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Git Diagnostic Tests.

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GIT Diagnostic tests: from Davidson & Dr.Ikbal-Kuwait.

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Git Diagnostic Tests.

  1. 1. Diagnostic Procedures in GIT Diseases:
  2. 2. Introduction: <ul><li>Major cause of morbidity & mortality. </li></ul><ul><li>10% of GP consultations are for indigestion. </li></ul><ul><li>¼ of GP consultations for diarrhea. </li></ul><ul><li>Infective diarrhea is a major cause of ill heath & death in developing countries. </li></ul><ul><li>GIT is one of the most common sites for cancer. </li></ul><ul><li>Major advances had occurred in the field of GE; </li></ul><ul><li>PUD proved to be an infective condition due to HP & Nobel prize had been given recently to its discoverer, Marshal. </li></ul><ul><li>Molecular events in the CRC development had been discovered & from this effort became successful in its prevention by NSAIDs. </li></ul><ul><li>GIT endoscopy made diagnosis of GIT diseases very easy. </li></ul><ul><li>Therapeutic endoscopy made it possible to replace surgery for many GIT conditions as GI bleeding, bilairy stone removal & stenting, palliative cancer stenting, polyp removal, PEG & endoscopic mucosal resection. </li></ul>
  3. 3. History: <ul><li>Dysphagia: difficult swallowing </li></ul><ul><li>Odynophagia: painful swallowing. </li></ul><ul><li>Aphagia: can not swallow. </li></ul><ul><li>Heart burn. </li></ul><ul><li>Non cardiac chest pain. </li></ul><ul><li>Regurgitation. </li></ul><ul><li>Aerophagia: eructation. </li></ul><ul><li>Hematemesis. </li></ul><ul><li>Melena. </li></ul><ul><li>Hematochesia: fresh bleeding per rectum. </li></ul><ul><li>Dyspepsia: abnormal digestion. </li></ul><ul><li>Anorexia. </li></ul><ul><li>Flatulence. </li></ul><ul><li>Alteration in bowel habits. </li></ul><ul><li>Bleeding per rectum. </li></ul><ul><li>Abd pain. </li></ul>
  4. 4. Physical exams:
  5. 5. Diagnostic Procedures in GI Diseases <ul><li>The gastrointestinal system includes the GI tract and its associated glands </li></ul><ul><li>Esophagus </li></ul><ul><li>Stomach </li></ul><ul><li>Small intestine </li></ul><ul><li>Colon </li></ul><ul><li>Liver & Biliary tree </li></ul><ul><li>Pancreas </li></ul>
  6. 6. Diagnostic Procedures in GI Diseases <ul><li>The diagnostic tests can be divided into several categories: </li></ul><ul><li>Structural tests </li></ul><ul><li>Functional tests </li></ul><ul><li>Tests for Helicobacter pylori </li></ul><ul><li>Special blood tests </li></ul><ul><li>Special stool tests </li></ul>
  7. 7. Diagnostic Procedures in GI Diseases <ul><li>Structural Tests </li></ul>
  8. 8. Diagnostic Procedures in GI Diseases <ul><li>Structural Tests </li></ul><ul><li>Radiography </li></ul><ul><li>Ultrasonography </li></ul><ul><li>Nuclear Isotope Scanning </li></ul><ul><li>Magnetic Resonance Imaging </li></ul><ul><li>Gastrointestinal Endoscopy </li></ul><ul><li>Endoscopic Ultrasonography </li></ul>
  9. 9. Plain X Ray: <ul><li>Show gas within bowel for diagnosis of Int obst if there are dialated loops or fluid levels in the erect position. </li></ul><ul><li>Soft tissue of the liver, spleen& kidneys & calcifications in these organs, pancrease,blood vessels, LNs,calculi. </li></ul><ul><li>Chest XR in erect position show air under diaphragm in perforated viscus. </li></ul>
  10. 10. Contrast studies : <ul><li>Barium & double-cnotrast barium using air with barium, will show filling defects, strictures, erosions & ulcers & even motlity disorders if under fluroscopy. </li></ul>
  11. 11. Tests of structure: Imaging <ul><li>Contrast studies: uses & limitations. </li></ul>Indications Major uses Limitations Ba swallow: Dysphagia,rfelux,chest pain,motility disorder Stricture, HH,GERD,Achalasia. Aspiration risk Poor mucosal detail No biopsy Ba meal: Dyspepsia,epigastric pain,vomiting,anemia,perforation. DU,GU,Gastric Ca,GOO, Gastric emptying disorder. Low sensitivity for early cancer. No biopsy No HP assessment. Ba follow through: Diarrhea,abd pain, Obst by stricture Malabsorption. Chrons. Time consuming. Radiation exposure. Ba enema Abn bowel habit,Rectal bleeding,anemia,abd pain Ca, diverticuli,stricture,megacolon. Difficult in elderly. incontinance., No biopsy.
