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THE PROCEDURE

If the endoscopic examination is of some part of the digestive tract, you may be asked to fast for a certain amount of time (usually overnight) before undergoing the procedure. Depending on the type of examination (usually the more invasive the procedure, the more uncomfortable it may be), you may be given a mild sedative, either intravenously or by mouth, or a local or general anesthetic. The doctor will then insert the endoscope directly through a natural opening in the body (such as the mouth or anus) or insert it through a small incision and guide it to the area being examined. The procedure usually takes about 30 to 60 minutes.

Colon cancer

Doctors can use two types of endoscopes to see the inside of the colon (large intestine) directly—a colonoscope to view the entire large intestine, and a sigmoidoscope to see just the lower third. This image is of a cancerous growth (the dark pink area in the upper part of the image) on the inside wall of the large intestine.

Visual aids to diagnosis

The purpose of this section is to help you identify visual signs of illness. The color photographs on the following pages show some skin, eye, and nail disorders or problems. As a backup to the photographs, review the appropriate symptoms chart (see pages 201 to 369). If you are concerned about any symptom, talk to your doctor.

While you are looking at these photographs, keep in mind that many skin, eye, and nail problems look similar to one another. Symptoms can vary from person to person, and your symptoms may not resemble those shown here. But doctors are familiar with the full range of a disorder’s visual signs and can usually make an accurate diagnosis based on these signs.

Birthmarks

Strawberry hemangioma

A strawberry hemangioma (see page 1058) is a raised bright-red patch of skin that grows in the first few months of life and may bleed easily. After 6 to 10 months, the mark begins to shrink and fade. Most disappear by the time a child is 5 years old.

Stork bites

Stork bites, which are common, are flat, salmon-colored skin patches made up of blood vessels. They most often appear on the forehead, eyelids, upper nose, and the back of the neck in newborns. They may become darker when the baby is crying and turn white when pressed. Stork bites usually disappear by the time a baby is 18 months old.

Port wine stain

A port wine stain (see page 1058) is a flat or pebbled patch of purplish red skin that usually occurs on the face and may cover a large area. A port wine stain usually remains the same throughout life but may fade over time.

Mongolian spot

Mongolian spots (see page 1058) are bluish patches on a baby’s buttocks or lower back. The spots affect mostly babies of African or Asian descent, but they can also occur in white babies, usually in those of Hispanic or Mediterranean descent. They usually disappear by the time a child is 5 years old.

Café au lait spots

Café au lait spots are flat pigmented patches of skin that usually join and appear as a single patch. They are present from birth and remain unchanged throughout life. The presence of several café au lait spots may be a symptom of a genetic disorder called neurofibromatosis (see page 968).

Abnormal Coloration

Vitiligo

In vitiligo (see page 1072), irregularly shaped patches of skin lose all of their normal color and become much paler than the surrounding skin, although the texture of the skin remains the same. The unpigmented skin patches are often symmetrical mirror images on each side of the body. Vitiligo seems to result from an abnormal immune response. In most cases, the loss of pigment is permanent.

Jaundice

Jaundice (see page 785) is yellowing of the skin (as on the chest here) and the whites of the eyes, usually caused by liver disorders. Jaundice results from a buildup in the blood of bilirubin, a yellowish brown pigment that is normally removed from the bloodstream by the liver and excreted in bile.

Age spots

Age spots (see page 1059), also called liver spots or solar