This is a procedure which allows the doctor to see inside your oesophagus, stomach, and the first part of the small intestine (duodenum) and examine the lining directly. What to expect The gastroscope is a plastic-coated tube about as thick as a ballpoint pen and is flexible. It has a tiny camera attached that sends images to a viewing screen. During the test you will swallow the tube but the back of your throat is sprayed with anaesthetic so you don’t feel this. You will be offered a sedative (medicine that will make you sleepy but is not a general anaesthetic) as well. If the doctor sees any abnormalities they can take a biopsy (a small piece of tissue) to send to the laboratory for testing. This is not a painful procedure and will be performed at the day stay unit in a theatre suite (operating room) by a specialist doctor with nurses assisting. Complications from this procedure are very rare but can occur. They include: bleeding after a biopsy, if performed an allergic reaction to the sedative or throat spray perforation (tearing) of the stomach with the instrument (this is a serious but extremely rare complication). Before the procedure You will be asked not to eat anything from midnight the night before and not to take any of your medications on the day of the procedure. After the procedure You will stay in the day stay unit until the sedation has worn off which usually takes 1-2 hours. You will be given something to eat or drink before you go home. If you have been sedated, you are not to drive until the following day. If biopsies are taken these will be sent for analysis and results are available within 2-3 weeks. A report and copies of these are sent to your GP.

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.

This is a procedure which allows the doctor to see inside your large bowel and examine the surfaces directly and take biopsies (samples of tissue) if needed. Treatment of conditions can also be undertaken. What to expect The colonoscope is a flexible plastic-coated tube a little thicker than a ballpoint pen which has a tiny camera attached that sends images to a viewing screen. You will be given a sedative (medicine that will make you sleepy but is not a general anaesthetic). The tube is passed into the rectum (bottom) and gently moved along the large bowel. The procedure takes from 10 minutes to 1 hour and your oxygen levels and heart rhythm are monitored throughout. The procedure is performed in a day stay operating theatre. Before the procedure You will need to follow a special diet and take some laxatives (medicine to make you go to the toilet) over the days leading up to the test. Risks of a colonoscopy are rare but include: bleeding if a biopsy is performed allergic reaction to the sedative perforation (tearing) of the bowel wall.

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.

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 see https://www.hepatitisfoundation.org.nz/ Alcohol can affect the liver and cause inflammation which, if long term, can damage the liver permanently.

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.

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.

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 see www.crohnsandcolitis.org.nz

Diabetes is a disease that affects the way your body deals with sugar. The amount of sugar in the blood is controlled by insulin which is a hormone produced by the pancreas (an organ that lies near your stomach). Patients with diabetes have too much sugar in their blood. Lowering the blood sugar is important for the prevention of serious complications. Some indications that you may have diabetes include: change in your weight feeling thirsty excessive passing of urine blurred vision slow healing of sores tingling in hands and feet. If you experience any of these symptoms please see your doctor. In most people there are hardly any symptoms early in the disease. You are more likely to develop diabetes if you are overweight or have a family history of diabetes. Tests There are two types of tests in diabetes. Some are to diagnose if you have the condition and others are to monitor your treatment and manage the disease to prevent complications. Diagnosis testing The first test you will have had is a blood glucose (sugar) test. This is most sensitive if it is taken when you have an empty stomach so is usually done first thing in the morning before breakfast. If there is some question as to whether or not you have diabetes you will have a glucose tolerance test. For this test you have a blood test, then drink a very sweet drink and 2 hours later have another blood test. Monitoring testing Finger prick test. A very quick test where your finger is pricked, a drop of blood is collected on a strip and examined by a small hand-held machine. It takes less than a minute to do. Depending on the type of diabetes you have, you may have one of these machines at home and do your own test a few times a week or day. Glycosylated haemoglobin test (HbA1c). This is a test that is used to keep track of how your diabetes has being managed over the last 2 to 3 months. You might have 2 to 4 of these tests a year arranged by your doctor or diabetes nurse. Other tests Because diabetes can affect many other organs you will, over time, have other blood and urine tests as well as tests for your heart and eyes. Treatment Diabetes is treated with a combination of diet, exercise and medications. You may also be referred to a: dietician, to advise you on healthy eating podiatrist, for foot care dentist, to ensure your gums and teeth are well maintained nurse, to help with day-to-day management of your diabetes ophthalmologist, to monitor your eyes. The amount of sugar in the blood varies throughout the day but normally remains within a narrow range (usually 4 – 6 mmol/L). Even with medication it tends to be slightly higher in people with diabetes but you will learn what levelis your best target. You will receive lots of information about what you can do to manage your diabetes when, and after, you attend the clinic.