  12. 12. Tests of structure: Imaging <ul><li>U/S,CT,MRI:Increasingly used for abd diseases, noninvasive & offer detailed images of abd contents. </li></ul>Indications Major uses Limitations US: Masses,abscess,organs,ascites,biliary dilation,gall stones,guided needle aspiration & biopsy. Low sensitive for small ls. Little functional info. Operator dependent. Gass & obesity interfer with it. CT: Pancreatic dis,liver tumor deposits, tumor staging, vascular lesions. Expensive,high radiation, may underestimate stage of cancers as esophagus. MRI: Tumor stage,MRCP,pelvic/perineal, chrons fistula. Time consuming. Clusterphobia,role not fully established,limited availability.
  13. 13. Tests of structure: endoscopy <ul><li>Endoscpy: UGI, LGI, Enteroscopy, ERCP,EUS , Double balloon endoscopy, capsule video endoscopy. </li></ul><ul><li>Increasingly used for abd diseases, noninvasive & offer detailed images of abd contents. </li></ul>
  14. 14. Diagnostic Procedures in GI Diseases <ul><li>Functional Tests </li></ul>
  15. 15. Diagnostic Procedures in GI Diseases <ul><li>Functional Tests </li></ul><ul><li>Tests for motility </li></ul><ul><li>24 hour pH monitoring </li></ul><ul><li>Tests for acid output </li></ul><ul><li>Tests for malabsorption </li></ul><ul><li>Tests for pancreatic function </li></ul>
  16. 16. Gastrointestinal Endoscopy
  17. 17. Gastrointestinal Endoscopy <ul><li>Direct method to examine and biopsy the mucosal lining of the gastrointestinal tract </li></ul><ul><li>Various accessories are available to take biopsies and provide therapy </li></ul>
  18. 18. Gastrointestinal Endoscopy <ul><li>Types of Gastrointestinal Endoscopy </li></ul>
  19. 19. Gastrointestinal Endoscopy <ul><li>Types of Gastrointestinal Endoscopy </li></ul><ul><li>Esophagogastroduodenoscopy (Upper GI Endoscopy) </li></ul><ul><li>Small Bowel Enteroscopy (Jejunoscopy) </li></ul><ul><li>Colonoscopy (Lower GI Endoscopy) </li></ul><ul><li>Sigmoidoscopy </li></ul><ul><li>Endoscopic Retrograde Cholangiopancreatogram (ERCP) </li></ul>
  20. 20. Upper Gastrointestinal Endoscopy <ul><li>Heartburn </li></ul><ul><li>Dysphagia or odynophagia </li></ul><ul><li>Hematemesis or melena </li></ul><ul><li>Dyspepsia or upper abdominal pain </li></ul><ul><li>Unexplained weight loss or anemia </li></ul><ul><li>Evaluation of abnormal Barium meal X-ray </li></ul><ul><li>Suspected malabsorption </li></ul><ul><li>Control of bleeding </li></ul><ul><li>Dilation of stricture </li></ul><ul><li>Removal of foreign bodies </li></ul><ul><li>Removal of polyps </li></ul><ul><li>Tumor ablation </li></ul>Diagnostic Indications Therapeutic Indications
  21. 21. Upper Gastrointestinal Endoscopy <ul><li>Contraindications to Upper GI Endoscopy </li></ul><ul><li>Uncooperative patient </li></ul><ul><li>Hemodynamically unstable patient: Recnet AMI, Unstable angina or arrhythmia,Severe resp dis. </li></ul><ul><li>Suspected perforation </li></ul><ul><li>Severe RA of the cervical spine </li></ul><ul><li>Severe shock. </li></ul><ul><li>Atlanto axial sublaxation. </li></ul><ul><li>These may be relative in experienced hands. </li></ul>
  22. 22. Upper Gastrointestinal Endoscopy
  23. 23. Examples of therapeutic techniques in endoscopy.
