Your doctor has requested that you have a barium swallow. We hope the following information will answer some of the questions you may have about this procedure.

What is a barium swallow?

It is an examination of the oesophagus (food pipe) and the stomach. These areas of your body cannot normally be seen on X-ray images.

The procedure uses a type of X-ray, called fluoroscopy, to view images in real time.

The images are taken as you swallow a white liquid (called barium) down into your stomach. The procedure is carried out by a specialist radiographer.

How do I prepare for a barium swallow?

Please do not eat or drink for a minimum of 4 hours before your appointment time. If you need to, you can take small sips of water or clear fluid. Diabetic patients to ensure blood sugars are maintained.

Continue to take your normal medication unless otherwise instructed; however please inform us if you are allergic to anything.

If you are diabetic please ensure your blood sugars are maintained.

The procedure uses X-rays and the amount of radiation used is very low, however if you think you may be pregnant please inform the Imaging department before attending the appointment. The telephone number for the Imaging department can be found on the appointment letter.

On the day of the procedure

• You will arrive at Gate 18 and a member of the Imaging team will take you through to the fluoroscopy waiting room.
• The specialist radiographer will discuss the procedure with you. You will be given an opportunity to ask questions. If you are happy to proceed you will be asked to change into a hospital gown.
• You will be asked to stand next to the X-ray machine and you will then be asked to take mouthfuls of the liquid barium and to swallow it as the X-ray images are taken. The specialist radiographer will take a number of X-rays to watch the barium pass through your oesophagus and into your stomach.
• You may be asked to stand in different positions so the oesophagus and stomach can be viewed from several angles.
• The examination is usually complete within 20 minutes, but may take longer. You may need to wait for a few minutes afterwards so we can make sure we have all the necessary information.

After the examination

• There will still be some barium retained in the bowel and your stools will appear whitish in colour for a couple of days.
• Barium can occasionally cause constipation, so we recommend that you drink plenty of fluids afterwards.
• You can eat and drink normally after the examination. Eating a high fibre diet like bran or wholemeal bread can help, but the main thing is to drink plenty of fluids.

What are the risks associated with a barium swallow?

Barium swallows are generally regarded as a very safe test and problems rarely occur. The barium liquid is not absorbed by the body as it only coats the walls of the oesophagus, stomach and bowel.

• If you have difficulty in swallowing there is a risk of aspiration (breathing in) the barium. Please inform the Imaging department before your appointment if you are known to aspirate when you drink.
• Fluoroscopy involves the use of X-rays; however with modern equipment the risk is very low (NRPB 2014).

How will I get the results?

You will not get an indication of the result at the time of the examination, as analysis of the images will take place after you have left the department.

The specialist radiographer and a radiologist (specialist imaging doctor) will report on review your examination at the earliest opportunity. A written report will follow and this will be sent to the doctor who requested the examination. Allow 7-10 days for the doctor to receive the report.

Finally we hope this information is helpful. If you have any questions either before or after the procedure, the staff in the Imaging department will be happy to answer them.

The phone number for the X-ray department can be found on the appointment letter. 

References

© North Bristol NHS Trust. This edition published August 2023. Review due August 2026. NBT003313

This leaflet provides you with information about having a water soluble ileostomy enema. It explains what is involved and who you will meet.

What is an ileostomy enema?

This is an examination to look at the section of bowel leading to or from your stoma (opening onto the abdominal wall) using X-ray dye. The procedure is carried out by a specialist radiographer.

What preparation is required?

• Please do not eat or drink from midnight prior to the examination.
• If you are diabetic please ensure your blood sugars are maintained.
• Please bring a spare stoma bag to replace the removed stoma bag.

On the day of the procedure

• You will arrive at Gate 18 and a member of the Imaging team will take you through to the fluoroscopy waiting room.
• A specialist radiographer will discuss the procedure with you. You will be given an opportunity to ask questions. If you are happy to proceed you will be asked to change into a hospital gown.
• You will need to lie on the X-ray table where a small, soft plastic tube will be placed either into your back passage or your stoma, depending on the information your referring doctor requires.
• A small amount of clear X-ray dye will then be introduced into the bowel.
• During the procedure you may be asked to hold in as much fluid in your bowel as possible.
• It is not uncommon for dye to leak during the procedure; please do not be concerned if this happens but let us know.
• You may be asked to lie in various positions to enable the passage of dye to the area of interest.
• At the end of the examination we will drain out as much of the X-ray dye as we are able to.
• Despite best efforts some dye will remain in your bowel and over time will pass either into your stoma bag or into the back passage. This can take up to 12 hours.
• Once all the dye has been emptied there are no after effects following this procedure.
• The whole procedure will take approximately 45 minutes.

