Preparation for Colonoscopy

Preparation for Colonoscopy
• For a Colonoscpy examination, the colon needs to be empty, so
that the doctor can get a clear view of your large intestine.
• The laxative solution Exelyte or Colowash is available in all leading
pharmacies as a packet of 2 bottles of 45 ml each.
On the day before the test:
• Mix one bottle of Exelyte or Colowash (45 ml) with 1 bottle (300
ml) of Limca/Lime juice and drink it slowly over 30-40 min, in the
evening between 5-6 pm.
• You will start passing motions after a few hours.
• Drink plenty of clear fluids to keep yourself well hydrated during
this period.
• At night, you can have light meals like rice / dal / khichdi etc. Avoid
roti / chapatti /leafy vegetables or fruits.
On the day of the test:
• You can have tea/biscuits at 6 am.
• Mix the second bottle of Exelyte or Colowash (45 ml) with 1 bottle
(300 ml) of Limca/Lime juice and drink it slowly over 30-40 min,
from 7-8 am.
• You will start passing watery motions after some time.
• Drink plenty of clear fluids to keep yourself well hydrated during
this period. It is best to avoid eating anything thereafter.

Staging Avascular Necrosis of femoral head

Several different staging systems have been developed and continue to be used. Ficat initially developed an AVN staging system based on radiologic findings. This staging system was revised after the widespread use of MRI in the workup of AVN. The staging system presented in the below table is based on the consensus of the Subcommittee of Nomenclature of the International Association on Bone Circulation and Bone Necrosis (ARCO: Association of Research Circulation Osseous). The most important consideration is collapse of the femoral head cortex. Repair and complete recovery may be possible prior to collapse. Afterward, the collapse is irreversible.

Staging of Avascular Necrosis

Table

Stage	Clinical and Laboratory Findings
Stage 0	Patient is asymptomatic. Radiography findings are normal. Histology findings demonstrate osteonecrosis.
Stage I	Patient may or may not be symptomatic. Radiography and CT scan findings are unremarkable. AVN is considered likely based on MRI and bone scan results (may be subclassified by extent of involvement [see below]). Histology findings are abnormal.
Stage II	Patient is symptomatic. Plain radiography findings are abnormal and include osteopenia, osteosclerosis, or cysts. Subchondral radiolucency is absent. MRI findings are diagnostic.
Stage III	Patient is symptomatic. Radiographic findings include subchondral lucency (crescent sign) and subchondral collapse. Shape of the femoral head is generally preserved on radiographs and CT scans. Subclassification depends on the extent of crescent, as follows: Stage IIIa: Crescent is less than 15% of the articular surface. Stage IIIb: Crescent is 15-30% of the articular surface. Stage IIIc: Crescent is more than 30% of the articular surface.
Stage IV	Flattening or collapse of femoral head is present. Joint space may be irregular. CT scanning is more sensitive than radiography. Subclassification depends on the extent of collapsed surface, as follows: Stage IVa: Less than 15% of surface is collapsed. Stage IVb: Approximately 15-30% of surface is collapsed. Stage IVc: More than 30% of surface is collapsed.
Stage V	Radiography findings include narrowing of the joint space, osteoarthritis with sclerosis of acetabulum, and marginal osteophytes.
Stage VI	Findings include extensive destruction of the femoral head and joint.

Lumbar Spine MRI

Discitis 

Additional sequences

Sagittal STIR

Diffusion 

Contrast study SOS

Ask history of fever , night fever , chills whether  acute (<2 weeks) , subacute (>2 weeks)

Lab : elevated ESR,CRP


Disco-vertebral lesion &   Spondylo-discitis

same as in Discitis  

Coronal and sagittal STIR 

Sagittal GRE 

Diffusion

X-ray needed - at least Lateral view

Lab : elevated ESR, Mantoux test 



Spondylo-discitis with soft tissue component 

Contrast study  


Single Vertebral   lesion 

Additional MRI sequences

GRE sagittal


Multiple Vertebral lesions 


Generalized  marrow signal alteration 


Vertebral metastasis  




Osteoporotic collapse


Focal lesion in the thecal sac 


Dural/Meningeal thickening  




Arachnoditis 



Incidental SI joint pathology 




Psoas lesions 




Erector spinae atrophy 


Spinal cord cyst  



Extradural spinal cyst 




Spinal cord mass 




Fracture spine

Cortical surface with Osirix tool