?

Lakes > Public Hospital Services > Te Whatu Ora – Health New Zealand Lakes >

Gastroenterology | Lakes | Te Whatu Ora

Public Service, Gastroenterology & Hepatology (Liver), Endoscopy (Gastroenterology)

Today

8:00 AM to 4:30 PM.

Description

Formerly Lakes DHB Gastroenterology

Lakes DHB Gastroenterology is a specialist service provided within Internal Medicine.

We are a small team made up of three gastroenterologists and two clinical nurse specialists. We provide specialist medical support for gastroenterology inpatients as well as running regular outpatient clinics and endoscopic procedures.

The gastroenterology nurse specialists provide flexible support particularly for those diagnosed with Inflammatory Bowel Diseases (Crohns disease and ulcerative colitis) as well as managing treatment for people with Hepatitis B and Hepatitis C.

Gastroenterology is supported by wider hospital teams such as in outpatients and on the medical or surgical wards. People who come into the Gastroenterology service are likely to come across our support teams such as in:

Where to find us: see the Rotorua Hospital map here.

We also provide visiting endoscopy services to Taupō Hospital.

What is Gastroenterology?

Gastroenterology is the specialty within medicine that looks at the digestive system and its associated structures. Your digestive tract is the passage which food passes through allowing you to get all the nutrients and energy your body needs to function. It starts at your mouth, going through the oesophagus into your stomach. It then goes into your small intestine, your large intestine, and finishes at the rectum and anus (bottom). The liver and its associated structures are also an important part of gastroenterology. It is a large organ attached to the small intestine providing functions associated with the digestion of food but also many other important health functions. 

Clinical Nurse Specialists - Samantha Wilkinson (Inflammatory Bowel Disease), Waverley Brinkler (Hepatitis B/Hepatitis C)

Consultants

Referral Expectations

Your GP will refer you to our department if they are concerned that you have problems that require a specialist opinion regarding the diagnosis or treatment of a gastroenterology condition.

Waiting times for clinics range from 1-6 months depending on urgency, which is assessed from the letter we receive from your GP.

Before coming to our clinic, you may be asked to undergo tests such as blood tests, urine tests or stool/faeces tests (you collect a sample of your urine or poo for analysis).

Clinic appointments last 30-40 minutes. A history of your symptoms will be taken as well as a review of any medications you are on (please bring these with you). You may also be examined and, if necessary, this might include an internal rectal examination. This involves the gentle insertion of the doctor's finger or a tube a short way into your bottom to look inside.

From this appointment you might be referred on for one or more of the following; blood tests, X-ray tests, ultrasound scan, CT scan or MRI. Endoscopic procedures might also be requested such as a camera examination down through your oesophagus (gastroscopy) or up into your bowel (colonoscopy). There is further information on some of these below and the doctor or nurse can explain the details of what a procedure might involve.

Charges

New Zealand citizens or those who have obtained permanent residence are entitled to publicly funded health care.

Non-residents may be required to pay for their health care.

Click here to read more about eligibility for funded care at Lakes DHB.

Hours

8:00 AM to 4:30 PM.

Mon – Fri 8:00 AM – 4:30 PM

Procedures/Treatments/Common Conditions

Outpatients

Medical clinics are currently located in the main outpatient area just beyond the main hospital entrance to the right. Reception staff will check you in, outpatient nurses will then weigh you and do observations such as blood pressure. There may then be another wait in the waiting room until the Gastroenterology doctor is able to see you. Clinical Nurse Specialist clinics are located in the OPRS (Old Persons Rehabilitation Services) clinic rooms which are on the right just before the hospital canteen. Reception staff will check you in and the nurse specialist will do any observations necessary alongside the appointment.

Medical clinics are currently located in the main outpatient area just beyond the main hospital entrance to the right. Reception staff will check you in, outpatient nurses will then weigh you and do observations such as blood pressure. There may then be another wait in the waiting room until the Gastroenterology doctor is able to see you.
 
Clinical Nurse Specialist clinics are located in the OPRS (Old Persons Rehabilitation Services) clinic rooms which are on the right just before the hospital canteen. Reception staff will check you in and the nurse specialist will do any observations necessary alongside the appointment.
Endoscopy

Within theatres there is a suite dedicated to endoscopic procedures which are camera tests looking into the gut. These are the best way to see what is going on inside the gut so help with diagnosing a condition and, in some cases, doing certain interventions. You will receive detailed instructions before any procedure. There are also specialised nurses in the unit able to support you throughout. There is also a unit in Taupo Hospital where the doctors do endoscopic procedures on a regular visiting basis.