DEXA scanning (dual energy x-ray absorptiometry) is a technique used to measure bone mineral density, which is essentially an estimate of bone strength. You will lie on a couch for 5-10 minutes while an x-ray gantry passes over the area to be assesses (usually the lower spine and hip), although the forearm can also be measured.

Osteoporosis is a disease that weakens your bones. Osteoporosis is not painful but it makes your bones more prone to breaking (fracture). Women are more likely than men to suffer from osteoporosis and as you get older you are more likely to have it. Tests Osteoporosis can be diagnosed by measuring bone mineral density (BMD). This test involves taking x-rays or a computer tomography (CT) scan of the bones in your spine, wrist, arm or leg. You may be asked to have a blood test to look for reasons why you might have osteoporosis. Treatment There is no cure for osteoporosis, but there are treatments that can improve bone strength and reduce your chances of breaking a bone. If you are diagnosed with osteoporosis you may be prescribed several medications to improve your bone strength. You will have follow-up either with your GP or specialist to make sure that the medication suits you. You will be given some more detailed reading about things you can do to help manage your osteoporosis and about the type of medication you are on.

In this condition the normal bone remodelling process, in which new bone tissue gradually replaces older bone tissue, becomes disrupted. The new bone formed may become weak and misshapen, leading to pain and increased risk of fractures.

The thyroid is a gland that sits in the front, and towards the bottom of, your neck. It is responsible for producing a hormone called thyroxin. Thyroxin has an important role in the body as it affects many organs including the heart, muscles and bones. Diseases that affect the thyroid can make it either overactive (producing too much thyroxin), underactive (not producing enough thyroxin) or enlarged (goitre). Endocrinologists specialise in these diseases as well as cancer of the thyroid. Tests Thyroid problems are usually picked up with a blood test but there are other tests you may have to work out why the problem has occurred. These include: an ultrasound scan. This is where a hand-held scanner head is passed over your thyroid gland and pictures are taken a nuclear medicine scan. This is where you are given something to drink that contains a substance that only goes to the thyroid gland. Although it is radioactive it does not damage you or anyone else. Pictures are then taken of the thyroid gland that give the doctor information about what might be causing the problem fine needle aspirate (FNA). This is where the doctor puts a very fine needle (smaller than for a blood test) into the thyroid gland to take some cells to look at under the microscope.

The parathyroid glands are four small glands located in the neck which produce parathyroid hormone, a hormone involved in the regulation of calcium and phosphate levels. Overactivity of one or more of the glands results in excessive parathyroid hormone production. Hyperparathyroidism may be: primary - caused by problems in the glands themselves and leads to high levels of calcium in the blood (hypercalcaemia) or secondary - caused by low levels of calcium in the body.

The pituitary gland is in your brain. It controls most of the endocrine (hormone) system in your body. When disorders occur in this gland a variety of problems can appear. If your doctor thinks you have problems in this area (usually discovered with a series of blood tests) they will refer you to a specialist endocrinologist.