Are there any risks or side effects associated with this examination?

A water soluble ileostomy enema is a safe examination; however as with any examination there are small risks but these are extremely rare.

• The soft tube is inserted into the rectum (back passage) or stoma could cause a slight tear. A small injury of this nature will often resolve itself.
• There is also a very rare risk that your bowel could perforate (a small tear could be made in the wall of the bowel). This may require further examination or another procedure.
• An allergic reaction to the X-ray dye is extremely rare.
• As with all X-ray examinations, we will do our best to keep the exposure to radiation to the absolute minimum.

Will the examination be painful?

You may experience a little discomfort while the tube is inserted and when we fill your bowel with the X-ray dye. This is due to the stretching of the tissue after weeks of non-use. The specialist radiographer will take great care to minimise any discomfort for you.

Is there an alternative examination?

No, there is no alternative examination available.

What about after care?

• After the examination you can eat and drink normally.
• Some residual clear X-ray dye may pass into the stoma bag following the procedure.
• You will notice the stoma bag filling quicker than expected.
• You may also experience movement from your back passage as the X-ray dye passes through your bowel.

When will I get the results?

The specialist radiographer will review your examination at the earliest opportunity then make a written report. This will be sent to the doctor who requested the examination. Allow 7-10 days for the doctor to receive the report.

If you already have a clinic appointment you will receive the results then, otherwise you will receive a letter with a date for a clinic appointment.

Privacy and dignity

At North Bristol NHS Trust we are committed to providing the best possible experience for patients, ensuring the need for privacy and dignity in a safe, caring environment. We will treat every patient as an individual and respect their cultural values and beliefs.

Sometimes tests, although necessary, can be embarrassing or undignified for patients but we will endeavour to do everything we can to make you as comfortable as possible during your visit to the department. We hope that the information on this page will answer any questions you may have but please feel free to contact us if you have any particular worries, questions or concerns.

The phone number for the Imaging department can be found on the appointment letter.

References

© North Bristol NHS Trust. This edition published August 2023. Review due August 2026. NBT003312

This information is for patients whose doctor has requested that you have a colonic transit study. We hope the following information will answer some of the questions you may have about this procedure.

What is a colonic transit study?

It is an examination that evaluates the function of your large bowel (or colon). This study assesses how quickly material moves through your bowel. The procedure is carried out by a specialist radiographer.

How do I prepare for a colonic transit study?

You may continue to eat and drink normally throughout the duration of this study. Do not use any laxatives before or during this study.

You will be given a pack of capsules which you will need to take over a period of 3 days and then you will come for your x-ray on the 6th day. Please take the capsules as near to 9:00am as possible on each day.

• Day 1: Swallow the 2 capsules number one (1) on the foil
• Day 2: Swallow the 2 capsules numbered two (2) on the foil
• Day 3: Swallow the 2 capsules numbered three (3) on the foil
• Day 4: There are no capsules to take today
• Day 5: There are no capsules to take today
• Day 6: Attend the Imaging Department, Gate 18, Southmead Hospital.

If you are vegetarian/vegan please be aware that the capsules contain gelatine.

You can continue to take your normal medication unless otherwise instructed; however please inform us if you are allergic to anything.

The procedure uses x-rays and the amount of radiation used is small, however if you think you may be pregnant please inform the imaging department before attending the appointment (NRPB 2014).

On the day of the procedure:

• You will arrive at Gate 18 and a member of the Imaging team will take you through to the fluoroscopy waiting room.
• You will be asked to confirm your details and that you have taken the capsules. You will then be brought through to the X-ray room.
• You will be asked to lie down on the X-ray table and the radiographer will take an X-ray of your abdomen.

After the examination:

Once the radiographer has checked that the X-ray image is adequate, you may go home.

What are the risks associated with a colonic transit study?

