What are Abdominal series (plain films) primarily used for?
- Eval of perforation, obstruction, or foreign object
- views are supine and upright
- KUB- kidneys, ureters, bladder
What are barium enemas looking for?
- colon polyps, cancer, strictures, diverticula, fissures, ulcers
- mainly used in rural settings, being replaced by colonoscopy and CT colonography
What is a barium swallow used for?
- esophageal structure and function that EGD can miss
- -Hypopharyngeal and cricopharyngeal disorders
- delineates strictures, ulcerations, reflux, and hiatal hernia
What is an abdominal ultrasound used for?
- liver, gallbladder and ducts, pancreas, spleen, kidneys
- doppler assesses blood flow
- cheap!
Endoscopic Ultrasound (EUS) uses?
- cancer staging
- drainage of pancreatic pseudocyst
Abdominal CT scan uses?
retroperitoneal and intra-abdominal organs for: masses, abscess, small bowel obstruction location, mesenteric ischemia, appendicitis, colonic imaging or fluid collection. IV and oral contrast are used.
Esophagogastroduodenoscopy (EGD) uses?
- Indications: evaluate suspected or known upper GI pathology.
- Bleeding, dysphagia, refractory GERD or dyspepsia, ulcers, anemia after lower endoscopy performed.
- Risks: bleeding, perforation, infection (rare)
- conscious sedation
Capsule Endoscopy uses?
- evaluate jejunum and ileum beyond EGD
- swallow camera
Small Bowel enteroscopy uses?
Similar to EGD except able to reach into proximal-mid jejunum or almost the entire small bowel IF spiral enteroscopy is used. Able to perform biopsies
Risks: Bleeding or perforation.
Gold standard exam for lower GI bleeding (GIB)?
Colonoscopy
Colonoscopy uses?
Indications: Evaluate diseases of colonic mucosa, colorectal cancer screening, anemia and lower GIB
Risks: perforation, bleeding, discomfort.
Virtual colonoscopy:
Air + CT
-downside. if you see something then you have to do a colonoscopy anyway
Sigmoidoscopy:
-similar to colonoscopy but doesn’t reach as far.
used in rural areas
Endoscopic Retrograde Cholangio Pancreatography (ERCP)
-evaluate the biliary and pancreatic ductal systems and openings.
-Indications: Sphincter of Oddi dysfunction, adenomas, carcinomas, bile duct stones, cholelithiasis w/ choledocholithiasis, ductal stent placement, gallstone pancreatitis.
Risks: 7% morbidity. Pancreatitis, hemorrhage, cholangitis, perforation & death.
MCC of duodenal ulcers
H. pylori
3 proteins the liver makes?
Albumin, globulins and fibrinogen
H. Pyloria antibody test
Indicated for chronic or recurrent gastric or duodenal ulcers/inflammation.
Most common method because of ease of test.
Serologic immunoassay very accurately detects H. pylori.
IgG anti-H. pylori antibody is most commonly used. It elevates 2 months after infection and stays elevated for a year after tx.
May also be performed in stool.
H. Pylori Urea breath test:
Indicated for chronic or recurrent gastric or duodenal ulcers/inflammation.
H. pylori metabolize urea to CO2 via produced urease.
The patient ingests carbon labeled urea which the gastric mucosa absorbs. If H. pylori are present, urea is converted to CO2 which stomach capillaries uptake and circulate to the lungs. The labeled carbon is measureable through exhalation by gas chromatography.
Samples are collected before and 30 minutes after carbon/urea ingestion.
test for detecting and monitoring pancreatitis:
Amylase
Used for evaluating pancreatic disease, most commonly acute pancreatitis.
Lipase
Is Hep A treated?
no. its self limiting
