Large Bowel CT Scan (CT Colonogram)

Large Bowel CT Scan (CT Colonogram) Department of Radiology Information for Patients i Radiology Leaflet No. 06 University Hospitals of Leicester NHS Trust

Introduction Please read your appointment letter carefully to check which hospital you must attend for your appointment. This leaflet tells you about your examination. Please read it carefully as it contains important information and instructions. Important information to consider: If there is any possibility that you may be pregnant, please contact the Radiology Department immediately. For female patients aged 10 to 55 this examination must be carried out within 10 days of the start of your menstrual cycle unless there is no chance that you may be pregnant. If your appointment is outside this time please contact the Radiology Department on the telephone number on your appointment letter to reschedule your examination. You will be asked to confirm the first day of your last period before the examination starts. Please bring this information with you. If you have a colostomy or ileostomy, please contact the Radiology Department DO NOT take the sodium picosulfate laxative (CitraFleet or Picolax). If you have renal failure or are on dialysis please contact the Radiology Department as soon as possible. It may be that we are not aware that you have renal failure. You will need to monitor your fluid allowance after taking the laxative. If you are unsure about your fluid allowance in relation to the laxative effect please seek advice from your home care nurse, dialysis nurse or kidney specialist. 2

Important information to consider: (continued) Continue to take your usual medication unless told otherwise by your doctor. If you require an interpreter, or if you have any special requirements please contact the Radiology Department for further information. Information for patients with diabetes This leaflet includes specific information for diabetic patients on insulin or tablets. Your insulin dose will need to be altered. Please contact your diabetes specialist nurse directly to discuss this at least one week before your appointment. If your diabetes is managed by the diabetic team at: Glenfield Hospital telephone 0116 250 2390 Leicester General Hospital telephone 0116 258 4919 Leicester Royal Infirmary telephone 0116 258 5758 If your diabetes is managed by your GP or practice nurse please contact your surgery. If you are diabetic you should have received a morning appointment. If you have not, please contact the Radiology Department. It may be that we are not aware that you are diabetic. Bring your own insulin with you to the hospital, along with any instructions you have for giving it. 3

What is a CT Colonogram? A CT colonogram is a CT scan of the large bowel (sometimes called colon or large intestine). This is a modern way of examining the lining of the bowel. It is quicker and more comfortable than other available tests such as colonoscopy and barium enemas. It is particularly suitable for more frail or immobile patients, but is becoming increasingly popular in all age groups and fitness levels. Your doctor will have taken into account your symptoms and decided that this is the most appropriate examination for your particular problem. How to prepare for the examination Please follow the diet and timetable instructions in this leaflet on pages six to eight, not those in the sodium picosulfate laxative (CitraFleet or Picolax) information sheet that may have been included with your letter. To help the examination to be successful it is important that your bowel is as clear of faeces as possible. The sodium picosulfate laxative (CitraFleet or Picolax) you have received with this leaflet will clean the bowel thoroughly if you follow the instructions and the diet in this leaflet carefully. The laxative works by giving you diarrhoea. This is unpleasant but necessary and may last up until your appointment. Do not take the enclosed sodium picosulfate laxative (CitraFleet or Picolax) if you have a colostomy or ileostomy. The preparation starts two days before the day of your CT colonogram with a diet to reduce the amount of faeces in the bowel. The laxative is to be taken the day before your examination. Easy access to a toilet will be required for most of this day. It may not be practical to go to work. 4

Tips Keep within easy reach of a toilet as vigorous bowel movements will start after the laxative has been taken. Putting white petroleum jelly (Vaseline) around the anus helps prevent soreness. Drink plenty of fluids. This helps cleanse the bowel and reduces the chance of bad headaches from fluid loss, try to drink at least a cup of fluid every hour whilst awake. Instructions on how to mix the laxative Sodium picosulfate laxative (CitraFleet or Picolax). To make up the laxative solution, mix one sachet in a cup of cold water. Stir for 2-3 minutes and then drink the mixture. If the mixture becomes hot, wait until it cools sufficiently to drink. Laxative - side-effects The laxative may cause headaches, tiredness, nausea, griping and anal pain. Isolated cases of allergic reactions and of vomiting and severe diarrhoea with related symptoms have been reported. (Refer to the laxative patient information leaflet for more information) If you have any problems please see your GP. Follow the timetable overleaf carefully. Remember The cleaner the bowel the better the test 5

