Cirrhosis is the term used to describe a diseased liver that has been badly scarred, usually due to many years of injury. Many people who have developed cirrhosis have no symptoms or have only fatigue, which is very common. However, as the cirrhosis progresses, symptoms often develop as the liver is no longer able to perform its normal functions. | Symptoms include: swollen legs and an enlarged abdomen easy bruising and bleeding frequent bacterial infections malnutrition, especially muscle wasting in the temples and upper arms jaundice (a yellow tinge to the skin and eyes). Cirrhosis is diagnosed using a number of tests including: blood tests, ultrasound scans and a biopsy of the liver. Treatment options depend on the severity of damage to the liver and include dietary changes and avoidance of substances such as alcohol that can further damage the liver. Medication may be given to prevent complications and treat symptoms of liver failure. There is no cure other than liver transplantation.

It can often be difficult to diagnosis gastric problems based on symptoms alone, for this reason your doctor has ordered a colonoscopy to confirm the diagnosis of your condition. A colonoscopy is an examination that involves using a long flexible tube that is small enough to enter via the rectum and travel through the bowel. This enables the doctor to see the inside of your bowel. What Happens Before the Colonoscopy? The colonoscopy is performed either at the Endoscopy Unit at Middlemore Hospital Department of Gastroenterology or at Manukau SuperClinic. Your doctor will explain the procedure to you prior to your examination and will get you to sign a consent form, saying that you agree to have the procedure. Before the procedure takes place, your bowel needs to be completely clear of faecal matter. To accomplish this you must follow these instructions carefully: (1) On the afternoon before your test you will be asked to drink 3-4 litres of a preparation called ‘Klean Prep’. This works by cleaning the bowel and causes you to frequently go to the toilet. (2) It is important that your bowel return is “clear” for us to be able to safely perform the procedure. This means there has to be no particles and the return should be a urine colour. Your nurse will want to know what your bowel return is like. You will need to drink the bowel preparation until the return is clear. (3) You should not eat or drink anything for at least 6-8 hours prior to the examination. How Long Does the Examination Take? The test itself is usually takes between 30-45 minutes. However, depending on your case and the findings, may take slightly more time. What Happens During the Colonoscopy? You will be taken on a bed into the procedure room where you will be asked to lie on your left hand side. An instrument that measures your pulse and oxygen levels will be placed on your finger. A sedative will be given via the drip in your arm or hand to help relax you – it will not put you to sleep completely. You will be given an oxygen mask to wear throughout the procedure. The doctor will then start the examination. To help in moving the scope (tube) around the bowel you may be asked to change your position and the nurse may have to apply pressure to parts of your stomach. If required a biopsy may be taken during the procedure. A biopsy is when a small amount of tissue is taken from the lining of the bowel and examined later. You will not feel the biopsy being taken. What Happens After the Colonoscopy? You will be taken on your bed into the recovery room. Here the nurse will check your blood pressure and pulse. You will be given time to wake before getting changed and going home. After the examination you may feel a little drowsy as the sedative wears off. You can usually eat and drink straight after the examination. It is normal to experience some gas pains caused by the use of air during the procedure. A walk can sometimes relieve this bloated feeling. The results of the examination will be sent your doctor and these and any treatment details will be discussed with you at a later date. Are There Any Risks? As with any procedure there are risks but these are very rare and a colonoscopy is considered one of the safest medical procedures you can have. Risks may include, bleeding, perforation of the bowel lining and discomfort. Your doctor will discuss these with you, before you sign the consent form.

A flexible tube with a tiny video camera attached (endoscope) is inserted through the mouth into the stomach and small intestine while you are under sedation (you have been given medication to make you drowsy). A smaller tube is then moved through the first tube into the bile duct (the tube that connects your gallbladder to your intestines) through which dye is injected and an x-ray is taken to visualise the ducts. This procedure also enables the removal of stones from the ducts without the need for surgery.