There are no side effects from these capsules and they will be passed with your stool (poo) over the next few days if they haven’t done so already.

How will I get the results?

You will not get an indication of the result at the time of the examination, as analysis of the images will take place after you have left the department. 

The radiographer will review your examination at the earliest opportunity and compile a written report this will be sent to the doctor who requested the examination. Allow 7-10 days for the doctor to receive the report. 

Finally we hope this information is helpful. If you have any questions either before or after the procedure the staff in the X-ray department will be happy to answer them. 

The phone number for the X-ray department can be found on the appointment letter.

References

© North Bristol NHS Trust. This edition published March 2024. Review due March 2027. NBT003311.

Your doctor has requested that you have a urethrogram. We hope the following information will answer some of the questions you may have about this procedure.

What is a urethrogram/peri-catheter urethrogram?

This is an examination of the tube (urethra) that carries urine from your bladder to the outside of your body. Using X-ray dye, the length of the tube from the bladder to the outside will be demonstrated.

What preparation is required?

No preparation is required before the urethrogram; you can eat and drink as normal. There is no requirement to stop taking any regular medications.

The procedure uses X-rays and the amount of radiation used is very low, however if you think you may be pregnant please inform the department before attending the appointment.

What happens when I arrive?

• You will arrive at Gate 18 reception area and a member of the Imaging team will take you through to the fluoroscopy waiting room.
• A doctor or specialist radiographer will discuss the procedure with you. You will be given an opportunity to ask questions. If you are happy to proceed you will be asked to change into a hospital gown.

What will happen during the examination?

• You will also be asked your relevant medical history, including any allergies you may suffer from.
• We will ask you to lie on the X-ray table on your back.
• The area around the urethra will then be cleaned with a sterile cleaning fluid and a lubricating jelly administered.
• A small plastic tube called a catheter will be gently inserted by the doctor or specialist radiographer into the opening of the urethra and a small balloon at the end of the catheter may be inflated to keep the catheter in place if required.
• X-rays are then taken as the dye is introduced through the catheter.
• Depending on the information your referring doctor requires, we sometimes will then fill your bladder through this tube, remove the tube and then take X-rays as you urinate into a container.
• The procedure normally takes between 20 to 30 minutes.

Are there any risks or side effects to the examination?

An urethrogram is a safe examination.

• An allergic reaction to the X-ray dye is extremely rare.
• As with any bladder catheterization there is a small risk of infection. Following this examination if you find it painful to urinate or experience increased urgency in urinating or if you have a temperature, please contact your GP or 111 service as you may need antibiotics.
• If you experience any discomfort urinating, it usually resolves in less than 12 hours. Your urine may also be slightly pink after the test but it is not anything to worry about. You should see your GP or contact the 111 service if you experience any bleeding or difficulties with passing urine.

As with all X-ray examinations, we will do our best to keep the exposure to radiation to an absolute minimum.

Will the examination be painful?

An urethrogram may cause a little discomfort during catheterization.

In addition, as the dye is introduced you may have a sensation of pressure in your urethra, especially if you do have a stricture (narrowing) of that area.

When will I get the results?

You will not get an indication of the result at the time of the examination, as analysis of the images will take place after you have left the department.

The specialist radiographer and a doctor will report your examination at the earliest opportunity then make a written report. This will be sent to your doctor who requested the examination. Allow 7-10 days for the doctor to receive the report.

Is there an alternative examination?

There is no alternate examination.

Aftercare advice

At the end of the examination the majority of the X-ray dye will have been removed from your bladder, however the X-ray dye we use is sticky and you may notice this on your skin. It washes off easily.

Following the examination, you will be able to continue with your normal everyday activities including going back to work.

Privacy and dignity

At North Bristol NHS Trust we are committed to providing the best possible experience for patients, ensuring the need for privacy and dignity in a safe, caring environment. We will treat every patient as an individual and respect their cultural values and beliefs.

Sometimes tests, although necessary, can be embarrassing or undignified for patients but we will do our best to do everything we can to make you as comfortable as possible during your visit to the department.

We hope that the information on this page will answer any questions you may have but please feel free to contact us if you have any particular worries, questions or concerns.

Questions and concerns

If you have any questions, please do not hesitate to call us on the number in your appointment letter.