Timetable 2 days 7am before Start the low residue diet. Only eat and drink things from the diet list on the next pages. If you are diabetic, take normal dose of insulin and see the low residue diet on page seven. 1 day 8am before Take the first sachet of laxative (see mixing instructions). Keep to the low residue diet for breakfast and lunch and drink plenty of clear fluids (drinks without milk). If you are diabetic take normal dose of insulin 1 day 4pm before Take the second sachet of laxative NO MORE FOOD today If you are diabetic, your insulin/tablets dose will need to be altered, please contact your Diabetes Specialist Nurse. Continue to drink plenty of clear fluids. You will be very hungry by now, but, NO LATE NIGHT SNACKS Day of your CT colonogram 6 Keep drinking plenty of clear fluids By now any bowel movements should be fluid You may eat a light meal from the low residue diet sheet (on pages 7 and 8) within the three hours before your appointment time. For example, 1 piece of toast with a poached egg or cheese.

Low residue diet You may only eat meals made up of the foods listed below. MEAT FISH CHEESE EGGS Lean meats, poultry, bacon, offal, (Quorn, bean curd) Fresh or frozen, tinned in brine Any type Boiled, poached, scrambled MILK ½ pint per day (full cream, skimmed or semi - skimmed), lassi FATS ½ oz per day butter, margarine, ghee OR 1 oz daily low fat spread BREAD OR White only - no more than 4 slices per day CHAPATTI Made with white flour (No.1) - no more than 4 per day POTATOES OR RICE CRACKERS BISCUITS SWEETS SUGAR DESSERTS BEVERAGES SEASONINGS Boiled or mashed - 4 Large egg sized per day White - 4 tablespoons per day Plain (not high fibre) e.g. cream crackers Rich tea, arrowroot Boiled sweets, mints, jellies Brown or white, honey, syrup, jelly type jam or marmalade (without fruit pieces) gur or jaggery Jelly Tea, coffee (milk from allowance), Lucozade, fizzy drinks, Ribena, Oxo, Marmite, wine, beer Salt, ground pepper, vinegar 7

Diabetic low residue diet You may only eat meals made up of the foods listed below. MEAT FISH CHEESE 8 Lean meats, poultry, bacon, offal, Fresh or frozen, tinned in brine Any type EGGS Boiled, poached, scrambled MILK ½ pint per day (full cream, skimmed or semi - skimmed) FATS ½ oz per day butter, margarine, OR 1 oz daily low fat spread BREAD OR White only - no more than 4 slices per day CHAPATTI Made with white flour (No.1) - no more than 4 per day POTATOES OR Boiled or mashed - 4 egg sized per day only RICE White - 4 tablespoons per day CRACKERS Plain (not high fibre) e.g. cream crackers BISCUITS Rich tea, arrowroot BEVERAGES Tea, coffee (milk from allowance), low calorie, sugar-free or diet squash or pop. Oxo, Marmite, wine, beer SEASONINGS Salt, ground pepper, vinegar Information for diabetic patients on insulin and/or tablets Do not eat foods or drinks mentioned in this diet sheet that you would not normally eat unless you are having a 'Hypo' / low blood sugar. Bring a drink containing sugar (i.e. Lucozade) with you to the hospital. If, at any time, you feel faint or dizzy and think you are having a hypo or if your blood sugar is less than 4mmol/l, drink half a cup of this drink, and tell the staff you have done so when you arrive.

