disorders frequently lead to goiters or thyroid nodules. A thyroid goiter is a large lump that can be felt near the base of the neck and is made of swollen thyroid tissue or nodules (excess cell growth). Nodules and goiters are diagnosed by CT scan or ultrasound. Obstructive goiters can cause pain, coughing, and abnormal breathing. The most common cause of goiters is hyperthyroidism (overactive thyroid). However, Hashimoto's is also known to cause goiters or nodules. Goiters develop from continued damage from antibodies to the thyroid over time. At times, a goiter can result from a cancerous thyroid tumor. Most goiters and nodules are themselves benign.

The exact causes of thyroid cancer are unknown. People who develop thyroid cancer may or may not have another thyroid problem such as Hashimoto's or Grave's disease. Symptoms of thyroid cancer include a nodule that can be felt on the neck, hoarseness, difficulty swallowing, swelling in the neck, and neck and throat pain. CT and MRI scans are used to diagnose thyroid cancer. There are four types of thyroid cancer which vary in intensity. Thyroidectomy (thyroid removal surgery) is usually prescribed to treat thyroid cancer.

Thyroid problems are often long-term conditions that require some form of treatment. With regular monitoring and medication, many people with thyroid problems are able to lead active and fulfilling lives.