References

North Bristol Trust (2010) Privacy and Dignity policy

University Hospital Southampton NHS Foundation Trust (2017) Patient information factsheet, “Having a Urethrogram”

Royal Surrey County Hospital Foundation Trust (2014) Patient Information leaflet, “Male Urethrogram”

© North Bristol NHS Trust. This edition published August 2023. Review due August 2026. NBT003310. 

This information is for patients whose doctor has requested that you have a cystogram. We hope the following information will answer some of the questions you may have about this procedure.

What is cystogram?

This is an examination of the bladder using X-ray dye to show the structure and shape of the bladder and occasionally the micturating (emptying) of the bladder.

Why do I need a cystogram?

It may be that you have had symptoms such as bladder infections, blood in the urine, problems with incontinence (leaking urine) or other symptoms which suggest that you may have a problem with the structure of the bladder. This examination is also used following recent bladder surgery or bladder injury.

What preparation is required?

No preparation is required before a cystogram; you can eat and drink as normal. There is no requirement to stop taking any regular medications.

The procedure uses X-rays and the amount of radiation used is very low, however if you think you may be pregnant please inform the department before attending the appointment.

During the cystogram there is a chance of the X-ray dye passing around the outside of the catheter to the skin surface, this is known as bypassing around the catheter. This may require a change of underwear.

What will happen during the examination?

• You will arrive at Gate 18 and a member of the Imaging team will take you through to the fluoroscopy waiting room.
• A radiographer will discuss the procedure with you. You will be given an opportunity to ask questions. If you are happy to proceed you will be asked to change into a hospital gown.
• You will also be asked about your relevant medical history, including any allergies you may suffer from.
• You will then be asked to lie on the X-ray table on your back.
• If you already have a bladder catheter in situ, we will disconnect the bag and attach our bottle of X-ray dye to your catheter.
• If you do not have a catheter we will place one inside your bladder.
• X-rays are then used to image the filling bladder as the dye is slowly introduced through the catheter.
• Depending on the information your referring doctor requires, occasionally we will remove the tube and then move the table to a standing position so that we are able to take X-rays as you urinate the dye into a container.

The procedure normally takes between 20 to 30 minutes but please allow an hour for the appointment.

Please be assured we will do our best to maintain your dignity and privacy throughout this procedure.

Are there any risks or side effects to the examination?

The cystogram is a safe examination.

• An allergic reaction to the X-ray dye is extremely rare.
• As with any bladder catheterization there is a small risk of infection. Following this examination, if you find it painful with increased urgency in urinating or if you have a temperature, please contact your GP or NHS 111 as a course of antibiotics may be required.
• If catheterization is required during the examination you may experience discomfort urinating, it usually resolves in less than 12 hours. Your urine may also be slightly pink after the test but it is not anything to worry about. You should see your GP or contact the NHS 111 service if you experience any bleeding or difficulties with passing urine.

Will the examination be painful?

A cystogram may cause a little discomfort during catheterization. In addition as the X-ray dye is introduced your bladder will start to feel full, if the feeling of “fullness” becomes unbearable please inform the radiographer during the procedure.

What about aftercare?

At the end of the examination the majority of the X-ray dye will have been removed from your bladder, however the X-ray dye we use is sticky. It washes off easily.

Following the examination, you will be able to continue with your normal everyday activities including going back to work.

Is there an alternative examination?

Patients referred for this test may also be referred for a cystoscopy to look at the structure of the urethra and bladder. A cystogram however, provides information on how the bladder behaves as it fills and can demonstrate reflux (back flow of dye) from the bladder up the ureters towards the kidneys.

When will I get the results?

You will not get an indication of the result at the time of the examination, as analysis of the images will take place after you have left the department.

The radiographer and a radiologist (specialist imaging doctor) will report on your examination at the earliest opportunity then make a written report. This will be sent to the doctor who requested the examination. Allow 7-10 days for the doctor to receive the report.

Privacy and dignity

At North Bristol NHS Trust we are committed to providing the best possible experience for patients, ensuring the need for privacy and dignity in a safe, caring environment. We will treat every patient as an individual and respect their cultural values and beliefs.

Sometimes tests, although necessary, can be embarrassing or undignified for patients but we will do our best to do everything we can to make you as comfortable as possible during your visit to the department.

