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1. Diagnostic Procedures in GIT Diseases:

2. 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. F lat u l e n c e. 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 • • • • • • 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: • • • 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 • • • • • Esophagogastroduodenoscopy (Upper GI Endoscopy) Small Bowel Enteroscopy (Jejunoscopy) Colonoscopy (Lower GI Endoscopy) Sigmoidoscopy Endoscopic Retrograde Cholangiopancreatogram (ERCP)

16. Upper Gastrointestinal Endoscopy • • • • • • • • • • • • 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 • • • • 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 Ulcer Gastric Ulcer E so ph a g iti s

20. Lower Gastrointestinal Endoscopy • • • • • • • 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 • • • • Diagnostic Indications Therapeutic Indications Control of bleeding Removal of polyps Tumor ablation Dilation of stricture

21. Lower Gastrointestinal Endoscopy Contraindications to Lower GI Endoscopy • • • • 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 I n di ca t i o n s

25. Endoscopic Retrograde Cholangiopancreatogram I n di ca t i o n s • • • • • • 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 • • • • 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 • • • • • • Obtained through endoscpy or percutanously & sent for histopath exam. Reasons for biopsy or cytological exams: cytology of suspected malignant lesions. Histological assessment of mucosal abn ormalitie s. Diagnosis of infections( candida, HP,Giardia). Analysis of genetic mutations as oncogenes , tumor suppressor genes.

45. 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.

46. 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

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) C a r c i no- E m bryonic Antigen (CEA) • • • • • Stool tests Stool microscopy Stool ova & parasites Stool culture Stool C. difficile toxin Stool occult blood