DIAGNOSTIC

PROCEDURES AND TESTS

IN GASTROENTEROLOGY
ENDOSCOPY

 A procedure that uses an endoscope to examine the inside of the body. An endoscope is a
thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to
remove tissue to be checked under a microscope for signs of disease.
ENDOSCOPY
TYPES OF ENDOSCOPY

* GASTROSCOPY
 COLONOSCOPY
 LAPAROSCOPY
 PROCTOSCOPY
 CYSTOSCOPY
 BRONCHOSCOPY
 LARYNGOSCOPY
 NASOPHARYNGOSCOPY
USES

 . Endoscopy can help identify

 ulcers,
 bleeding,
 celiac disease,
 blockages,
 inflammation, and
 tumors.
USES

 It can help find the cause of unexplained symptoms,

 such as heartburn,
 abdonimal pain,
 bleeding,
 nausea,
 vomiting,
 and pain.
ENDOSCOPIC PROCESS

 ENDOSCOPIC PROCESS
 The endoscope also has a channel through which surgeons can manipulate tiny
instruments, such as forceps, surgical scissors, and suction devices.
 A variety of instruments can be fitted to the endoscope for different purposes.
 A surgeon introduces the endoscope into the body either through a body opening, such as
the mouth or the anus, or through a small incision in the skin.
PROCEDURE

 Fast before the endoscopy.

 Typically need to stop eating solid food for eight hours and stop drinking liquids for four
hours before your endoscopy.
 This is to ensure your stomach is empty for the procedure.
 Stop taking certain medications. You'll need to stop taking certain blood-thinning
medications in the days before your endoscopy, if possible. Blood thinners may increase
your risk of bleeding if certain procedures are performed during the endoscopy. If you
have ongoing conditions, such as diabetes, heart disease or high blood pressure, your
provider will give you specific instructions regarding your
PROCEDURE

 Stop taking certain medications.

 You'll need to stop taking certain blood-thinning medications in the days before your
endoscopy, if possible.
 Blood thinners may increase your risk of bleeding if certain procedures are performed
during the endoscopy.
 If you have ongoing conditions, such as diabetes, heart disease or high blood pressure,
your provider will give you specific instructions regarding your Medications
RISK FACTORS

 Infection,
 over-sedation,
 perforation,
 or a tear of the stomach
 or esophagus lining and bleeding.
GASTROSCOPY

 A gastroscopy is a test to check inside your throat, food pipe (oesophagus) and stomach,
known as the upper part of your digestive system.
 This test can help find what's causing your A gastroscope is a thin, tube-like instrument
with a light and a lens for viewing. It may also have a tool to remove tissue to be checked
under a microscope for signs of disease. symptoms.
GASTROSCOPY
GASTROSCOPY
CAUSES

 widen your food pipe (oesophagus) if it’s too narrow and causing pain or difficulties when
you swallow
 stop bleeding inside your stomach or oesophagus
 remove growths
 with feeding if you’re unable to eat normally (a gastroscopy can help doctors place a
feeding tube into your stomach)
 Checking for cancer
PREPARATION

 You should avoid eating or drinking for 4-6 hours before the test. The stomach needs to
be empty. (Small sips of water may be allowed up to two hours before the test.)
 If you have a sedative you will need somebody to accompany you home.
 Advice about medication which may need to be stopped before the test.
RISK FACTORS

 Accidental tearing of a blood vessel in the oesophagus or stomach leading to bleeding

 Internal bleeding that can further result in the elimination of black stools with a rough,
tar-like texture
 Pain in the neck, chest and stomach
 Discomfort and aching while swallowing food
 Breathing problems
 Fever
 Nausea and vomiting
ERCP

 Endoscopic retrograde cholangiopancreatography, or ERCP, is a procedure to diagnose

and treat problems in the liver, gallbladder, bile ducts, and pancreas. It combines X-ray
and the use of an endoscope—a long, flexible, lighted tube.
ERCP
ERCP USES

 pancreatic ducts may be narrowed or blocked due to:

 • tumors
 • gallstones that form in the gallbladder
 and become stuck in the ducts
 • inflammation due to trauma or illness, such as pancreatitis
 • infection
 • Dysfunction of valves in the ducts, called sphincters,
 • scarring of the ducts (sclerosis),
 • Pseudo-cysts—accumulations of fluid and tissue debris
USES

 cardiopulmonary,
 neurologic,
 or cardiovascular status;
 and existing bowel perforation.
 • Structural abnormalities of the esophagus, stomach, or small intestine may be relative
contraindications for ERCP.
 • An altered surgical anatomy.
 • ERCP with sphincterotomy or ampullectomy is relatively contraindicated in
coagulopathic patients.
PREPARATION OF PATIENT BEFORE
ERCP

 • The upper GI tract must be empty.

