• Chronic diarrhea.
• Lower gastrointestinal bleeding.
• Abdominal pain.
• Evaluation of radiographic abnormalities.
• Filling defects.
• Initial diagnosis and follow-up evaluation of inflammatory bowel
• Removal of foreign bodies.
• Dilatation of colonic strictures.
• Diagnosis and removal of polyps.
• Histopathologic evaluation of pinhead-sized biopsy specimens.
• Cardiorespiratory collapse.
• Hemodynamically unstable patient.
• Unstable airway.
• Intestinal perforation.
• Cervical spine trauma.
• Toxic, fulminant colitis.
• Coagulopathy (prothrombin time > 18 sec).
• Thrombocytopenia (platelet count < 100,000/μL).
• Intestinal tract surgery within previous month.
• Food intake within previous 6 hours.
• Bowel obstruction.
• Fiberoptic or video endoscopes.
• Biopsy forceps.
• Nets and baskets.
• Heater probes.
• Electrocautery probes and snares.
• Balloon-dilation devices.
• Obtain medical history and physical examination
for clearance from pulmonary, cardiovascular, and hematologic standpoints.
• Obtain laboratory tests, if needed.
• Primary care providers can prepare patients and families by explaining
that the colonoscopy provides detailed diagnostic information and
rarely causes complications (1/2000 chance of significant
bleeding or perforation).
• Have parents sign a consent form.
• Bowel preparation.
• Clear liquids for 24 hours prior to procedure (infants:
12 hours); avoid red-colored fluids.
• Sodium phosphate, magnesium citrate, MiraLax (for 4 days), polyethylene
glycol (PEG) lavage solution, enemas (saline or phosphate) if needed.
• No oral intake after midnight before procedure.
• Antibiotics for endocarditis prophylaxis in at-risk patients.
• Antibiotics for immunosuppressed patients or those with central
• The colon is divided into 5 sections:
• The rectum as well as the sigmoid and descending colon are the
areas where juvenile polyps and ulcerative colitis are commonly
• The junction between the descending and transverse colons is
usually marked by the bluish blush of the spleen.
• The transverse colon can be recognized by the triangular-shaped
• The junction between the transverse and ascending (or right colon)
is usually marked by the bluish blush of the liver.
• The cecum can be verified by finding the small appendiceal opening,
the ileocecal valve, or seeing light transilluminate the right lower
• The cecum and terminal ileum are often involved in Crohn disease.
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