A chaperone will be available for the examination if required as per the North Bristol Trust chaperoning policy.

We hope that the information on this page will answer any questions you may have.

If you have any questions, please do not hesitate to call us on the number in your appointment letter. 

References

© North Bristol NHS Trust. This edition published August 2023. Review due August 2026. NBT003309

This leaflet has been produced to help explain what your procedure entails. We hope you will find it helpful. Please ask if there is anything that is not clear.

When is this done?

This is done when there are some changes in the breast which have been found on mammogram or ultrasound scan which we are concerned about, but we cannot actually feel anything in the breast. Therefore a fine wire will be inserted into your breast to help the surgeon locate the correct area.

Before your operation

Prior to your operation you will be asked to attend a pre-operative assessment. This appointment is to ensure you are fit for a general anaesthetic.

In hospital

The wire will be inserted in the Breast Care Centre on the morning of your operation (or occasionally the day before) and a mammogram or ultrasound will be performed and used as a guide to placing the wire. This maybe a bit uncomfortable but it is necessary and should not last too long. Although the placing of the fine wire will take seconds, the whole procedure will take approximately half an hour. A local anaesthetic is normally offered for this procedure, but some are performed without it.

The wire will be coiled flat against the skin and secured firmly and a dressing placed over the top. On the day of the operation you will be taken to theatre for your surgery, which will be performed under a general anaesthetic. By carefully tracing along the guide wire, the surgeon removes the wire and a piece of breast tissue. The specimen is then x-rayed to confirm it contains all the abnormality.

As a result of the operation you will have a small scar on the breast.

Risks / complications

Your ultimate safety is our first priority, but as with all procedures involving needles, there are always potential risks.

There is a very small risk of brusing and infection and on extremely rare occasions a pneumothorax (introduction of air into the covering of the lungs) may be induced. Every precaution will be taken to avoid any of these. Any risks of surgery will be fully discussed with you before your operation.

Going home

Depending on individual circumstances you will be able to go home later the same day or the following day.

Stitches and dressing

The stitch (suture) is made of absorbable material and therefore you will not need to have any stitches removed. You will have a clear plastic dressing over your wound which means you can shower or bathe normally. Try to keep the transparent dressing on for seven days. You can then remove the dressing and treat the skin as normal. If the dressing does not come off easily or you do not feel able to remove the dressing telephone your Clinical Nurse Specialist for advice.

Outpatient appointment

You will be given an appointment approximately 2 weeks after your operation to discuss the results of your surgery, either in person by attending the clinic or by telephone.

At home

Some bruising of the surrounding area is very common and may take several weeks to completely clear. Take painkillers (e.g. Paracetamol) for any discomfort. You may find it more comfortable to wear a bra. Resume normal daily activities as soon as you feel able.

More information

If you have any questions or anxieties, please contact either your Clinical Nurse Specialist or GP for advice.

How to contact us:

General enquiries: 0117 414 7000 

© North Bristol NHS Trust. This edition published December 2023. Review due December 2026. NBT002744

This page has been produced to help explain the biopsy you have had. We hope that you will find it helpful.

What is an ultrasound guided core biopsy?

An ultrasound guided core biopsy is the way we take a sample of breast tissue so that it can be looked at under a microscope. We use the ultrasound machine to guide us to the area that we want to take the sample from.

Why have I had this procedure carried out?

You have had this procedure carried out because there is an area in your breast that we need to take a closer look at, so that a diagnosis can be made.

Results

You will be informed before you leave the clinic how and when you will get the results of the biopsy.

After your biopsy

You have had some local anaesthetic, which has numbed the area. This will wear off after a few hours and you may feel some soreness. A mild painkiller such as paracetamol may be taken (avoid aspirin/ibuprofen).

Wound dressing

You have had some paper stitches and a showerproof dressing applied to the area. You can remove these after two to three days by soaking them off in the bath.

Bruising

It is normal to have some bruising around the area of the biopsy but this should start to go in one to two weeks.

Bathing / swimming

It is fine to have a shower or a shallow bath. Do not soak the dressing in the bath until you are going to remove it. Do not swim until the wound has healed.