Diabetic low residue diet (continued) Bring your own insulin, and any instructions you have for giving it, with you to the hospital. If you have any queries about your insulin or diabetes management contact your diabetes specialist nurse. What happens during the examination? On arrival at the Radiology Department you will be directed to the relevant waiting area and asked to change into a hospital gown. You will be taken into the scan room where the examination will be explained to you and you can ask any questions that you may have. You will be asked to lie down on the scan table. Before the examination you will be given a small injection into a vein in your arm. The injection relaxes your bowel and prevents spasm for a short time to help retain the air. This improves the pictures that are taken. The injection may make your eyesight blurred but this should pass after about 30 minutes. A small tube will be inserted into your rectum (back passage), through which air will be passed to inflate the large bowel so that all the surfaces of the bowel can be seen clearly during the scan. This will make you feel as if you want to pass wind. It is very important that you hold onto the air that is put inside. It may be necessary to perform the scan more than once with you lying in different positions. If you have difficulty turning, the staff will help you into the correct position. You may also have an injection of a contrast agent (a colourless liquid which shows up on x-rays and CT scans) through the needle already in your arm. This will show up the blood vessels. The supervising radiologist will decide this on the day and you will be fully informed. 9

Important information The contrast agent contains iodine and is excreted in your urine by the kidneys. Please tell the CT staff on arrival : If you are allergic to iodine, have any other allergies or suffer from asthma. If you have reacted previously to an intravenous contrast agent. The dye used for kidney X-rays and CT scanning. If you are on renal dialysis, have any problems with your kidneys or are seeing a kidney specialist. How long will it take? You may be in the Radiology Department for up to 90 minutes. The CT scan takes between 10 and 30 minutes. The time will vary for each patient. Who will be doing the examination? A radiologist (a specialist x-ray doctor) or a specialist radiographer will carry out the examination. During the examination there will also be a radiographer and a radiology assistant present in the room to help with the examination. On occasions a student may also be present. If you wish, you can request that the student is not present during your examination. 10

What happens after the examination? Once the examination is over, the needle in your arm will be removed and you will be taken to the toilet to get rid of the air. After this you can go home. You may eat and drink normally immediately after the examination. You may bring a snack to eat after the examination. This would be particularly useful if you are travelling to and from the hospital by ambulance. After the examination a few patients get pain in their abdomen, like trapped wind, which soon passes. If you have any problems with this or experience any discomfort please speak to a member of staff. Eye symptoms - if you were given an injection (of buscopan) during the examination, the muscles of your eyes may have relaxed as well as the muscles of your bowel. This may cause a blurring of vision in some patients. If you are affected then we advise you do not drive until it returns to normal (this usually takes up to half an hour). If you experience any pain in the eyes in the next 24 hours (this is very rare), please contact your GP urgently and show them this leaflet or the aftercare sheet you will be given after the examination is finished. Dry mouth - the injection in your arm may cause you to have a dry mouth. This will not last long. How do I get the results? The results will not be given to you immediately. Your CT scan pictures will be interpreted by a radiologist and the results will be sent to the consultant or GP who referred you for this examination. An explanation on how to get your results will be given to you after your examination. If you are an inpatient the results will be given to the doctors looking after you on the ward. 11

Further information for patients with diabetes If you are diabetic and are taking METFORMIN (also called GLUCOPHAGE, GLUCOVANCE, DUFORMIN, ORABET or GLUCAMET) tablets, continue to take these as normal until the time of your examination. When you arrive in the department please let us know you are diabetic. At the time of your examination you will be asked if you are taking METFORMIN (or GLUCOPHAGE, GLUCOVANCE, DUFORMIN, ORABET or GLUCAMET) before the doctor, radiographer or nurse gives you the injection of radiological contrast agent. If you are taking METFORMIN (or GLUCOPHAGE, GLUCOVANCE, DUFORMIN, ORABET or GLUCAMET) it is necessary for you to stop taking these tablets for a few days after the radiological test. This is to avoid the build up of acid in the blood. Stopping the tablets temporarily will not cause any harm to you. After the examination you will need to contact your GP surgery to arrange a blood test to determine whether it is safe to start taking your tablets again. At this time you do NOT need to see your GP and will NOT need a GP appointment. If you are an inpatient staff on your ward will arrange a blood test for you. The blood test should not be performed until at least two days (48-72 hours) after your radiological examination or scan. A small sample of your blood will be taken by an assistant in the GP's practice and sent to a laboratory for analysis. Once the results of your blood test are known to your GP, he/she will be able to advise you if it is safe to restart your tablets. Again, you will NOT need to arrange an appointment with your doctor. 12

