diagnostic test help in diagnostic/ assessment purposes

1. Diagnostic Procedures in GIT Diseases:

2. History:
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Dysphagia: difficult swallowing
Odynophagia: painful swallowing.
Aphagia: can not swallow.
Heart burn.
Non cardiac chest pain.
Regurgitation.
Aerophagia: eructation.
Hematemesis.
Melena.
Hematochesia: fresh bleeding per rectum.
Dyspepsia: abnormal digestion.
Anorexia.
Flatulence.
Alteration in bowel habits.
Bleeding per rectum.
Abd pain.

3. Physical exams:

4. Diagnostic Procedures in GI Diseases
• The gastrointestinal
system includes the GI
tract and its associated
glands
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Esophagus
Stomach
Small intestine
Colon
Liver & Biliary tree
Pancreas

5. Diagnostic Procedures in GI Diseases
• The diagnostic tests can be divided into
several categories:
• Structural tests
• Functional tests
• Special blood tests
• Special stool tests

6. Diagnostic Procedures in GI Diseases
Structural Tests
• Radiography
• Ultrasonography
• Magnetic Resonance Imaging
• Gastrointestinal Endoscopy
• Endoscopic Ultrasonography

7. Plain X Ray:
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Show gas within bowel for diagnosis of Int obst if there are dialated loops
or fluid levels in the erect position.
Soft tissue of the liver, spleen& kidneys & calcifications in these organs,
pancreas, blood vessels, calculi.
Chest XR in erect position show air under diaphragm in perforated
viscus.

8. Contrast studies:
• Barium & double-cnotrast barium using air with
barium, will show filling defects, strictures, erosions
& ulcers & even motlity disorders if under fluroscopy.

9. Tests of structure: endoscopy
• Endoscpy: UGI, LGI,ERCP,EUS , Double balloon
endoscopy, capsule video endoscopy.
• Increasingly used for abd diseases, noninvasive & offer
detailed images of abd contents.

10. Diagnostic Procedures in GI Diseases
Functional Tests

11. Diagnostic Procedures in GI Diseases
Functional Tests
• Tests for motility
• 24 hour pH monitoring
• Tests for acid output

12. Gastrointestinal Endoscopy

13. Gastrointestinal Endoscopy
• Direct method to
examine and biopsy
the mucosal lining of
the gastrointestinal
tract
• Various accessories
are available to take
biopsies and provide
therapy

14. Gastrointestinal Endoscopy
Types of Gastrointestinal Endoscopy

15. Gastrointestinal Endoscopy
Types of Gastrointestinal Endoscopy
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Esophagogastroduodenoscopy (Upper GI Endoscopy)
Small Bowel Enteroscopy (Jejunoscopy)
Colonoscopy (Lower GI Endoscopy)
Sigmoidoscopy
Endoscopic Retrograde Cholangiopancreatogram (ERCP)

16. Upper Gastrointestinal Endoscopy
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Diagnostic Indications
Heartburn
Dysphagia or odynophagia
Hematemesis or melena
Dyspepsia or upper abdominal
pain
Unexplained weight loss or
anemia
Evaluation of abnormal Barium
meal X-ray
Suspected malabsorption
Therapeutic Indications
Control of bleeding
Dilation of stricture
Removal of foreign bodies
Removal of polyps
Tumor ablation

17. Upper Gastrointestinal Endoscopy
Contraindications to Upper GI Endoscopy
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Uncooperative patient
Hemodynamically unstable patient: Recnet AMI, Unstable angina or
arrhythmia,Severe resp dis.
Severe injury of the cervical spine
Severe shock.

18. Upper Gastrointestinal Endoscopy

19. Upper Gastrointestinal Endoscopy
Normal Esophagus Normal Stomach Normal Duodenum
Duodenal UlcerGastric UlcerEsophagitis

20. Lower Gastrointestinal Endoscopy
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Chronic diarrhea
Rectal bleeding
Unexplained abdominal pain
Constipation, change in bowel
habits or stool caliber
Unexplained weight loss
enema x-ray
Personal or family history of
colon cancer
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Diagnostic Indications Therapeutic Indications
Control of bleeding
Removal of polyps
Tumor ablation
Dilation of stricture

21. Lower Gastrointestinal Endoscopy
Contraindications to Lower GI Endoscopy
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Uncooperative patient Hemodynamically
unstable patient Suspected perforation
Suspected colonic obstruction Soon
after a myocardial infarction

22. Lower Gastrointestinal Endoscopy

23. Lower Gastrointestinal Endoscopy
Normal Colon Colon Cancer
Colon Polyp and Polypectomy

24. Endoscopic Retrograde Cholangiopancreatogram
Indications

25. Endoscopic Retrograde Cholangiopancreatogram
Indications
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• Obstructive jaundice (benign or
malignant)
Ascending cholangitis
Gallstone pancreatitis
Unexplained jaundice or
elevated LFT’s
Bile duct injury or leak after
cholecystectomy
Chronic pancreatitis
Pancreatic cancer