Bleeding

Very occasionally some people experience a small amount of bleeding. If this happens, apply firm pressure over the top of the dressing with the flat of your hand for five minutes and it should stop.

If you have any concerns about the wound please contact us or your GP for advice.

© North Bristol NHS Trust. This edition published January 2023. Review due January 2026. NBT002743

Breast Cancer Clinical Nurse Specialist and Support Team

The Clinical Nurse Specialist (CNS) Team

The Breast Care Clinical Nurse Specialists are experts in breast cancer care; we work as part of the Cancer Support Team. We can answer your questions and give you information about your diagnosis, treatment, and support available during and after your care.

Cancer Support Worker (CSW)

The Cancer Support Team also has Support Workers. They are trained to provide support and information about physical, emotional, and practical concerns to help you self-manage your recovery and return to a healthy a lifestyle as soon as possible.

Personalised Care and Support Planning (PCSP)

Personalised Care and Support Planning is a conversation and assessment you will be offered with your Clinical Nurse Specialist and/or Cancer Support Worker, to help discuss your health and wellbeing in relation to your cancer. It will assess your individual needs and concerns, to understand what matters to you.

Personalised Care and Support Planning includes sharing information with you about diet, physical activity, fatigue, and other practical information relevant to you. This may include anything from emotional support to signposting you to local support services, such as benefits advice.

Making decisions about your healthcare

At NBT we encourage you to be a partner in your healthcare.

When patients work with healthcare professionals to make decisions about their healthcare plan and treatment, this is called shared decision making. Shared decision making ensures that you are supported to make decisions that are right for you. This means supporting you to choose tests and treatments based on medical evidence, as well as your individual preferences, beliefs, and values.

It can be helpful to write down questions you have for your healthcare team. You should bring these, and a pen and paper to make any notes when you have appointments.

Some questions that may be helpful to ask:

• What are my options?
• What are the possible benefits and risks of those options? 
• What support and information is available to help me make my decisions?

Shared decision making matters to us. Tell us what matters to you.

NGS Macmillan Wellbeing Centre

We offer help and information about different kinds of cancers and treatments.

We also talk about money, benefits you might get, what to eat, and exercises to do. If you have concerns or just want to talk with one of the team, we have time to listen and help you.

The centre offers ‘drop-ins’ for coffee and a chat or appointments for specific needs.

Opening times: Monday to Friday, 08:30 - 16:15

Phone number:  0117 414 7051

Cancer Information Session

As part of your routine care you may be invited to a group education and support session at or soon after the time of a cancer diagnosis.

The session provides:

• Information about cancer and related topics that help you participate in your care and recovery.
• The opportunity to meet other people with similar experiences.
• Help to enable you to make choices best suited to you.

Venue: NGS Macmillan Wellbeing Centre, Southmead Hospital.

Days and times: Mondays 13:30 - 14:30, Thursdays 10:00 - 11:00

Useful contact information

© North Bristol NHS Trust. This edition published May 2024. Review due May 2027. NBT003202.

What is a Sentinel Node Biopsy?

Sentinel node biopsy is an operation to remove the first lymph nodes in your armpit (axilla) that are responsible for draining the area of your breast involved by a breast cancer. This lymph node is then looked at in under a microscope to see whether there are tumour cells in it.

Several large research studies have shown the benefit of sentinel node biopsy and it is now the standard treatment for early breast cancers where the pre-operative ultrasound scan of the axilla shows no obvious signs of cancer.

What are lymph glands/nodes?

The lymphatic system is a system of lymph vessels and lymph glands throughout the body which play an important role in fighting infections and tumours. The lymph glands responsible for the breast lie mainly within your armpit, but occasionally may be within your chest or neck.

The number of lymph nodes in your armpit can vary. The average is around 15 to 20. Out of these there are 1 to 4 lymph nodes into which all the lymph fluid from the breast will first drain.

Why is it so important to know whether tumour cells are present in the lymph nodes in the arm pit?

Very important decisions regarding the overall treatment of your breast cancer are made, based on whether the lymph glands contain tumour cells. This treatment may involve further surgery, radiotherapy, hormone treatment, chemotherapy or a combination of these treatments.

What are the alternatives to this operation?