  24. 24. Upper Gastrointestinal Endoscopy Normal Esophagus Normal Stomach Normal Duodenum Duodenal Ulcer Gastric Ulcer Esophagitis
  25. 25. Lower Gastrointestinal Endoscopy <ul><li>Chronic diarrhea </li></ul><ul><li>Rectal bleeding </li></ul><ul><li>Iron deficiency anemia </li></ul><ul><li>Unexplained abdominal pain </li></ul><ul><li>Constipation, change in bowel habits or stool caliber </li></ul><ul><li>Unexplained weight loss </li></ul><ul><li>Evaluation of abnormal Barium enema x-ray </li></ul><ul><li>Personal or family history of colon cancer </li></ul><ul><li>Personal history of IBD </li></ul><ul><li>Control of bleeding </li></ul><ul><li>Removal of polyps </li></ul><ul><li>Tumor ablation </li></ul><ul><li>Dilation of stricture </li></ul><ul><li>Colonic decompression </li></ul><ul><li>Reduction of sigmoid volvulus </li></ul>Diagnostic Indications Therapeutic Indications
  26. 26. Lower Gastrointestinal Endoscopy <ul><li>Contraindications to Lower GI Endoscopy </li></ul><ul><li>Uncooperative patient </li></ul><ul><li>Hemodynamically unstable patient </li></ul><ul><li>Suspected perforation </li></ul><ul><li>Suspected colonic obstruction </li></ul><ul><li>Suspected diverticulitis </li></ul><ul><li>Soon after a myocardial infarction </li></ul>
  27. 27. Lower Gastrointestinal Endoscopy
  28. 28. Lower Gastrointestinal Endoscopy Normal Colon Colon Cancer Colon Polyp and Polypectomy
  29. 29. Endoscopic Retrograde Cholangiopancreatogram <ul><li>Indications </li></ul>
  30. 30. Endoscopic Retrograde Cholangiopancreatogram <ul><li>Indications </li></ul><ul><li>Obstructive jaundice (benign or malignant) </li></ul><ul><li>Ascending cholangitis </li></ul><ul><li>Gallstone pancreatitis </li></ul><ul><li>Unexplained jaundice or elevated LFT’s </li></ul><ul><li>Bile duct injury or leak after cholecystectomy </li></ul><ul><li>Chronic pancreatitis </li></ul><ul><li>Pancreatic cancer </li></ul><ul><li>Suspected Sphincter of Oddi dysfunction </li></ul>
  31. 31. Endoscopic Retrograde Cholangiopancreatogram Gallstone impacted at ampulla, sphincterotomy being done and stones removed
  32. 32. Endoscopic Retrograde Cholangiopancreatogram Pancreatic cancer with dilated bile duct and pancreatic duct (Double Duct sign)
  33. 33. Endoscopic Ultrasound <ul><li>The ultrasound probe is placed at the tip of the endoscope </li></ul><ul><li>Allows ultrasonography of organs from a close distance </li></ul><ul><li>Allows close evaluation of the bowel wall </li></ul><ul><li>Can be used to take fine needle aspiration samples from adjoining regions/organs </li></ul>
  34. 34. Endoscopic Ultrasound A T3 Rectal Tumor on EUS
  35. 35. Diagnostic Procedures in GI Diseases
  36. 36. Capsule Endoscopy
  37. 37. Capsule Endoscopy
  38. 38. Capsule Endoscopy <ul><li>Capsule endoscopy is intended for visualization of the small bowel mucosa </li></ul><ul><li>It may be used as a tool in the detection of abnormalities of the small bowel in adults and children from 10 years of age and up </li></ul>Diagnostic Indications
  39. 39. Capsule Endoscopy <ul><li>Capsule endoscopy is contraindicated for use under the following conditions: </li></ul><ul><ul><li>In patients with known or suspected gastrointestinal obstruction, strictures, or fistulas based on the clinical picture or pre-procedure testing and profile </li></ul></ul><ul><ul><li>In patients with cardiac pacemakers or other implanted electromedical devices </li></ul></ul><ul><ul><li>In patients with swallowing disorders </li></ul></ul>Contraindications
