Diagnostic Procedures in GIT Diseases:

History:

• 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.
Physical exams:
 Diagnostic Procedures in GI Diseases

• The gastrointestinal
system includes the GI
tract and its
associated glands

• Esophagus
• Stomach
• Small intestine
• Colon
• Liver & Biliary tree
• Pancreas
 Diagnostic Procedures in GI Diseases

• The diagnostic tests can be divided into

several categories:
• Structural tests
• Functional tests
• Special blood tests
• Special stool tests
 Diagnostic Procedures in GI Diseases

Structural Tests
• Radiography
• Ultrasonography
• Magnetic Resonance Imaging
• Gastrointestinal Endoscopy
• Endoscopic Ultrasonography
 Plain X Ray:

• 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.
 Contrast studies:

• Barium & double-cnotrast barium using air with

barium, will show filling defects, strictures, erosions
& ulcers & even motlity disorders if under fluroscopy.
 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.
 Diagnostic Procedures in GI Diseases

Functional Tests
 Diagnostic Procedures in GI Diseases

Functional Tests
• Tests for motility
• 24 hour pH monitoring
• Tests for acid output
Gastrointestinal Endoscopy
 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
 Gastrointestinal Endoscopy

Types of Gastrointestinal Endoscopy

 Gastrointestinal Endoscopy

Types of Gastrointestinal Endoscopy

• Esophagogastroduodenoscopy (Upper GI Endoscopy)

• Small Bowel Enteroscopy (Jejunoscopy)
• Colonoscopy (Lower GI Endoscopy)
• Sigmoidoscopy
• Endoscopic Retrograde Cholangiopancreatogram
(ERCP)
 Upper Gastrointestinal Endoscopy

Diagnostic Indications Therapeutic Indications

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

Contraindications to Upper GI Endoscopy

• Uncooperative patient
• Hemodynamically unstable patient: Recnet AMI, Unstable angina or
arrhythmia,Severe resp dis.
• Severe injury of the cervical spine
• Severe shock.
Upper Gastrointestinal Endoscopy
Upper Gastrointestinal Endoscopy
Normal Esophagus Normal Stomach Normal Duodenum

Esophagitis Gastric Ulcer Duodenal Ulcer

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

Contraindications to Lower GI Endoscopy

• Uncooperative patient Hemodynamically

• unstable patient Suspected perforation
• Suspected colonic obstruction Soon
• after a myocardial infarction
Lower Gastrointestinal Endoscopy
Lower Gastrointestinal Endoscopy
Normal Colon Colon Cancer

Colon Polyp and Polypectomy

 Endoscopic Retrograde Cholangiopancreatogram

Indications
 Endoscopic Retrograde Cholangiopancreatogram

Indications
• 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
 Endoscopic Retrograde Cholangiopancreatogram

Gallstone impacted at ampulla, sphincterotomy being done and stones removed

 Endoscopic Ultrasound

• 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
Diagnostic Procedures in GI Diseases
Capsule Endoscopy
Capsule Endoscopy
 Capsule Endoscopy

Diagnostic Indications
• 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
 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

 Diagnostic Procedures in GI Diseases

Functional Tests
 Diagnostic Procedures in GI Diseases

Functional Tests
• Tests for motility
• Tests for pH
• Tests for acid output
 Functional Tests in GI Diseases

Tests for motility

 Functional Tests in GI Diseases

Tests for motility

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

Esophageal Manometry Tracings

 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.
Functional Tests in GI Diseases
24 Hour pH Monitoring
 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
Functional Tests in GI Diseases
Anorectal Manometry
 Tests of structure: Biopsy

• 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.
 2.Tests of infection: Bacterial cultures

• 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.

 Diagnostic Procedures in GI Diseases

Liver Biopsy
• 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
Diagnostic Procedures in GI Diseases
Diagnostic Procedures in GI Diseases
 Diagnostic Procedures in GI Diseases

Blood tests Stool tests

• Liver function tests • Stool microscopy

(LFT’S) • Stool ova & parasites
• Hepatitis serology
• Stool culture
• S. Amylase &
• Stool C. difficile toxin
Lipase
• Stool occult blood
• Alfa-Feto Protein
(AFP)
• Carcino-Embryonic
Antigen (CEA)