A Sentinel Node Biopsy is not a treatment for breast cancer; it is done to gain more information. The main alternative is to have the majority of the nodes removed from your armpit in an operation called Axillary Node Clearance. Problems such as pain, numbness, lymphoedema (long term fluid swelling) and shoulder stiffness can be more common following an Axillary Node Clearance.

How do you identify the sentinel lymph node?

We use a combination of 2 methods to identify the sentinel lymph nodes:

Isotope Injection

On the morning of your operation (or occasionally the day before) a small amount of radioactive material called Technetium is injected into your breast. This radioactive material is carried into your armpit by the lymph vessels and trapped in the sentinel node.

Blue Dye Injection

This is injected once you are asleep in theatre at the beginning of your operation. This dye stains the sentinel node blue so that it helps your surgeon to find the correct lymph node.

The surgery

A small cut is made in your armpit if you are having breast preserving surgery. If you are having a mastectomy, your surgeon will be able to reach the sentinel nodes through the mastectomy scar, so you won’t have an extra scar in your armpit. A hand held gamma probe used in the Operating Theatre guides your surgeon to the radioactive material injected previously. Your surgeon will remove any lymph nodes that are radioactive or blue in colour. 

What is the advantage of sentinel node biopsy?

Sentinel node biopsy is a 95% accurate way of determining the stage of your disease. It is a smaller operation than the alternative Axillary Node Clearance (where all the armpit nodes are removed) and recovery time is usually quicker, less painful and the risk of long term arm swelling is significantly lower.

What are the disadvantages of sentinel node biopsy?

In less than 5% of cases sentinel node biopsy does not accurately find disease within the armpit.

Other complications include:

• Staining of the skin. The colour from the blue dye will stay in the breast area for several months, but it is not dangerous and will gradually fade. Very rarely, the staining can last for more than one year.
• Blue/green urine and faeces. As the dye is flushed from your body, you may notice a bluish discolouration of your urine and your stools. This will last for 24-48 hours before returning to normal. 
• Allergy. There is a small risk of an allergic reaction to the blue dye (less than 1%). Your surgeon will look for signs of allergy during your operation. If you do have a reaction, you will be given medication and you will be closely monitored.
• Stiffness or limited movement in the affected arm. It is common to feel this afterwards and it will improve as the wound heals. You will be given an exercise leaflet to follow after your operation.
• Discomfort. You may experience some discomfort afterwards. This will improve as your wounds heal. Your doctor will prescribe painkillers to help ease any pain. 
• Numbness or tingling around the wound. This should return to normal as your body heals. If you become worried, please contact your breast team. 
• Seroma. Sometimes a pocket of fluid will collect at the site of your biopsy – this is called a seroma. Signs of a seroma can be swelling, a feeling of fluid moving in the area and discomfort. This usually settles down by itself after 4-6 weeks. A small number of people may need to come back to the clinic to have it drained with a needle.
• Infection. As with all operations, there can be a risk of infection. If you notice signs of infection, such as redness, or your wound becomes very painful and hot, or you have a temperature, please contact your doctor or breast care nurse to have your wound assessed. 
• Lymphoedema. In approximately less than 5 out of 100 people the arm or breast can become swollen as a result of the surgery, this is called lymphoedema.  You will be given a leaflet called Reducing the Risk of Lymphoeodema which contains advice for you to follow. Swelling caused by lymphoedema does not usually happen straight away following surgery, but is a longer term complication.

If you do notice swelling please contact your Specialist Nurse or Medical team for advice.

Can sentinel node biopsy be unsuccessful?

Occasionally the radioactive fluid and blue dye does not find the sentinel node/s (this happens in less than 5% / one in twenty). If this happens the surgeon, during the same operation will remove approximately four nodes to make sure that the node which is likely to be the sentinel lymph node is removed. 

Does sentinel node biopsy affect whether I have a lumpectomy or mastectomy?

No – having a sentinel node biopsy will not affect whether your tumour is suitable for lumpectomy (wide local excision) or mastectomy.

What will happen if my sentinel node contains tumour?

We would discuss your case at the Multidisciplinary Team meeting. Further treatment to the remaining lymph nodes in your arm pit such as radiotherapy or more surgery is usually recommended. There may be an opportunity to enter a clinical trial.

What if the sentinel node biopsy is negative? 