  40. 40. Diagnostic Procedures in GI Diseases <ul><li>Functional Tests </li></ul>
  41. 41. Diagnostic Procedures in GI Diseases <ul><li>Functional Tests </li></ul><ul><li>Tests for motility </li></ul><ul><li>Tests for pH </li></ul><ul><li>Tests for acid output </li></ul><ul><li>Tests for malabsorption </li></ul><ul><li>Tests for pancreatic function </li></ul>
  42. 42. Functional Tests in GI Diseases <ul><li>Tests for motility </li></ul>
  43. 43. Functional Tests in GI Diseases <ul><li>Tests for motility </li></ul><ul><li>Esophageal Manometry </li></ul><ul><li>24 Hour pH Monitoring </li></ul><ul><li>Anorectal Manometry </li></ul>
  44. 44. Functional Tests in GI Diseases <ul><li>Indications for Esophageal Manometry </li></ul><ul><li>Oropharyngeal dysphagia with normal structural studies </li></ul><ul><li>- Cricopharyngeal achalasia, Pharyngeo-UES dyscoordination </li></ul><ul><li>Esophageal dysphagia with normal structural studies </li></ul><ul><li>- Primary esophageal body dysmotility e.g. Achalasia, Diffuse esophageal spasm, Nutcracker esophagus, Hypertensive LES, Collagen vascular disease, Amyloidosis, Hypothyroidism, etc. </li></ul><ul><li>Noncardiac chest pain </li></ul>
  45. 45. Functional Tests in GI Diseases Esophageal Manometry Tracings Esophageal Manometry
  46. 46. Functional Tests in GI Diseases <ul><li>24 Hour pH Monitoring </li></ul><ul><li>Indications </li></ul><ul><li>Patients with non cardiac chest pain </li></ul><ul><li>Refractory acid reflux symptoms: evaluate treatment efficacy </li></ul><ul><li>Pre and post-operative evaluation of antireflux surgery </li></ul><ul><li>Patients with atypical presentations of acid reflux (ENT, pulmonary) </li></ul>
  47. 47. Functional Tests in GI Diseases 24 Hour pH Monitoring
  48. 48. Functional Tests in GI Diseases <ul><li>Anorectal Manometry </li></ul><ul><li>Used in the clinical assessment of patients in whom a problem with defecation is suspected </li></ul><ul><li>This technique is helpful in evaluating the anorectal sphincter mechanism </li></ul><ul><li>Contraindicated in the presence of an anal fissure, since the resting anal pressure is abnormally high </li></ul>
  49. 49. Functional Tests in GI Diseases Anorectal Manometry
  50. 50. Tests of structure: Biopsy <ul><li>Obtained through endoscpy or percutanously & sent for histopath exam. </li></ul><ul><li>Reasons for biopsy or cytological exams: </li></ul><ul><li>Brash cytology of suspected malignant lesions. </li></ul><ul><li>Histological assessment of mucosal abns. </li></ul><ul><li>Diagnosis of infections( candida, HP,Giardia). </li></ul><ul><li>Measure enzymes as disacharidases. </li></ul><ul><li>Analysis of genetic mutations as oncogenes , tumor suppressor genes. </li></ul>
  51. 51. 2.Tests of infection: Bacterial cultures <ul><li>For identifying causes of diarrhea sp if acute or bloody. </li></ul><ul><li>Causes of infective diarrhea: </li></ul><ul><li>Viruses: Rota, adeno, entero, requires EM or viral cultures. </li></ul><ul><li>Bacteria: Campylo jej, EC,Salmonella,clostridium difficile( ned toxine isolation). </li></ul><ul><li>Protozoa: Giardia,ameba, cryptosporidium & moicrospora. </li></ul>