Further information for patients with diabetes (continued) The surgery will either contact you within a week of the blood test or you should contact the surgery to find out the result of the test and whether you can restart your tablets. If you are diabetic and taking insulin or any other diabetic treatment, but not METFORMIN or GLUCOPHAGE, GLUCOVANCE, DUFORMIN, ORABET or GLUCAMET then there is no need to alter your treatment or have a blood test. Please ask the radiographer, nurse or doctor dealing with you if you would like further advice. Relatives and escorts You may wish to bring a friend or relative to accompany you to and from the Radiology Department when you have your examination although they may not always be allowed into the examination room. This may be useful if you do not understand English very well or if you have any special needs. Risks and benefits A CT scan produces detailed images of your bowel, organs and blood vessels. There is a very small risk from the effects of the injection. Some patients get a warm feeling and/or a metallic taste when the injection is given and can sometimes feel sick. If you do get these feelings they usually last about a minute. The risk of having x-rays is very small indeed. We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation. 13

Risks and benefits (continued) The risks of radiation are slightly higher for the unborn child so we must ask female patients aged 10 to 55 years about their menstrual history. The radiation from the x-rays during a CT colonogram is equivalent to receiving approximately a few years of natural background radiation. The benefits of this examination outweigh any potential risk and the risk from not having the examination could be greater. We will take all safeguards to minimise the amount of x-rays you receive. Other sources of information Websites: For general information about radiology departments visit the Royal College of Radiologists website: www.goingfora.com For information about the effects of x-rays read the publication: X-rays how safe are they on the Health Protection Agency website: www.hpa.org.uk. Please note that the views expressed in these websites do not necessarily reflect the views of UHL or the NHS. University Hospitals of Leicester website: www.uhl-tr.nhs.uk NHS Direct: For health advice or information you can call NHS Direct on 0845 46 47 or visit the website: www.nhsdirect.nhs.uk Additional information How was it for you? If you wish to make any comments or suggestions regarding your visit to the radiology department. Please fill in a suggestion form or speak to a member of staff. Suggestion forms are located in all waiting areas within the department. 14

Additional information (continued) We review our information leaflets on a regular basis. If you have any comments about how we can improve these leaflets please speak to a member of staff. Directions and car parking Hospital car parking is available to all hospital patients and visitors. Spaces are limited so please allow plenty of time to find a car parking space. A charge is payable. Bus services to the hospital There is a regular bus service from the city centre. Phone Traveline on 0871 200 2233 for times and routes. A Hospital Hopper bus links the three hospitals, Beaumont Leys Centre, Hamilton Centre and the railway station. Buses run every 30 minutes between 7 am and 6.30 pm Monday to Friday. A charge is payable for this service. Children Baby changing facilities are available. Please ask to be shown to them if you wish to use them. We are unable to offer childcare facilities. If you need to bring your children with you, please bring along an adult who can supervise them whilst your examination is being carried out. Radiology staff are not able to look after your children. Facilities available Refreshments: Refreshments including hot and cold drinks are available in the hospital. Please ask a member of staff for directions. Shops: Each hospital contains a shop selling magazines, newspapers, sweets and drinks. Please ask a member of staff for directions. 15

If you would like this information in another language or format, please contact the Service Equality Manager on 0116 258 8295 Haddaad rabto warqadan oo turjuman oo ku duuban cajalad ama qoraal ah fadlan la xiriir, Maamulaha Adeegga Sinaanta 0116 258 8295. Eĝer bu broşürün (kitapçıĝın) yazılı veya kasetli açıklamasını isterseniz lütfen servis müdürüne 0116 258 8295 telefonundan ulaşabilirsiniz. Produced by: Imaging Patient Information Group. Edition 4. Produced: August 2009. Review date: August 2012 (Goldson8/09)8090851KR IMA034-0809