26. Endoscopic Retrograde Cholangiopancreatogram
Gallstone impacted at ampulla, sphincterotomy being done and stones removed

27. Endoscopic Ultrasound
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The ultrasound probe is placed
at the tip of the endoscope
Allows ultrasonography of
organs from a close distance
Allows close evaluation of the
bowel wall
Can be used to take fine needle
aspiration samples from
adjoining regions/organs

28. Diagnostic Procedures in GI Diseases

29. Capsule Endoscopy

30. Capsule Endoscopy

31. Capsule Endoscopy
• Capsule endoscopy is intended for visualization of the small bowel
mucosa
• 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
Diagnostic Indications

32. Capsule Endoscopy
Contraindications
• Capsule endoscopy is contraindicated for use under the following
conditions:
– In patients with known or suspected gastrointestinal obstruction,
strictures, or fistulas based on the clinical picture or pre-procedure
testing and profile
– In patients with cardiac pacemakers or other implanted
electromedical devices
– In patients with swallowing disorders

33. Diagnostic Procedures in GI Diseases
Functional Tests

34. Diagnostic Procedures in GI Diseases
Functional Tests
• Tests for motility
• Tests for pH
• Tests for acid output

35. Functional Tests in GI Diseases
Tests for motility

36. Functional Tests in GI Diseases
Tests for motility
• Esophageal Manometry
• 24 Hour pH Monitoring
• Anorectal Manometry

37. Esophageal Manometry
Esophageal Manometry is an outpatient test used to identify problems
with movement and pressure in the esophagus that may lead to
problems like heartburn. The esophagus is the "food pipe" leading from
the mouth to the stomach. Manometry measures the strength and
muscle coordination of your esophagus when you swallow.

38. Functional Tests in GI Diseases
Indications for Esophageal Manometry
-Evaluation of non cardiac chest pain
-Esophageal symptoms not diagnosed by
endoscopy
-Evaluation for achalasia
-Non obstructive dysphagia

39. Functional Tests in GI Diseases
Esophageal Manometry Tracings
Esophageal Manometry

40. 24 Hour pH Monitoring
The 24-hour esophageal pH test is an outpatient procedure performed to
measure the pH or amount of acid that flows into the esophagus from
the stomach during a 24-hour period.
The pH test is commonly used to help identify the cause of various
symptoms, including:
Heartburn, primarily in patients who have failed medical treatment and
are candidates for surgery
Uncommon symptoms of GERD (gastro esophageal reflux disease),
such as chest pain.

41. Functional Tests in GI Diseases
24 Hour pH Monitoring

42. Functional Tests in GI Diseases
Anorectal Manometry
• Used in the clinical assessment of patients in whom a
problem with defecation is suspected
• Anorectal Manometry is a technique used to measure
contractility in the anus and rectum. This technique uses
a balloon in the rectum to distend the rectum and a
pressure sensor at the internal anal sphincter to measure
the presence or absence of the rectosphincteric reflex

43. Functional Tests in GI Diseases
Anorectal Manometry

44. Tests of structure: Biopsy
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Obtained through endoscpy or percutanously & sent for histopath exam.
Reasons for biopsy or cytological exams:
cytology of suspected malignant lesions.
Histological assessment of mucosal abnormalities.
Diagnosis of infections( candida, HP,Giardia).
Analysis of genetic mutations as oncogenes ,
tumor suppressor genes.

45. 2.Tests of infection: Bacterial cultures
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For identifying causes of diarrhea if acute or bloody.
Causes of infective diarrhea:
Viruses: Rota, adeno, entero, requires viral cultures.
Bacteria: Campylo jej, Salmonella, clostridium difficile.
Protozoa: Giardia, ameba, cryptosporidium & moicrospora.

46. Diagnostic Procedures in GI Diseases
Liver Biopsy
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• 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
The most common way a liver biopsy is obtained is by inserting a
needle into the liver percutaneously
Other ways to biopsy the liver are transjugular, laparoscopic and
surgical
• In case of a localized lesion in the liver a US or CT guided biopsy is
performed

47. Diagnostic Procedures in GI Diseases

48. Diagnostic Procedures in GI Diseases

49. Diagnostic Procedures in GI Diseases
Blood tests
• Liver function tests
(LFT’S)
• Hepatitis serology
• S. Amylase & Lipase
• Alfa-Feto Protein (AFP)
• Carcino-Embryonic
Antigen (CEA)
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Stool tests
Stool microscopy
Stool ova & parasites
Stool culture
Stool C. difficile toxin
Stool occult blood