The adrenal glands are two small, hormone-producing structures that sit on top of the kidneys. They are made up of two distinct parts: the outer cortex – produces steroid hormones including cortisol, aldosterone and sex hormones the inner medulla – produces adrenaline and noradrenaline Disorders of the adrenal glands can result in under- or over-production of particular hormones, depending upon which part of the gland is affected e.g. in Cushing’s syndrome there is an excess of cortisol while in Addison’s disease there is not enough cortisol.

Polycystic ovary syndrome (PCOS) is a hormonal disorder that can cause you to have a variety of symptoms, including no periods or irregular periods, increased hair growth on the face and body, acne (pimples) and increased bodyweight. PCOS is also one of the main causes of infertility in women. The ovaries of women with PCOS often contain many small cysts (fluid-filled sacs), but this does not seem to be the cause of the condition. For women who have not reached menopause, the most common treatment is the birth control pill, which will regulate your periods. There are also other medicines that can help control the symptoms.

There are several types of memory problems people can have. If you are referred because of memory concerns it is very helpful to bring along a family member. It is also very important to bring all of your medications with you as these can often affect memory. A full medical examination will be done and you will be asked some questions to test your memory and concentration as well as mood. You are likely to have blood tests looking for some causes of memory loss and depending on your history you may be referred for a CT scan of your brain. This is a computerised X-ray, which involves you lying down for about 15 minutes while a machine passes over you.

This is a condition of gradual loss of memory and other functions of awareness or thinking such as concentration over time. There are several types of dementia including Alzheimer’s disease and vascular dementia, which is due to the same sort of illnesses that cause stroke.

These are not a natural part of aging. There are many reasons why people fall over and a review of your medical problems and medications may well reveal some reasons for falling that can be fixed. If you have lots of falls, seeing a specialist as well as the physiotherapist and occupational therapist can reduce your chances of falling again. You will be asked about the circumstances surrounding your falls and it is helpful if family or friends who witnessed your falls come into the clinic with you. You will have an examination looking at your general health as well as strength, balance, vision and memory. An occupational therapist may come to your home to look into any changes that can be made to improve safety. For more information on falls prevention the ACC website has information on https://www.acc.co.nz/preventing-injury/trips-falls/?smooth-scroll=content-after-navs

A stroke is where the blood supply to an area of the brain is interrupted causing damage to brain cells. This happens either with a clot in the blood vessel or the blood vessel bursting. The effects of a stroke depend on where in the brain, and how big, the interruption to blood flow is. Most people who have had a stroke are admitted to hospital. If the stroke has had significant physical effects you may be admitted to our rehabilitation unit aimed at increasing your independence, preventing complications from stroke and preventing further strokes. For more information on stroke a very useful website is the New Zealand Stroke Foundation site www.stroke.org.nz

Asthma symptoms include coughing, wheezing, a tight feeling in the chest and trouble breathing. Asthma occurs when the main breathing tubes of your lungs are over-sensitive and react to things that don’t affect other people. As a result of this they become swollen and narrow. If your asthma is not getting better with standard treatment (preventor and reliever inhalers) or you are having more asthma attacks than you or your doctor are comfortable with, you may be referred to a specialist. In most cases you'll be asked to give a complete medical history and will also be examined by the doctor. Sometimes other conditions can appear like asthma or complicate asthma, so you may be asked to have some tests to help in the diagnosis. Tests looking for severity and complicating features of asthma include: chest X-ray, spirometry and CT chest. For more details see below. You may, however, not need any of these tests. Treatment This includes taking medicines as well as changing some lifestyle factors. A peak flow meter can be used to keep a watch on your asthma and help with plans to prevent attacks. Stopping smoking is very important as is learning to recognise what brings an asthma attack on. Asthma is treated with inhaled medicines. There are two types: a preventor medicine is taken every day. It soothes the irritated breathing tubes and prevents worsening of asthma, “asthma attacks”. a reliever treats the asthma attacks. It relaxes the tightened muscles around the breathing tubes. For more information on asthma see www.asthmanz.co.nz

