Investigations of GIT diseases Tests of structures Tests of infection Tests of function Imaging Histology US, CT MRI Endoscopy Contrast studies Plain Radiograph Bacterial culture Serology Breath Tests Pancreatic Exocrine function Mucosal Inflammation/ permeability Absorption GIT Motility Radioisotope Tests

Indications: Indications: Possible motility disorder,e.g. achalasia or gastroparesis.Possible motility disorder,e.g. achalasia or gastroparesis. Suspected perforation or Fistula(non-ionic contrast)Suspected perforation or Fistula(non-ionic contrast) Limitations: Limitations: Risk of aspirationRisk of aspiration Poor mucosal detailPoor mucosal detail Unable to biopsyUnable to biopsy Low sensitivity for early cancerLow sensitivity for early cancer

Epiphrenic diverticulum as shown by barium swallow

Esophageal carcinoma

Duodenal bulb Descending duodenum Ascending duodenum

Gastric ulcer

Duodenal ulcer

Indications: Indications: Diarrhea & abdominal pain of small bowel originDiarrhea & abdominal pain of small bowel origin Possible obstruction by strictures etc.Possible obstruction by strictures etc. Major uses: Major uses: MalabsorptionMalabsorption Crohn ’ s diseaseCrohn ’ s disease Limitations: Limitations: Time consumingTime consuming Radiation exposureRadiation exposure Relative insensitivity.Relative insensitivity.

Chronic intestinal psuedoobstruction

Intestinal Tuberculosis At diagnosis Intestinal Tuberculosis (after 5 months of therapy)

Early stenosing Crohn’s disease

Crohn’s disease

Indications and major uses: Indications and major uses: Altered bowel habitAltered bowel habit Evaluation of strictures or diverticular dis.Evaluation of strictures or diverticular dis. MegacolonMegacolon Chronic constipationChronic constipation Suspected colon cancer (but superseded by colonoscopy )Suspected colon cancer (but superseded by colonoscopy ) Limitations: Limitations: Difficult in frail elderly or incontinent patientsDifficult in frail elderly or incontinent patients Sigmoidoscopy is also necessary to evaluate rectumSigmoidoscopy is also necessary to evaluate rectum Possibly misses polyps < 1 cmPossibly misses polyps < 1 cm

Scattered diverticulosis of the left colon

Double contrast barium enema (normal)

Barium enema showing familial adenomatosis coli Arrow point to cancer arise in this setting

Pancolonic diverticulosis

Chronic Ulcerative Colitis

Major uses: Major uses: Abdominal massesAbdominal masses OrganomegalyOrganomegaly AscitesAscites Biliary tract dilatationBiliary tract dilatation GallstonesGallstones Guided needle aspiration & biopsy of lesionsGuided needle aspiration & biopsy of lesions Limitations: Limitations: Low sensitivity for small lesionsLow sensitivity for small lesions Little functional informationLittle functional information Operator dependantOperator dependant Gas & obesity may obscure viewGas & obesity may obscure view

Major uses: Major uses: Assessment of pancreatic diseaseAssessment of pancreatic disease Hepatic tumor depositsHepatic tumor deposits Tumor stagingTumor staging Assessment of vascularity of lesions.Assessment of vascularity of lesions. Limitations: Limitations: ExpensiveExpensive High radiation doseHigh radiation dose AvailabilityAvailability

Major uses: Major uses: Hepatic tumor stagingHepatic tumor staging MRCPMRCP Pelvic/perianal diseasePelvic/perianal disease Crohn ’ s fistulaeCrohn ’ s fistulae Small bowel visualisationSmall bowel visualisation Limitations: Limitations: Limited availabilityLimited availability Time consumingTime consuming “ Claustrophobic ” for some.“ Claustrophobic ” for some. Contraindicated in presence of metallic prosthesis, cardiac pacemaker, cochlear implants.Contraindicated in presence of metallic prosthesis, cardiac pacemaker, cochlear implants.

