1. Additional Suffixes & Digestive System Terminology
Chapter 6
Pages 187 – 214

2. Laboratory Tests Page 193 Amylase and lipase tests
Liver function tests (LFTs)
Stool culture
Stool guaiac test or Hemoccult test
Amylase & Lipase Tests = Tests for the levels of amylase & lipases enzymes in the blood
Increase levels are associated with pancreatitis
Liver Function Tests (LFTs) = Tests for the presence of enzymes & bilirubin in blood
LFTs are performed on blood serum (clear fluid that remains after blood has clotted). Examples of LFTs are tests for ALT (alanine transaminase) & AST (aspartate transaminase). ALT & AST are enzymes present in many tissues. Levels are elevated in the serum of patients with liver disease. High ALT & AST levels indicated damage to liver cells (as in hepatitis)
Alkaline phosphatase (alk phos) is another enzyme that may be elevated in patients with liver, bone, & other diseases.
Serum bilirubin levels are elevated in patients with liver disease & jaundice. A direct bilirubin test measures conjugated bilirubin. High levels indicate liver disease or biliary obstruction. An indirect bilirubin test measures unconjugated bilirubin. Increased levels suggest excessive hemolysis, as may occur in a newborn.
Stool Culture = Test for microorganisms present in feces.
Feces are placed in a growth medium & examined microscopically
Picture A
Stool Guaiac Test or Hemoccult Test = Test to detect occult (hidden) blood in feces
This is an important screening test for colon cancer. Guaiac is a chemical from the wood of trees. When added to a stool sample, it reacts with any blood present in the feces.
Picture B

3. Clinical Procedure: X-Ray Test
Page 194
Clinical Procedure: X-Ray Test
Lower gastrointestinal series (barium enema)
Upper gastrointestinal series
X-ray imagining is used in many ways to detect pathologic conditions. In dental practice, x-ray images are commonly use to locate cavities (caries). Many of the x-ray tests listed here use a contrast medium (substance that x-rays cannot penetrate) to visualize a specific area of the digestive system
The contrast, because of its increased density relative to body tissue, allows organs & parts to be distinguished from one another on the film or screen.
Lower Gastrointestinal Series (barium enema) = X-ray image of the colon & rectum obtained after injection of barium into the rectum
Radiologists inject barium (a contrast medium) by enema into the rectum
Upper Gastrointestinal Series = X-ray image of the esophagus, stomach, & small intestine obtained after administering barium by mouth
Often performed immediately after an upper gastrointestinal series, a small bowel follow-through study shows sequential x-ray pictures of the small intestine as barium passes through. A barium swallow is a study of the esophagus.
PICTURE - A, Barium enema. This x-ray image from a barium enema study demonstrates diverticulosis. The arrowheads point to the diverticula throughout the colon. Most patients with diverticula are asymptomatic, but complications (diverticulitis, perforated diverticulum, obstruction, or hemorrhage) may occur. B, An x-ray image of a small-bowel follow-through study demonstrating the normal appearance of the jejunum (J) in the upper left abdomen and of the ileum (I) in the right lower abdomen. Notice the contrast material within the stomach (S) and cecum (C).

4. Clinical Procedure: X-Ray Test
Page 194
Clinical Procedure: X-Ray Test
Cholangiography
Cholangiography = X-ray examination of the biliary system performed after injection of contrast into the bile ducts.
In percutaneous transheptic cholangiography, the contrast medium is injected using a needle placed through the abdominal wall into the biliary vessels of the liver. In endoscopic retrograde cholangiopancreatography (ERCP) contrast medium is administered through an oral catheter (tube) & then passes through the esophagus, stomach, & duodenum & into bile ducts. This procedure helps diagnose problems involving the bile ducts, gallbladder, & pancreas.
PICTURE –  A, Endoscopic retrograde cholangiopancreatography (ERCP) showing choledocholithiasis in a patient with biliary colic (pain). Multiple stones are visible in the gallbladder and common bile duct. The stones (arrows) are seen as filling defects in the contrast-opacified gallbladder and duct. This patient was treated with open (performed via laparotomy) cholecystectomy and choledocholithotomy. B, Computed tomography scan with contrast showing large “porcelain stone” in the gallbladder. The patient was asymptomatic, but a therapeutic option with this type of stone is removal of the gallbladder (using laparoscopy) to prevent any future problems (such as cholecystitis or carcinoma of the gallbladder).

5. Clinical Procedure: X-Ray Test
Page 194
Clinical Procedure: X-Ray Test
Computed tomography (CT scan)
computed tomography (CT) = A series of x-ray images are taken in multiple views (especially cross section)
A CT scan uses a circular array of x-ray beams to produce the cross-sectional image based on difference in tissue densities. Use of contrast material allows visualization of organs & blood vessels & highlights differences in blood flow between normal & disease tissues. Tomography produces a series of x-ray pictures showing multiple views of an organ. An earlier name for a CT scan is "CAT scan" (computerized axial tomography scan).
PICTURE -  Computed tomography (CT) images of normal and diseased liver. A, Normal liver. Contrast material has been injected intravenously, making blood vessels appear bright. The liver (L) and spleen (S) are the same density on this CT image. B, Fatty liver. The radiodensity of the liver tissue is reduced because of the large volume of fat contained in the tissue, making it appear darker than normal. Excess fat can lead to inflammation of the liver and cirrhosis.