  52. 52. Functional Tests in GI Diseases <ul><li>Tests for Malabsorption </li></ul>
  53. 53. Functional Tests in GI Diseases <ul><li>Tests for Malabsorption </li></ul><ul><li>Serum screening tests for malabsorption </li></ul><ul><li>S. Calcium, Albumin, Iron, Vitamin B 12 , Folate, Carotene, Prothrombin time </li></ul><ul><li>Quantitative fecal fat determination </li></ul><ul><li>D-xylose absorption test </li></ul><ul><li>Small bowel biopsy </li></ul><ul><li>Schilling test for Vitamin B 12 absorption </li></ul><ul><li>Hydrogen Breath Test for lactose intolerance </li></ul>
  54. 54. Diagnostic Procedures in GI Diseases <ul><li>Liver Biopsy </li></ul><ul><li>Liver biopsy is a diagnostic procedure used to obtain a small amount of liver tissue which can be examined under a microscope to help identify the cause or stage of liver disease </li></ul><ul><li>The most common way a liver biopsy is obtained is by inserting a needle into the liver percutaneously </li></ul><ul><li>Other ways to biopsy the liver are transjugular, laparoscopic and surgical </li></ul><ul><li>In case of a localized lesion in the liver a US or CT guided biopsy is performed </li></ul>
  55. 55. Diagnostic Procedures in GI Diseases
  56. 56. Diagnostic Procedures in GI Diseases
  57. 57. Diagnostic Procedures in GI Diseases <ul><li>Tests for Helicobacter pylori </li></ul>
  58. 58. Diagnostic Procedures in GI Diseases <ul><li>Tests for Helicobacter pylori </li></ul><ul><li>Non-invasive </li></ul><ul><li>C 13 or C 14 Urea Breath Test </li></ul><ul><li>H. pylori IgG titer (serology) </li></ul><ul><li>Stool antigene for H Pylori. </li></ul><ul><li>Invasive </li></ul><ul><li>Gastric mucosal biopsy </li></ul><ul><li>Rapid Urease test </li></ul>
  59. 59. Diagnostic Procedures in GI Diseases <ul><li>Tests for Helicobacter pylori </li></ul><ul><li>C 13 or C 14 Urea Breath Test </li></ul>
  60. 60. Diagnostic Procedures in GI Diseases <ul><li>Tests for Helicobacter pylori </li></ul><ul><li>Mucosal Biopsy </li></ul>
  61. 61. Diagnostic Procedures in GI Diseases <ul><li>Tests for Helicobacter pylori </li></ul><ul><li>Rapid Urease Test </li></ul><ul><li>This test is based on the urease enzyme present in the H. pylori </li></ul><ul><li>Urea is split into NH 3 and CO 2 </li></ul><ul><li>The change in pH causes a color change in the medium </li></ul>
  62. 62. Diagnostic Procedures in GI Diseases <ul><li>Blood tests </li></ul><ul><li>Liver function tests (LFT’S) </li></ul><ul><li>Hepatitis serology </li></ul><ul><li>S. Amylase & Lipase </li></ul><ul><li>Alfa-Feto Protein (AFP) </li></ul><ul><li>Carcino-Embryonic Antigen (CEA) </li></ul><ul><li>Stool tests </li></ul><ul><li>Stool microscopy </li></ul><ul><li>Stool ova & parasites </li></ul><ul><li>Stool culture </li></ul><ul><li>Stool C. difficile toxin </li></ul><ul><li>Stool occult blood </li></ul>
  63. 63. Diagnostic Procedures in GI Diseases
  64. 64. Diagnostic Procedures in GI Diseases
  65. 65. Diagnostic Procedures in GI Diseases
  66. 66. Diagnostic Procedures in GI Diseases
  67. 67. Diagnostic Procedures in GI Diseases
  68. 68. Diagnostic Procedures in GI Diseases
  69. 69. Diagnostic Procedures in GI Diseases
  70. 70. Diagnostic Procedures in GI Diseases
  71. 71. Diagnostic Procedures in GI Diseases
  72. 72. Diagnostic Procedures in GI Diseases

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