It can often be difficult to make a diagnosis of gastric problems based on symptoms alone, for this reason your doctor may order a gastroscopy to confirm the diagnosis of your condition. A gastroscopy involves using a long flexible tube that is small enough to enter via the mouth and travel down the digestive system. This enables the doctor to see the inside of your stomach. What Happens Before the Gastroscopy? The gastroscopy is performed in the Endoscopy Unit at Middlemore Hospital Department of Gastroenterology or at Manukau SuperClinic. You should not eat or drink anything for at least 6-8 hours prior to the examination. Your doctor will explain the procedure to you prior to your examination and will get you to sign a consent form, saying that you agree to have the procedure. How Long Does the Examination Take? The test itself is usually no longer than about 4-5 minutes. However, depending on your case and the findings, may take slightly more time but generally no longer than 10 minutes. What Happens During the Gastroscopy? You will be walked to the procedure room where you will be asked to lie on your left side. An instrument that measures your pulse and oxygen levels will be placed on your finger. Your throat will then be sprayed with an anaesthetic spray to numb it; if you have dentures these will also be removed. For those who have their own teeth a mouth guard will be put in your mouth to protect your teeth. A sedative will then be given via the drip in your arm or hand to help relax you - it will not put you to sleep completely. You may also be given oxygen and this is given via a tube that fits into your nose. The tube will then be placed into your mouth and the doctor will instruct you to swallow it. At first you may feel uncomfortable but once the gastroscope is in place the rest of the procedure should cause little or no discomfort. An examination of your food pipe and stomach is then performed. If needed, a biopsy can be taken while the examination tube is in place. A biopsy is when a small amount of tissue is taken from the lining of the stomach and examined later. You will not feel the biopsy being taken. What Happens After the Gastroscopy? You will be taken on your bed into the recovery room. Here the nurse will check your blood pressure and pulse. You will be given time to wake completely before being discharged (approximately 30-45 mins). After the examination you may feel a little drowsy as the sedative wears off. You can usually eat and drink half an hour after the examination. The results of the examination will be sent to your doctor and these and any treatment details will be discussed with you. Are There Any Risks? As with any procedure there are risks but these are very rare and a gastroscopy is considered one of the safest medical procedures you can have. Risks may include, bleeding, perforation of the stomach lining and discomfort. Your doctor will discuss these with you, before you sign the patient consent form.

This is inflammation of the liver, commonly caused by viruses. Hepatitis B and C are viruses that can cause chronic (long term) inflammation and damage to the liver. These viruses are passed from person to person through body fluids. For more information about Hepatitis B and C view the Hepatitis Foundation of New Zealand website. Alcohol can affect the liver and cause inflammation which, if long term, can damage the liver permanently.

There are two types of IBD, ulcerative colitis and Crohn’s disease. In these conditions, the immune system attacks the lining of the colon causing inflammation and ulceration, bleeding and diarrhoea. In ulcerative colitis this only involves the large intestine, whereas in Crohn’s disease areas within the entire intestine can be involved. Both diseases are chronic (long term) with symptoms coming (relapse) and going (remission) over a number of years. Symptoms depend on what part of the intestine is involved but include: abdominal pain diarrhoea with bleeding tiredness fevers infections around the anus (bottom) weight loss can occur if the condition has been present for some time Diagnosis is made when the symptoms, examination and blood tests suggest inflammatory bowel disease, infection is ruled out, and you undergo a colonoscopy with biopsy. Treatment depends on the severity of the symptoms and what part of the intestine is affected. Medication is aimed at suppressing the immune system, which is harming the lining of the bowel. This is done via oral or intravenous medication as well as medication given as an enema (via the bottom). Other treatments include changes in the diet to optimise nutrition and health. Treatment in some cases requires surgery to remove affected parts of the bowel. For more information view the Crohn's and Colitis New Zealand website.

The best way to establish what type of liver disease is present and the extent of the disease, is a biopsy. It is usually performed by inserting a needle into the liver through the skin and taking a small sample of liver tissue. Examination of the sample under the microscope can demonstrate what damage or what type of disease is present. Before your doctor does this procedure, they will check whether or not you are at increased risk of bleeding by doing blood tests. Following the procedure, you will need to be monitored for several hours before you are discharged to go home.

Peptic ulcers are sores or eroded areas that form in the lining of the digestive tract. They usually occur in the stomach (gastric ulcer) or in the duodenum (duodenal ulcer), which is the first part of the small intestine. People with peptic ulcers can have a wide variety of symptoms and signs, can be completely symptom-free or, much less commonly, can develop potentially life-threatening complications such as bleeding. Signs and symptoms of ulcers include: pain / burning or discomfort (usually in the upper abdomen) bloating an early sense of fullness with eating lack of appetite nausea vomiting bleeding, which is made apparent by blood in the stool, either in noticeable or microscopic amounts (very brisk bleeding will result in black and tarry stools that smell bad). Smoking, alcohol, anti-inflammatory medication and aspirin increase the risk of developing ulcers. Psychological stress and dietary factors (once thought to be the cause of ulcers) do not appear to have a major role in their development. Helicobacter pylori, a bacteria that is frequently found in the stomach is a major cause of stomach ulcers. If this is found you will be given a course of antibiotics. Diagnosis is made by the history, examination and sometimes blood tests. You may be asked to have a gastroscopy (see above) to clarify the diagnosis and aid with treatment. Treatment consists of medication to reduce the amount of acid in the stomach which aids in the healing of ulcers and avoidance of things that cause ulcers in the first place.