Investigations of GIT diseases Tests of structures Tests of infection Tests of function Imaging Histology US, CT MRI Endoscopy Contrast studies Plain Radiograph Bacterial culture Serology Breath Tests Pancreatic Exocrine function Mucosal Inflammation/ permeability Absorption GIT Motility Radioisotope Tests

INDICATIONS. Dyspepsia over 55 yr or with alarm symptom Dyspepsia over 55 yr or with alarm symptom Atypical chest pain Atypical chest pain Dysphagia,Vomiting,Loss of weight Dysphagia,Vomiting,Loss of weight Acute or chronic gastrointestinal bleeding Acute or chronic gastrointestinal bleeding suspicious barium meal,C T.SCREENING for esophareal varices suspicious barium meal,C T.SCREENING for esophareal varices Therapeutic. Therapeutic. Duodenal biopsies Duodenal biopsiesCONTRAINDICATIONS Severe shock,Recent MI,Unstable angina, Arrhythmia Severe shock,Recent MI,Unstable angina, Arrhythmia Severe respiratory dis., Atlantoaxial subluxation Severe respiratory dis., Atlantoaxial subluxation Possible visceral perforation Possible visceral perforationCOMPLICATION Cardiorespiratory depression due to sedation Cardiorespiratory depression due to sedation Aspiration pneumonia Aspiration pneumonia Perforation Perforation

Video endoscopy unit

Normal esophagus

Esophageal Diverticulum

Malignant esophageal lesion

Esophageal varices

Barrett’s Esophagus

Achalasia

Esophageal Ulcer HIV patient

Normal Stomach Body

Erosive Gastritis

Capsule Endoscopy Indication Indication Obscure GI bleeding Obscure GI bleeding Small bowel Crohn ’ s dis,Coeliac dis, Small bowel Crohn ’ s dis,Coeliac dis, Familial polyposis syndrome Familial polyposis syndrome Contraindication Contraindication Small bowel stricture,pacemaker Small bowel stricture,pacemaker

Double Balloon enteroscopy Indication Diagnostic Therapeutics Indication Diagnostic Therapeutics Contraindication Contraindication Complications: abdominal pain 20% pancreatitis perforation Complications: abdominal pain 20% pancreatitis perforation

colonoscopy colonoscopyIndications Suspected infl.bowl dis., ch.Diarrhoea Suspected infl.bowl dis., ch.Diarrhoea Altered bowl habit Altered bowl habit Rectal bleeding or anemia Rectal bleeding or anemia Assessment of abnormal barium enema Assessment of abnormal barium enema Colorectal cancer screening Colorectal cancer screening Colorectal adenoma follow-up Colorectal adenoma follow-up Therapeutic procedures Therapeutic procedures

Contraindications Severe, active ulcerative colitis Severe, active ulcerative colitis Recent MI,unstable angina arrhythmia,severe resp. dis. Recent MI,unstable angina arrhythmia,severe resp. dis. Atlantoaxial sublax.,?Visceral perfor. Atlantoaxial sublax.,?Visceral perfor.Complication Cardioresp. Dep. Due to sedation Cardioresp. Dep. Due to sedation Perforation Perforation Bleeding Bleeding

Normal Colonscopy

Stool cultures are essential in the investigation of diarrhea, especially when it is acute or bloody, to identify pathogenic organism. Stool cultures are essential in the investigation of diarrhea, especially when it is acute or bloody, to identify pathogenic organism. Detection of antibodies plays a limited role in the diagnosis of GIT infection caused by organism like H Pylori, Salmonella species, and E. histolytica. Detection of antibodies plays a limited role in the diagnosis of GIT infection caused by organism like H Pylori, Salmonella species, and E. histolytica.

Gastrointestinal motility Oesophageal motility: Gastric emptying: Small intestinal transit: Colonic & anorectal motility:

Dynamic test 2

Radioisotope tests Gastric emptying study. Urea breath test. Meckles scan.. Somatostatin receptor scan.