 Generally, no eating or drinking is allowed 8 hours before ERCP.
 • Smoking and chewing gum are also prohibited during this time.
 • Current medications may need to be adjusted or avoided.
 Most medications can be continued as usual.
 • Removal of any dentures, jewelry, or contact lenses before having an ERCP.
PROCEDURE

 • A plastic catheter or cannula is inserted through the ampulla, and radiocontrast is

injected into the bile ducts and/or pancreatic duct. Fluoroscopy is used to look for
blockages, or other lesions such as stones.
 • When needed, the opening of the ampulla can be enlarged (sphincterotomy) with an
electrified wire (sphincterotome) and access into the bile duct obtained so that gallstones
may be removed or other therapy performed.
PROCEDURE

 A Plastic catheter or cannula is inserted through the ampulla, and radiocontrast is injected
into the bile ducts and/or pancreatic duct. Fluoroscopy is used to look for blockages, or
other lesions such as stones. • When needed, the opening of the ampulla can be enlarged
(sphincterotomy) with an electrified wire (sphincterotome) and access into the bile duct
obtained so that gallstones may be removed or other therapy performed.
AFTER THE PROCEDURE

 AFTER THE PROCEDURE

 • Patients are monitored in the endoscopy area for 1-2 hours until the effects of the
sedatives have worn off & observed for complications.
 • Eating or drinking is allowed if the throat is no longer numb and are able to swallow
without choking.
 • If a gallstone was removed or placed a stent during the test, the patient is made to stay in
the hospital
COMPLICATIONS

 Undergoing ERCP can lead to complications involving

 infection,
 bleeding,
 perforation,
 or inflammation of the pancreas (pancreatitis).
Proctosigmoidoscopy

 Proctosigmoidoscopy (Proctoscopy,Sigmoidoscopy) is an internal examination of the

lower large bowel (colon), using an instrument called a sigmoidoscope. The
sigmoidoscope is a small camera attached to a flexible tube. It is inserted into the colon to
examine the rectum, and the sigmoid and descending portions of the colon.
PROCTOSIGMOIDOSCOPY
INDICATIONS

 diagnose a disease in rectum or anus, including cancer

 find the cause of bleeding from the rectum
 diagnose hemorrhoids
 remove a sample of tissue for testing, called a biopsy
 find and remove polyps and other abnormal growths
 monitor rectal cancer after surgery or other treatments
RISK FACTORS

 infection
 belly pain
 a tear in the rectum (this is rare)
PROCEDURE

 A gastroenterologist (a specialist in diseases of the digestive system) will gently insert a

gloved and lubricated finger (or fingers) into the rectum to check for blockage and to
dilate the anus. This is called a digital rectal examination.
 Following the digital rectal exam, the sigmoidoscope will be inserted. This flexible
fiberoptic tube is about 20 inches long.
 The scope is gently advanced into the colon. Air is introduced into the scope to aid in
viewing. The air may cause the urge to defecate. As the sigmoidoscope is slowly
removed, the lining of the bowel is carefully examined. A channel in the scope allows for
the passage of forceps for biopsies or other instruments for therapy.
Proctosigmoidoscopy USES

 Inflammatory bowel disease

 Bowel obstruction
 Colon cancer
 Colon polyps
 Diverticulosis (the presence of abnormal pouches on the lining of the intestines)
 Causes of diarrhea
 Causes of abdominal pain
COMPLICATIONS

 Perforation,
 bleeding,
 abdominal discomfort
 and cardiac arrhythmias
Flexible Sigmoidoscopy

 Flexible sigmoidoscopy is a procedure wherein a sigmoidoscope is inserted through the

anus, the distal colonic mucosa (up to 60 cm from the anal verge) is examined, and any
diagnostic or therapeutic maneuvers performed, as needed.
 A sigmoidoscopy is a diagnostic test used to check the sigmoid colon, which is the lower
part of your colon or large intestine. This section of your colon is close to your rectum and
anus.
FLEXIBLE SIGMOIDOSCOPY
Flexible Sigmoidoscopy Indications

