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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
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Contrast Studies
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Barium Swallow &Meal Indications: Limitations:
Possible motility disorder,e.g. achalasia or gastroparesis. Suspected perforation or Fistula(non-ionic contrast) Limitations: Risk of aspiration Poor mucosal detail Unable to biopsy Low sensitivity for early cancer
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diffuse esophageal spasm
Barium swallow in patient with diffuse esophageal spasm
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Epiphrenic diverticulum as shown by barium swallow
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Esophageal carcinoma
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Normal Barium Meal Duodenal bulb Descending duodenum
Ascending duodenum
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Gastric ulcer
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Duodenal ulcer
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Barium follow-through
Indications: Diarrhea & abdominal pain of small bowel origin Possible obstruction by strictures etc. Major uses: Malabsorption Crohn’s disease Limitations: Time consuming Radiation exposure Relative insensitivity.
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Chronic intestinal psuedoobstruction
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Intestinal Tuberculosis At diagnosis
(after 5 months of therapy)
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Early stenosing Crohn’s disease
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Crohn’s disease
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Barium Enema Indications and major uses: Limitations:
Altered bowel habit Evaluation of strictures or diverticular dis. Megacolon Chronic constipation Suspected colon cancer (but superseded by colonoscopy) Limitations: Difficult in frail elderly or incontinent patients Sigmoidoscopy is also necessary to evaluate rectum Possibly misses polyps < 1 cm
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Scattered diverticulosis of the left colon
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Double contrast barium enema
(normal)
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Barium enema showing familial adenomatosis coli
Arrow point to cancer arise in this setting
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Pancolonic diverticulosis
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Chronic Ulcerative Colitis
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US & Doppler CT MRI (CT)-PET
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Ultrasound Major uses: Limitations: Abdominal masses Organomegaly
Ascites Biliary tract dilatation Gallstones Guided needle aspiration & biopsy of lesions Limitations: Low sensitivity for small lesions Little functional information Operator dependant Gas & obesity may obscure view
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CT Scan Major uses: Limitations: Assessment of pancreatic disease
Hepatic tumor deposits Tumor staging Assessment of vascularity of lesions. Limitations: Expensive High radiation dose Availability
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MRI Major uses: Limitations: Hepatic tumor staging MRCP
Pelvic/perianal disease Crohn’s fistulae Small bowel visualisation Limitations: Limited availability Time consuming “Claustrophobic” for some. Contraindicated in presence of metallic prosthesis, cardiac pacemaker, cochlear implants.
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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
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Upper GIT Endoscopy
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INDICATIONS. CONTRAINDICATIONS COMPLICATION
Dyspepsia over 55 yr or with alarm symptom Atypical chest pain Dysphagia ,Vomiting ,Loss of weight Acute or chronic gastrointestinal bleeding suspicious barium meal ,C T .SCREENING for esophareal varices Therapeutic. Duodenal biopsies CONTRAINDICATIONS Severe shock ,Recent MI ,Unstable angina , Arrhythmia Severe respiratory dis., Atlantoaxial subluxation Possible visceral perforation COMPLICATION Cardiorespiratory depression due to sedation Aspiration pneumonia Perforation
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Video endoscopy unit
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Normal esophagus
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Esophageal Diverticulum
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Malignant esophageal lesion
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Esophageal varices
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Barrett’s Esophagus
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Achalasia
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Esophageal Ulcer HIV patient
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Normal Stomach Body
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Erosive Gastritis
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Capsule Endoscopy Indication Obscure GI bleeding
Small bowel Crohn’s dis ,Coeliac dis, Familial polyposis syndrome Contraindication Small bowel stricture ,pacemaker
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Double Balloon enteroscopy
Indication Diagnostic Therapeutics Contraindication Complications: abdominal pain 20% pancreatitis perforation
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Colonscopy
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colonoscopy Indications Suspected infl.bowl dis. , ch.Diarrhoea Altered bowl habit Rectal bleeding or anemia Assessment of abnormal barium enema Colorectal cancer screening Colorectal adenoma follow-up Therapeutic procedures
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Contraindications Severe , active ulcerative colitis Recent MI,unstable angina arrhythmia ,severe resp. dis. Atlantoaxial sublax. ,?Visceral perfor. Complication Cardioresp. Dep. Due to sedation Perforation Bleeding
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Normal Colonscopy
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TESTS OF INFECTION
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Bacterial Cultures Serology Breath Tests
Stool cultures are essential in the investigation of diarrhea, especially when it is acute or bloody, to identify pathogenic organism. Serology Detection of antibodies plays a limited role in the diagnosis of GIT infection caused by organism like H Pylori, Salmonella species, and E. histolytica. Breath Tests
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Gastrointestinal motility
Oesophageal motility: Gastric emptying: Small intestinal transit: Colonic & anorectal motility:
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Dynamic test 2
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Radioisotope tests Gastric emptying study. Urea breath test.
Meckles scan.. Somatostatin receptor scan.
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