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Good day friends This is your surgeon Dr. Pandiaraja Today we are going to How to do a colonoscopy This is a case of lower GI bleeding for evaluation The planned procedure is colonoscopy Diagnosis: Ulcerative colitis Intraveonous sedation is used as anesthesia Patient positioned in left lateral position The first step of the procedure 1. Inspect anal regions for fissure or fistula or mass 2. Colonoscopy is passed through anus after doing per rectal examination with lignocaine gel 3. After introduction first we will anal canal 4. After visualization of distal rectum insufflate air and proceed to rectosigmoid junction 5. After visualization of sigmoid proceed to descending colon with gentle push 6. Scope is always in the center of the lumen 7. In a case of suspected looping withdraw the scope and do suctioning and proceed 8. Splenic flexure appears as bluish in colour due to presence of spleen 9. Transverse colon appears as triangular fashion 10. After transverse colon, hepatic flexure appears by sharp angulation 11. Further advances lead to ascending colon 12. Caecum appear as crow foot 13. Bow and arrow sign helps to identify ileocaecal valve 14. Granular appearance of small bowel confirms the intubation of ileum 15. Slow withdraw allow us to visualize blind spots 16. Biopsy forceps is used to take biopsy in suspected area 17. Retroflexion of scope allow us to examine rectal lesions