 Flexible Sigmoidoscopy Indications:

 Routine screening of adults over age 50
  Evaluation of suspected distal colonic disease when there is no indication for
colonoscopy
  Inflammatory bowel disease
  Chronic diarrhea
  Pseudomembranous colitis
  Radiation colitis Sigmoid volvulus  Foreign body removal  Lower GI bleeding
INDICATIONS

Foreign body removal

 Sigmoid volvulus
 Lower GI bleeding
 Evaluation of the colon in conjunction with a barium enema
BENEFIT

 The flexible sigmoidoscopy procedure usually takes between five and 15 minutes.
 It's done by a specially trained doctor or nurse. You don't usually need to have an
anaesthetic or sedative for a flexible sigmoidoscopy. The procedure can be uncomfortable
at first, but it doesn't usually hurt.
COLONOSCOPY

 A colonoscopy (koe-lun-OS-kuh-pee) is an exam used to look for changes — such as

swollen, irritated tissues, polyps or cancer — in the large intestine (colon) and rectum.
During a colonoscopy, a long, flexible tube (colonoscope) is inserted into the rectum.
COLONOSCOPY
INDICATION

 Diarrhoea
 Abdominal pain
 Bleeding per rectum,
 unexplained anemia,
 weight loss
 Postpolypectomy surveillance
 Prevention/aftercare colorectal carcinoma
 Pathological thickening of the colon wall detected by other imaging procedures
CONTRAINDICATION

 Perforated intestine
 Acute diverticulitis
 Deep ulcerations
 Severe ischemic necroses
 Fulminant colitis
 Cardiopulmonary decompensation Complications and RisksContra Indications
 Risk of perforation
 Injury to blood vessels causing bleeding
PREPARATION

 Patient performs effective bowel cleansing

 • Liquid diet 1 – 2 days before procedure
 • Temporarily stop taking blood-thinners
 • Laxatives to clean out bowel
PROCEDURE

 Patient administered intravenous sedation

 • Colonoscope maneuvered through colon
 • Polyps removed if located
 • Patient to recovery after procedure
 • Procedure takes 30 minutes
AFTER THE PROCEDURE

 Usually in recovery for 30 minutes • Patient discusses findings with doctor • May have
follow-up appointment • Driver to take patient home • May continue normal diet,
medications
BENEFITS

 Can detect colon cancer

 • Polyps removed before colon cancer develops
RECOMMENDED FREQUENCY

 Men and Woman at age 50

 • Repeated at 10 year intervals
 • More frequent if other risk factors present
 • Family history, IBS
SMALL BOWEL ENTEROSCOPY

 A small bowel enteroscopy allows a physician to navigate the entire small bowel from
either an oral or rectal approach, enabling them to perform both diagnostic and
therapeutic techniques within the small bowel without the need of an open surgical
procedure.
SMALL BOWEL ENTEROSCOPY
 ENDOSCOPIC ULTRASOUND

 Endoscopic ultrasound (EUS) is a minimally invasive procedure to assess diseases of the

digestive (gastrointestinal) tract and other nearby organs and tissues. Endoscopic
ultrasound combines the use of a thin, flexible tube (endoscope) inserted into the
gastrointestinal tract and a device that uses sound waves to create images (ultrasound).
Endoscopic ultrasound
PROCEDURE

 The high-frequency sound waves produce detailed images of the digestive tract and
surrounding organs and tissues, including the lungs, pancreas, gall bladder, liver and
lymph nodes.
 An endoscopic tube may also have a small needle to remove fluid or tissue samples
(biopsy) for examination in a lab. This procedure is called EUS-guided fine-needle
aspiration or EUS-guided fine-needle biopsy. Other EUS-guided procedures can be used
to drain fluid from a lesion or inject a drug at a specific site.
RADIOLOGICAL INVESTIGATIONS

 Barium swalow
 Upper gastrointestinal series
 Barium enema
BARIUM SWALLOW

 A barium swallow, also called an esophagogram, is an imaging test that checks for
problems in your upper GI tract. Your upper GI tract includes your mouth, back of the
throat, esophagus, stomach, and first part of your small intestine. The test uses a special
type of x-ray called fluoroscopy. Fluoroscopy shows internal organs moving in real time.
The test also involves drinking a chalky-tasting liquid that contains barium. Barium is a
substance that makes parts of your body show up more clearly on an x-ray.
BARIUM SWALLOW
USES

