Bowel Preparation

From Anvita Health Wiki

Contents 1 Indications 2 Procedure 3 More General Terms 4 References

Indications

• prepare the bowel for endoscopy or surgery
• ingestion of poison, drug overdose (use Polyethylene glycol)

• ingestion of massive amounts of a toxic substance
• ingestion of metals ( iron, Li+) that do nod adsorb to activated charcoal
• ingestion of sustained-release pharmceuticals
• body packers (wrapped packages of cocaine, heroin)
• ingestion of large pills or foreign bodies
• concretions

Procedure

• Magnesium citrate:

• alone or in combination with other laxatives
• liquid diet necessary for 24-48 hours
• drink plenty of fluids to prevent dehydration

• Polyethylene glycol ( PEG) solutions

• Go-Lytely, CoLyte
• work well without causing electrolyte imbalances
• tastes bad
• 4 liters of fluid

• Sodium phosphate solution ( Fleet Phospho-soda)

• often better tolerated because patients drink a smaller amount
• may combine with bisocodyl 20 mg (4 x 5 mg tabs) [2]
• may cause water & electrolyte disturbances

• dehydration, hyperphosphatemia, hypokalemia, hypocalcemia

• may cause acute renal failure [5]

• Sodium phosphate tablets (Visicol)

• better tolerated than most preps
• 40 tablets total; 20 in PM, 20 in AM of procedure
• take 3 tablets at a time with 8 oz of water every 15 min

• AVOID sodium phosphate in patients with:

• congestive heart failure
• unstable angina
• impaired renal function
• liver disease

• Use polyethylene glycol ( PEG) solutions in high-risk patients.
• Avoid iron within one week of procedure.

• iron interferes with visualizing the colon

• Avoid NSAIDs within one week of procedure.

• NSAIDs increase the risk of bleeding if polyps are removed.
  

• Walking aids bowel preparation [3]

More General Terms

• gastroenterology (GI)
• clinical procedure

References

1. Prescriber's Letter 8(1):2 2001
2. Journal Watch 24(24):187, 2004 Hookey LC, Depew WT, Vanner SJ. A prospective randomized trial comparing low-dose oral sodium phosphate plus stimulant laxatives with large volume polyethylene glycol solution for colon cleansing. Am J Gastroenterol. 2004 Nov;99(11):2217-22. PMID: [1]
3. Kim HS, Park DH, Kim JW, Jee MG, Baik SK, Kwon SO, Lee DK. Effectiveness of walking exercise as a bowel preparation for colonoscopy: a randomized controlled trial. Am J Gastroenterol. 2005 Sep;100(9):1964-9. PMID: [2]
4. Prescriber's Letter 16(2): 2009 CHART: Comparison of Bowel Prep Agents GUIDELINES: Consensus Document on Bowel Preparation Before Colonoscopy GUIDELINES: Canadian Association of Gastroenterology Position Paper on Commonly Used Preparations for Colonoscopy: Efficacy, Tolerability and Safety Detail-Document#: [3] (subscription needed) [4]
5. Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009

bowel preparation (whole bowel irrigation, bowel evacuation)