Within theatres there is a suite dedicated to endoscopic procedures which are camera tests looking into the gut. These are the best way to see what is going on inside the gut so help with diagnosing a condition and, in some cases, doing certain interventions. You will receive detailed instructions before any procedure. There are also specialised nurses in the unit able to support you throughout.
 
There is also a unit in Taupo Hospital where the doctors do endoscopic procedures on a regular visiting basis.
Day Stay Unit ('chemo suite')

Some patients may need intravenous (into the vein) medication to manage their condition; particularly those with Inflammatory Bowel Disease. The day case unit (also called the ‘chemo suite’) run a nurse led service and are experienced at managing these treatments safely.

Some patients may need intravenous (into the vein) medication to manage their condition; particularly those with Inflammatory Bowel Disease. The day case unit (also called the ‘chemo suite’) run a nurse led service and are experienced at managing these treatments safely.  
Inpatients

Sometimes people with gastroenterology problems will need to be admitted into hospital. Usually they will be looked after on the medical ward but, at times, surgical input might be required. We aim to work with a multidisciplinary approach so when individual cases need input from other specialists there will be joint care. That team might include colorectal surgeons, dietitians, specialist stoma therapy nurses and more.

Sometimes people with gastroenterology problems will need to be admitted into hospital. Usually they will be looked after on the medical ward but, at times, surgical input might be required. We aim to work with a multidisciplinary approach so when individual cases need input from other specialists there will be joint care. That team might include colorectal surgeons, dietitians, specialist stoma therapy nurses and more.
Gastroscopy

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. During the test the tube is passed through your throat down into your stomach and the start of your small intestine. The back of your throat is sprayed with anaesthetic to make this comfortable. 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 tiny 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 usually 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. More detailed instructions will be sent to you beforehand. 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 able to drive yourself until the following day so please make sure there is someone with you. The team can give you a copy of the report the doctor has written on the day of the procedure. However, 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.

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.  During the test the tube is passed through your throat down into your stomach and the start of your small intestine. The back of your throat is sprayed with anaesthetic to make this comfortable.  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 tiny 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 usually 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. More detailed instructions will be sent to you beforehand.

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 able to drive yourself until the following day so please make sure there is someone with you.

The team can give you a copy of the report the doctor has written on the day of the procedure. However, 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.

Endoscopic Retrograde Cholangio Pancreatography (ERCP)

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.

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.

Colonoscopy

This is a procedure which allows the doctor to see inside your large bowel and examine the surfaces directly to take biopsies (tiny 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. 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 medicine to make you go to the toilet and clear out your bowels (laxatives) over the days leading up to the test. Detailed instructions will be sent to you at the time. 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.

This is a procedure which allows the doctor to see inside your large bowel and examine the surfaces directly to take biopsies (tiny 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. 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 medicine to make you go to the toilet and clear out your bowels (laxatives) over the days leading up to the test. Detailed instructions will be sent to you at the time.

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.
Liver Fibroscan

This is a special type of ultrasound to measure any damage in your liver. Just like an ultrasound it involves jelly on your tummy and a probe that is moved around over the area of your liver. You will feel a regular thud – a bit like someone tapping your skin with their finger. The specialist doing the fibroscan will usually be able to tell you at the time whether there is much scarring or damage in your liver. There is no special preparation or aftercare instructions needed for a fibroscan.

This is a special type of ultrasound to measure any damage in your liver. Just like an ultrasound it involves jelly on your tummy and a probe that is moved around over the area of your liver. You will feel a regular thud – a bit like someone tapping your skin with their finger. The specialist doing the fibroscan will usually be able to tell  you at the time whether there is much scarring or damage in your liver. There is no special preparation or aftercare instructions needed for a fibroscan.

Hepatitis

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 live in blood and can be passed from person to person. For more information about Hepatitis B and C see https://www.hepatitisfoundation.org.nz/ Sometimes other things can also cause inflammation of the liver such as alcohol, drugs, or even too much fatty tissue. If not managed properly the liver can become permanently damaged so it is important to attend any appointments with the specialist helping with these.

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 live in blood and can be passed from person to person.  For more information about Hepatitis B and C see https://www.hepatitisfoundation.org.nz/

Sometimes other things can also cause inflammation of the liver such as alcohol, drugs, or even too much fatty tissue. If not managed properly the liver can become permanently damaged so it is important to attend any appointments with the specialist helping with these.
Cirrhosis

Cirrhosis is the term used to describe a diseased liver that has been badly scarred, usually due to many years of damage. Many people who have developed cirrhosis have no symptoms or have only mild symptoms such as tiredness; which is very common. However, as the cirrhosis progresses, more serious symptoms can 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. Depending on the cause of the cirrhosis and the severity of damage, treatments may include dietary changes, avoidance of substances such as alcohol, or anti-viral medication if there is a virus present. Medication may also be given to prevent complications and treat symptoms of liver failure.