This term is used to describe lung disease where the breathing tubes become blocked and the surrounding tissue and air sacs inside the lungs become damaged. COPD includes conditions such as emphysema, chronic bronchitis and chronic asthma. COPD is a long term and sometimes fatal disease that can be managed and slowed down. Smoking is the main cause of emphysema and chronic bronchitis. Chronic bronchitis is an inflammation of the main breathing tubes (bronchi) in the lungs, which results in the production of excess mucous (phlegm) and a reduction in the amount of airflow in and out of the lungs. In the early stages of chronic bronchitis, a cough usually occurs in the morning. As the disease progresses, coughing persists throughout the day. There is often associated shortness of breath and an increased rate of chest infections. Emphysema is the gradual destruction of the air sacs (alveoli) in the lungs. The alveoli are unable to completely relax. As they become larger they are not as good at transporting oxygen to the blood. Emphysema is cannot be cured, but can be managed through medication and lifestyle changes. Investigations You may have some of the following tests before or after your clinic appointment: chest X-ray, spirometry, lung function tests, CT chest. The specialist will decide if you need any of these tests, depending on your symptoms and examination findings. Treatment There are ways to manage COPD. The first and most important is to stop smoking if this applies to you. There are exercises and dietary changes that can help maintain and improve fitness. Medications include inhalers, although they are not used for everyone. If you have COPD it is a good idea to have the flu vaccination every year. For more information on COPD see www.asthmanz.co.nz

This is when abnormal (malignant) cells divide and grow in an uncontrolled fashion in the lung tissue. The effect of this is to destroy normal lung tissue and block off the breathing tubes. There are several types of lung cancer. The most common cause is cigarette smoke; however exposure to asbestos, marijuana smoke and a number of other chemicals can also increase your risk of developing cancer. Common signs and symptoms a cough that gets worse with time coughing up blood chest pain loss of appetite and weight tiredness repeated doses of, or not improving, bronchitis or pneumonia. Diagnosis To diagnose lung cancer your doctor will look at your medical and smoking history. You will also have a physical examination. This is usually followed by a number of tests. The aim of the tests is to confirm the diagnosis and find out what type of cancer it is which usually involves obtaining some cells to look at under the microscope. Test you are likely to have include: chest X-ray. This is the first test that may raise the question of a lung cancer. It is usually followed by other tests to confirm the diagnosis CT scans with or without fine needle aspirate (see below) bronchoscopy (see below). Treatment Once lung cancer is diagnosed, a process known as staging determines the extent of the disease. Knowing the type and stage of cancer means the doctor can plan your treatment. Different treatment options include: The type of surgery depends on the size and type of cancer radiotherapy is a form of high energy radiation (X-ray) that kills cancer cells chemotherapy is the use of drugs aimed at killing cancer cells. The aim of treatment is to keep the person as well as possible even if the cancer cannot be cured. If you have a lung cancer there will be ongoing follow up with specialists and nurses throughout treatment and afterwards. For more information about lung cancer see www.cancernz.org.nz

You may be advised to take lung function tests to find out how much air moves in and out as you breathe. The two most common tools used to measure lung function are spirometers and peak flow meters. Lung function tests are usually done before and after taking a medication known as a bronchodilator (asthma reliever medication) to open your airways.

Spirometry is a test which measures the speed at which your lungs can be filled and emptied of air. It can be used to diagnose problems of breathing and monitor the usefulness of treatment. In order to do spirometry, you take a deep breath in and blow out as hard as you can into a hollow tube attached to a spirometer machine for 6 seconds. You will be asked to do the test 3 times. The whole process takes 10 – 15 minutes depending on whether or not you are given some inhaled medicine and asked to do it again to monitor if there is an improvement.

During this test a thin fibreoptic tube is inserted into your breathing tubes, through the nose, to view the tubes and take a biopsy (remove cells or tissue) to see if there are cancer cells present. It is usually undertaken under local anesthetic. You may be given medicine to make you sleepy and relaxed. A specialist doctor does this procedure in an operating theatre environment.