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- 1. Common Indications for Endoscopy Common Indicationsfor Endoscopy GASTROENTEROLGY Disorders of the Alimentary Tract 314. Approach to the Patient with GastrointestinalDisease CLASSIFICATION OF GI DISEASES Impaired Digestionand Absorption Altered Secretion Altered Gut Transit Immune Dysregulation Impaired Gut Blood Flow Neoplastic Degeneration Disorders without Obvious Organic Abnormalities Genetic Influences ■TOOLS FOR PATIENT EVALUATION Laboratory Luminal Contents Endoscopy Radiography/NuclearMedicine Histopathology Functional Testing(manometry)
- 2. Common Indications for Endoscopy Common Indicationsfor Endoscopy Common Causes of Common Gastrointestinal (GI) Symptoms ABDOMINAL PAIN NAUSEA AND VOMITING DIARRHEA GI BLEEDING OBSTRUCTIVE JAUNDICE Appendicitis Medications Infection Ulcer disease Bile duct stones Gallstone disease GI obstruction Poorly absorbed sugars Esophagitis Cholangiocarcinoma Pancreatitis Motor disorders Inflammatory bowel disease Varices Cholangitis Diverticulitis Functional bowel disorder Microscopic colitis Vascular lesions Sclerosing cholangitis Ulcer disease Enteric infection Functional bowel disorder Neoplasm Ampullary stenosis Esophagitis Pregnancy Celiac disease Diverticula Ampullary carcinoma GI obstruction Endocrine disease Pancreatic insufficiency Hemorrhoids Pancreatitis Inflammatory bowel disease Motion sickness Hyperthyroidism Fissures Pancreatic tumor Functional bowel disorder Central nervous system disease Ischemia Inflammatory bowel disease Vascular disease Endocrine tumor Infectious colitis Gynecologic causes Renal stone
- 3. Common Indications for Endoscopy Common Indicationsfor Endoscopy EXTRA POINTS Visceral pain generally is midline in location and vague in character, whereas parietal pain is localized and precisely described. briskly bleeding upper sites can elicit voluminous red rectal bleeding, whereas slowly bleeding ascending colon sites may produce melena. Sudden awakening from sound sleep by pain suggests organic rather than functional disease. Diarrhea from malabsorption usually improves with fasting, whereas secretory diarrhea persists without oral intake. . Intestinal ischemia elicits severe pain but little tenderness. Patients with visceral pain may exhibit generalized discomfort, whereas those with parietal painor peritonitis have localized pain with involuntary guarding, rigidity, or rebound. Patients with musculoskeletal abdominal wall pain may note tenderness exacerbated by Valsalva or leg lift maneuvers Elevations in fecal calprotectin or lactoferrin are found in inflammatory conditions like IBD The most common intestinal maldigestion syndrome, lactase deficiency,
- 4. Common Indications for Endoscopy Common Indicationsfor Endoscopy
- 5. Common Indications for Endoscopy Common Indicationsfor Endoscopy UPPER ENDOSCOPY COLONOSCOPY ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY ENDOSCOPIC ULTRASOUND Dyspepsia despite treatment Dyspepsia with signs of organic disease Refractory vomiting Dysphagia Upper GI bleeding Anemia Weight loss Malabsorption Biopsy radiologic abnormality Polypectomy Place gastrostomy Barrett’s surveillance Palliate neoplasm Sample duodenal tissue/fluid Remove foreign body Endoscopic mucosal resection or ablation of dysplastic Barrett’s mucosa Place stent across stenosis Cancer screening Lower GI bleeding Anemia Diarrhea Polypectomy Obstruction Biopsy radiologic abnormality Cancer surveillance: family history prior polyp/ cancer, colitis Palliate neoplasm Remove foreign body Place stent across stenosis Jaundice Postbiliarysurgery complaints Cholangitis Gallstone pancreatitis Pancreatic/biliary/ampullary tumor Unexplainedpancreatitis Pancreatitis withunrelentingpain Fistulas Biopsy radiologic abnormality Pancreaticobiliary drainage Sample bile Sphincter ofOddi manometry Stagingof malignancy Characterize andbiopsy submucosal mass Bile duct stones Chronic pancreatitis Drain pseudocyst Anal continuity
- 6. Common Indications for Endoscopy Common Indicationsfor Endoscopy UPPER ENDOSCOPY COLONOSCOPY ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY Dyspepsia despite treatment Dyspepsia with signs of organic disease Refractory vomiting Dysphagia Upper GI bleeding Anemia Weight loss Malabsorption Biopsy radiologic abnormality Polypectomy Place gastrostomy Barrett’s surveillance Palliate neoplasm Sample duodenal tissue/fluid Remove foreign body Endoscopic mucosal resection or ablation ofdysplastic Barrett’s mucosa Place stent across stenosis Cancer screening Lower GI bleeding Anemia Diarrhea Polypectomy Obstruction Biopsy radiologic abnormality Cancer surveillance: family historyprior polyp/ cancer, colitis Palliate neoplasm Remove foreign body Place stent across stenosis Jaundice Postbiliarysurgery complaints Cholangitis Gallstone pancreatitis Pancreatic/biliary/ampullary tumor Unexplainedpancreatitis Pancreatitis withunrelentingpain Fistulas Biopsy radiologic abnormality Pancreaticobiliary drainage Sample bile Sphincter ofOddi manometry