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abdominal pain
Pain in the abdomen, ranging from vague discomfort to severe, intolerable suffering that may be localized or generalized, sudden or gradual in onset and arise from a number of different causes.

Is the growth of cells that is no longer within the normal control of healthy cells, where growth is unregulated. Malignant is a synonymous term.

Often the end result of chronic liver disease (e.g. viral hepatitis, excessive alcohol use), leading to extensive replacement of normal liver tissue or parenchyma with scar tissue or fibrosis that encases multiple tiny nodules of normal liver tissue, with the potential for progressive loss of liver function. There are grades of cirrhotic liver disease, with compensated (no significant complications of liver disease) or decompensated (presence of complications, including encephalopathy, variceal bleeding and or ascites) cirrhosis.

or large bowel, is generally 70cm in length, and is responsible for most of the water and electrolyte absorption, and acts as a repository for stool which is then excreted.

An endoscopic procedure performed with a flexible camera (1.7m in length), aimed to visualize the entire length of the large bowel from the anal opening to the cecum. Bowel preparation is necessary prior to the procedure.

colorectal cancer
Cancer or malignancy that originates in the colon (large bowel) or rectum. Risk of colorectal cancer increases with age and with a family history (e.g. a primary relative having colorectal cancer). The primary treatment for colorectal cancer is surgical resection.

Although individual definitions may vary, generally understood as either difficulty with defecation or infrequent defecation. Bowel habit is highly variable amongst individuals, but based on large numbers of patient's patterns, less than 3 bowel movements per week would be considered constipation. Additional concerns include incomplete emptying and excessive straining.

crohn's disease
(CD) A chronic inflammatory condition of the small or large bowel, often diagnosed early in life, characterized by transmural inflammation (affects all 5 layers of the bowel), skip lesion distribution (can occur anywhere from the mouth to anus), and symptoms often include diarrhea and belly pain. If untreated, Crohn's disease can lead to complications, resulting in surgery.

Although individual definitions may vary, generally understood as a decrease in stool form or increase in water content. It may be present acutely (less than or equal to 2 weeks) or chronically (present for longer than 4 weeks).

or 'indigestion', a symptom complex thought to be of gastroduodenal origin that often occurs after meals, and is characterized by upper abdominal pain, bloating, often nausea and early satiety (feeling of fullness with loss of desire to eat).

Endoscopic Mucosal Resection
An endoscopic procedure, aimed to remove a section of the most superficial layer of the bowel (mucosa) - variable techniques are employed. The general goal of this procedure is to completely remove or resect tissue that is abnormal e.g. adenomatous or dysplastic.

Endoscopic Retrograde Cholangiopancreatogram
(ERCP) a combined endoscopic and radiologic procedure, where the Ampulla of Vater (confluence of the ducts from the biliary system and pancreatic system merge, to enter into the small bowel in the duodenum) is cannulated with a catheter, and images are depicted by fluoroscopy. The purpose of this examination may be for diagnosis (to understand the biliary or pancreatic duct anatomy) and more commonly for the purpose of intervention, to remove a stone, place a stent or take biopsies.

endoscopic ultrasound
An advanced therapeutic technique where endoscopy and ultrasound are combined, with an ultrasound device housed within an endoscope, allowing for sonographic characterization of structures accessible intra-luminally (within the GI tract). Target organs of interest include the esophagus (eg. for staging esophageal tumors), pancreas (characterizing and potentially sampling pancreatic cysts and tumors), the biliary tree (to identify strictures, tumors or the presence/absence of gall stones), and the rectum (characterize rectal tumors).

Endoscopy (pronounced /ɛnˈdɒskəpi/) means looking inside and typically refers to looking inside the body for medical reasons using an endoscope (pronounced /ˈɛndəskoʊp/), an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ. Endoscopy can also refer to using a borescope in technical situations where direct line of-sight observation is not feasible.

The underlying cause of disease or abnormality

flexible sigmoidoscopy
An endoscopic procedure performed with a flexible camera, aimed to visualize the left colon as far as the splenic flexture about 50cm. Bowel preparation, usually with a fleet enema is required.

gastroesophageal reflux
(GERD) the movement of gastric contents proximally into the esophagus, often described as 'heartburn' or a sensation of burning in the epigastric (upper abdomen) or retrosternal (chest) area, that often occurs post-prandially (after a meal), and may be associated with regurgitation (not vomiting, rather a small amount of liquid contents is expelled up from the stomach into the mouth) or acid taste. The gastroesophageal junction normally relaxes on occasion for 'venting' but this may occur more frequently or for longer periods of time. Risk factors including overweight or obesity, hiatus hernia, some skin conditions, pregnancy and age.

Endoscopy evaluation of the upper gastrointestinal tract, including the esophagus (swallowing tube), stomach, and first part of the small bowel, up to and including the second or third portion of the duodenum. No bowel preparation is required, just fasting for 2 to 4 hours prior to the procedure.

Inflammation of the liver, that may have a number of potential etiologies or causes.

The subspecialty practice dedicated to treatment or management of disease that affect the liver.

Of unknown cause or origin.

inflammatory bowel disease
Comprised of 3 different chronic disease entities: ulcerative colitis, Crohn's disease and indeterminant colitis. This group of diseases manifest from immune dysregulation, may be localized to the small or large bowel and is complex in origin.

irritable bowel syndrome
(IBS) considered a 'functional gut disorder' that is complex in nature, and involves altered motility or movement of the gut (enteric nervous system) and pain sensation (visceral hypersensitivity). It is defined by completely normal investigations, in the context of chronic (>3mo) abdominal discomfort, often relieved with defecation (bowel movement) and altered bowel habit (alternating between diarrhea and constipation).

A large organ located in the right upper quadrant, responsible for many important functions including regulating fats (lipids) and glucose (production and storage), steroid hormone metabolism, detoxification of substances ingested (from the diet, medications), production of important proteins (for blood clotting for example), and processing the end-product of blood or hemoglobin (bilirubin).

There are two definitions, the (1) progressive, getting significantly worse with time (2) in reference to the nature of a tumor or growth, having 'malignant' origins or cancerous, reflecting uncontrolled growth that has the potential to spread.

Is the last segment of the colon, comprised of about 12cm of bowel and terminates with the anus. It is a storage site for stool and contains a series of muscular structures to aid in defection or the process of stool elimination.

small intestine
The 'work horse' of the gut, where most nutrients are absorbed, this organ sits between the stomach and large bowel or colon, can but 4-6 meters in length and has 3 parts: the duodenum, jejunum and ileum.

ulcerative colitis
(UC) A chronic inflammatory condition mostly isolated to the large bowel or colon, present from the very distal or end of the colon (anal verge) extending proximally (towards the mouth) in a continuous fashion, affecting on the mucosa (innermost layer). It is characterized by bloody diarrhea, urgency, and abdominal pain.

Referring Physicians