6. Clinical Procedure: Ultrasound Examinations
Page 196
Clinical Procedure: Ultrasound Examinations
Abdominal ultrasonography
Endoscopic ultrasonography (EUS)
abdominal ultrasonography = Sound waves beamed into the abdomen produce an image of abdominal viscera
Ultrasonography is especially useful for examination of fluid-filled structures such as the gallbladder
endoscopic ultrasonography (EUS) = Use of an endoscope combined with ultrasound to examine the organs of the gastrointestinal tract.
An endoscope is inserted through the mouth or rectum, & ultrasound images are obtained. This test is often used in assessing esophageal, pancreatic, & rectal cancer.

7. Clinical Procedure: Magnetic Resonance
Page 196
Clinical Procedure: Magnetic Resonance
Magnetic resonance imaging (MRI)
abdominal ultrasonography = Sound waves beamed into the abdomen produce an image of abdominal viscera
Ultrasonography is especially useful for examination of fluid-filled structures such as the gallbladder
endoscopic ultrasonography (EUS) = Use of an endoscope combined with ultrasound to examine the organs of the gastrointestinal tract.
An endoscope is inserted through the mouth or rectum, & ultrasound images are obtained. This test is often used in assessing esophageal, pancreatic, & rectal cancer.
magnetic resonance imaging (MRI) = Magnetic waves produce images of organs & tissues in all three planes of the body
This technique does not use x-rays. It detects subtle difference in tissue composition, water content, & blood vessel density & can show sites of trauma, infection, or cancer.
HIDA Scan = Radioactive imaging procedure that tracks the production & flow of bile from the liver & gallbladder to the intestine
HIDA stands for hepatobiliary iminodiacetic acid. Cholescintigraphy is another name for this test, which determines if the gallbladder is functioning properly.

8. Clinical Procedure: Nuclear Medicine Test
Page 196
Clinical Procedure: Nuclear Medicine Test
Hepatobiliary iminodiacetic acid scan (HIDA scan)
HIDA Scan = Radioactive imaging procedure that tracks the production & flow of bile from the liver & gallbladder to the intestine
HIDA stands for hepatobiliary iminodiacetic acid. Cholescintigraphy is another name for this test, which determines if the gallbladder is functioning properly.

9. Clinical Procedure: Other Procedures
Page 196
Clinical Procedure: Other Procedures
Gastric bypass or bariatric surgery
gastric bypass or bariatric surgery = Reducing the size of the stomach & diverting food to the jejunum (gastrojejunostomy).
This is bariatric surgery for severe obesity. The Roux-en-Y gastric bypass procedure reduces the size of the stomach to a volume of 2 tablespoons & bypasses much of the small intestine. The name Roux-en-Y comes from the surgeon who first described it (Cesar Roux) & anastomosis of the duodenum & jejunum, which looks like the letter Y.

10. Clinical Procedure: Other Procedures
Page 196
Clinical Procedure: Other Procedures
Gastrointestinal endoscopy
Laparoscopy
Liver biopsy
gastrointestinal endoscopy = Visual examination of the gastrointestinal tract using an endoscope.
A physician places a flexible fiber optic tube through the mouth or the anus to view parts of the gastrointestinal tract. Examples are esophagogastroduodenoscopy (EGD), colonoscopy, sigmoidoscopy, proctoscopy, & anoscopy. Virtual colonscopy (CT colongraphy) combines CT scanning & computer technology to enable physicians to examine the entire length of the colon by x-ray imaging in just minutes. Patients with abnormal findings require conventional colonoscopy afterward for further assessment or treatment, such as with biopsy or polypectomy.
PICTURES
Laparoscopy = Visual (endoscopic) examination of the abdomen with a laparoscope inserted through small incisions in the abdomen.
Laparoscopic cholecystectomy & laparoscopic appendectomy are performed by gastrointestinal & general surgeons.
Liver Biopsy = Removal of liver tissue for microscopic examination
A physician inserts a needle through the skin to remove a small piece of tissue for microscopic examination. The average sample is less than 1 inch long. The procedure helps doctors diagnose cirrhosis, chronic hepatitis, & tumors of the liver.

11. Clinical Procedure: Other Procedures
Page 196
Clinical Procedure: Other Procedures
Nasogastric intubation
Paracentesis (abdominocentesis)
Nasogastric Intubation = Insertion of a tube through the nose into the stomach
Physicians use a nasogastric (NG) tube to remove fluid postoperatively & to obtain gastric or intestinal contents for analysis
PICTURE
Paracentesis (abdominocentesis) = Surgical puncture to remove fluid from the abdomen
This procedure is necessary to drain fluid (accumulated in ascites) from the peritoneal (abdominal) cavity