If the sentinel node does not contain any breast cancer cells, you will not need any further treatment under your arm.

What if I have any further questions about sentinel node biopsy?

Please contact your Specialist Nurse or Consultant and they will be happy to help.

If you or the individual you are caring for need support reading this information please ask a member of staff for advice.

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT003365

Introduction

This information is for patients starting or have already started taking medication to help manage your liver. This page has information on the common medication used in the management of liver disease.

Long term inflammation can cause scarring and liver damage. Scarring of the liver is also known as cirrhosis. The aim of treatment is to stop the cirrhosis getting any worse and to treat any disabling or life threatening complications. 

For the management of cirrhosis, there can be different medication prescribed depending on your condition. This leaflet highlights the most common medication that can be used. You may be prescribed one or more of the medicines discussed in this leaflet. 

Hepatic encephalopathy

When the liver is working well, it can help get rid of waste products from your body. In liver disease, the body cannot get rid of the waste products effectively and they can be carried to the brain by your blood. This can cause confusion or short term memory problems.

Other symptoms may include feeling tired, tremors or having difficulty carrying out simple tasks.

Lactulose – is a sweet syrup-like medicine. It is a laxative which helps the body to remove toxins that can build up when the liver is failing. It also helps to prevent the growth of bacteria that produce ammonia in the bowel, which can affect brain function. It is important to have at least 2 to 3 bowel movements per day.

Rifaximin - helps to prevent infections and remove toxins from building up in the body when the liver is failing.

Ascites and peripheral oedema

Ascites (fluid building up in the tummy) and swelling in the ankles or legs (peripheral oedema) can be a common complication of cirrhosis. Ascites can be uncomfortable and may cause difficulty breathing.

Spironolactone and Furosemide are also known as diuretics. These medicines help the body get rid of excess fluid.

Antibiotics such as co-trimoxazole – fluid building up in the tummy (ascites) can become infected; antibiotics can be used to help treat the infection or may be used in lower doses to prevent infection.

Portal hypertension and variceal bleeding

Propranolol and carvedilol – known as beta blockers, reduce the risk of bleeding by helping to lower the high blood pressure in the main vein that takes blood to the liver (portal hypertension) and can help to reduce the risk or severity of bleeding.

Steroids

Prednisolone – steroids can help to reduce inflammation in the liver. Steroids are usually prescribed as a reducing course. It is best to take this medication with/after food.

Calcium and vitamin D supplementation – such as Adcal D3, can be prescribed for bone protection whilst taking a course of steroids. The calcium and vitamin D supplement may be stopped once the course of steroids has been completed.

Multivitamins

Thiamine – vitamin B supplement helps prevent toxins building up in the body due to the liver failing and supplement for vitamin B deficiency.

Sanatogen A-Z or Forceval – multivitamins which help to provide support for vitamin deficiency.

Side effects

All medication can be associated with side effects. For more detailed information, refer to the leaflet provided by the manufacturer in the medicine package.

Top tips for taking medication

• If you miss a dose, take the next one as soon as you remember, but do not take a double dose unless you are told to do so. If there is a problem or you forget more than one dose, ask your doctor or pharmacist for advice. Make sure you have enough supplies of your medicines, particularly over bank holidays or if you plan to travel away from home. Order repeat prescriptions well in advance in case the pharmacy runs out of stock.
• It is important that you take all your regular medication at the right time.
• If starting any new medication (including over the counter medication), always check with your community pharmacist or GP if is it safe with liver disease.

How will I get further prescriptions?

Your GP will prescribe your repeat prescriptions. You will be able to take your prescription to your local pharmacist to get more supplies, or the local pharmacy may receive your prescription directly from your GP surgery.

For more detailed information on medication, information is provided by the manufacturer in the medicine package. This leaflet has been designed to inform you what each medication is used for and why it is important.

If you have any further questions or concerns, please speak to your doctor or pharmacist.

Resources

Cirrhosis of the liver - British Liver Trust

Treatment for cirrhosis - NHS (www.nhs.uk)

How to contact us:

Appointments helpline: 0300 555 0103

LiverNurses@nbt.nhs.uk

Medicines.Information@nbt.nhs.uk

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

© North Bristol NHS Trust. This edition published June 2023. Review due June 2026. NBT003334