Cirrhosis is the term used to describe a diseased liver that has been badly scarred, usually due to many years of damage. Many people who have developed cirrhosis have no symptoms or have only mild symptoms such as tiredness; which is very common. However, as the cirrhosis progresses, more serious symptoms can 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.

Depending on the cause of the cirrhosis and the severity of damage, treatments may include dietary changes, avoidance of substances such as alcohol, or anti-viral medication if there is a virus present. Medication may also be given to prevent complications and treat symptoms of liver failure.
Peptic Ulcers

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 might be seen as blood in the stool, either in noticeable or microscopic amounts. Sometimes this will show as black and tarry stools that smell bad. Smoking, alcohol, anti-inflammatory medication (such as ibuprofen or diclofenac) and aspirin increase the risk of developing ulcers. Helicobacter pylori is a bacterium that is frequently found in the stomach and is a major cause of stomach ulcers. If this is found when you have a gastroscopy you will be given a course of antibiotics.

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 might be seen as blood in the stool, either in noticeable or microscopic amounts. Sometimes this will show as black and tarry stools that smell bad.
Smoking, alcohol, anti-inflammatory medication (such as ibuprofen or diclofenac) and aspirin increase the risk of developing ulcers.

Helicobacter pylori is a bacterium that is frequently found in the stomach and is a major cause of stomach ulcers.  If this is found when you have a gastroscopy you will be given a course of antibiotics.

Inflammatory Bowel Disease (IBD)

There are two types of IBD; ulcerative colitis and Crohn’s disease. It is not well understood what causes these conditions but part of the problem is that the immune system becomes over-active in the gut, damaging the gut lining. This damage causes inflammation which often leads to ulceration, bleeding and diarrhoea. In ulcerative colitis this only involves the large intestine, whereas in Crohn’s disease any area within the entire intestine could 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 and on how the disease is behaving at a particular time but might include: abdominal pain diarrhoea with, or without, bleeding weight loss tiredness fevers infections around the anus (bottom) Diagnosis is made by combining information from the symptoms, examination, blood tests and other investigations such as a colonoscopy with biopsies and/or radiological tests. Treatment depends on the severity of the symptoms and what part of the intestine is affected. Most medication is aimed at suppressing the immune system, because it is the immune system that is driving the inflammation damaging the gut. Medication could be oral (by mouth), by injection or by enema or suppository (via the bottom) depending on the individual situation. Treatment in some cases requires surgery to remove affected parts of the bowel. There are some important lifestyle considerations such as stopping smoking, if the diagnosis is Crohn's, or making some adjustments to diet in certain situations. For more information see www.crohnsandcolitis.org.nz

There are two types of IBD; ulcerative colitis and Crohn’s disease. It is not well understood what causes these conditions but part of the problem is that the immune system becomes over-active in the gut, damaging the gut lining. This damage causes inflammation which often leads to ulceration, bleeding and diarrhoea.  In ulcerative colitis this only involves the large intestine, whereas in Crohn’s disease any area within the entire intestine could 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 and on how the disease is behaving at a particular time but might include:                          

  • abdominal pain
  • diarrhoea with, or without, bleeding
  • weight loss
  • tiredness
  • fevers
  • infections around the anus (bottom) 

Diagnosis is made by combining information from the symptoms, examination, blood tests and other investigations such as a colonoscopy with biopsies and/or radiological tests.

Treatment depends on the severity of the symptoms and what part of the intestine is affected.  Most medication is aimed at suppressing the immune system, because it is the immune system that is driving the inflammation damaging the gut.  Medication could be oral (by mouth), by injection or by enema or suppository (via the bottom) depending on the individual situation. Treatment in some cases requires surgery to remove affected parts of the bowel. There are some important lifestyle considerations such as stopping smoking, if the diagnosis is Crohn's, or making some adjustments to diet in certain situations.

For more information see  www.crohnsandcolitis.org.nz

Pharmacy

Click here to find your nearest community pharmacy.

Other

Click on the location links for more information about your trip to Rotorua Hospital or Taupō Hospital, including:

Contact Details

Rotorua Hospital

Lakes

8:00 AM to 4:30 PM.

More details…

Taupō Hospital

Lakes

8:00 AM to 4:30 PM.

More details…

This page was last updated at 1:21PM on November 20, 2023. This information is reviewed and edited by Gastroenterology | Lakes | Te Whatu Ora.