 Ulcers
 Hiatal hernia, a condition in which part of your stomach pushes into the diaphragm. The
diaphragm is the muscle between your stomach and chest.
 GERD (gastroesophageal reflux disease), a condition in which contents of the stomach
leak backward into the esophagus
 Structural problems in the GI tract, such as polyps (abnormal growths) and diverticula
(pouches in the intestinal wall)
 Tumors
INDICATIONS

 Trouble swallowing
 Abdominal pain
 Vomiting
 Bloating
PROCEDURE

 You may need to remove your clothing. If so, you will be given a hospital gown.
 You will be given a lead shield or apron to wear over your pelvic area. This protects the area from
unnecessary radiation.
 You will stand, sit, or lie down on an x-ray table. You may be asked to change positions during the test.
 You will swallow a drink that contains barium. The drink is thick and chalky. It's usually flavored with
chocolate or strawberry to make it easier to swallow.
 While you swallow, the radiologist will watch images of the barium traveling down your throat to your
upper GI tract.
 You may be asked to hold your breath at certain times.
 The images will be recorded so they can be reviewed at a later time.
 Will I need to do anything to prepare for the test
UPPER GASTROINTESTINAL SERIES

 An upper gastrointestinal series (UGI) is a radiographic (X-ray) examination of the upper

gastrointestinal (GI) tract. The esophagus, stomach, and duodenum (first part of the small
intestine) are made visible on X-ray film by a liquid suspension. This liquid suspension
may be barium or a water-soluble contrast.
UPPER GASTROINTESTINAL SERIES
CONT

 An upper gastrointestinal series, also called a barium swallow, barium study, or barium
meal, is a series of radiographs used to examine the gastrointestinal tract for
abnormalities.
INDICATIONS

Difficulty swallowing
Chest and abdominal pain
Reflux (a backward flow of partially digested food and digestive juices)
Unexplained vomiting
Severe indigestion
Blood in the stool (indicating internal GI bleeding)
CONTRAINDICATION

 Recently operated patient . •

 Complete large bowel obstruction. •
 History/suspicion of aspiration . •
 Fistulous communication with any organ other than parts of GIT .
 • Recent biopsy of GIT , as barium granuloma formed at biopsy site.
complications

 Leakage of Ba from unsuspected perforation leading to Ba peritonitis

 • Aspiration of stomach contents (due to buscopan)
 • Barium impaction (partial bowel obstruction to complete bowel obstruction)
 • Barium appendicitis if Ba impacted in appendix
 • Adverse effects of pharmacological agents used.
BARIUM ENEMA

 A barium enema is an X-ray exam that can detect changes or abnormalities in the large
intestine (colon). The procedure is also called a colon X-ray. An enema is the injection of
a liquid into your rectum through a small tube.
BARIUM ENEMA
INDICATIONS

 abdominal pain
 blood in your stools
 a change in your bowel movements
 Crohn’s disease
 chronic diarrhea
 colorectal cancer
 diverticulitis
 irritable bowel syndrome
 polyps
 rectal bleeding
 a twisted loop of the bowels (volvulus)
 ulcerative colitis
PREPARATION

 Your doctor will ask you to cleanse your bowels the night before your test. This may
include using laxatives or taking an enema at home.

 You shouldn’t eat anything after midnight the night before your procedure. On the day of
the procedure, you can drink clear liquids, such as water, tea, juice, or broth. This is to
ensure that your colon is clear of any stool, which could show up in the X-ray images.
Tell your doctor if you’ve been having problems with your bowel movements prior to the
test.
PROCEDURE

 A well-lubricated enema tube is gently inserted into the rectum. Barium is injected
through this tube into the colon and rectum. A small balloon at the end of the tube is
inflated to keep the barium inside. X-rays are taken.
RISK FACTORS

 inflammation of the tissues around your colon

 obstruction of your gastrointestinal tract
 a perforated colon
 a tear in your colon wall
ABDOMINAL ULTRASOUND

 Abdominal ultrasound is a type of imaging test. It is used to look at organs in the

abdomen, including the liver, gallbladder, spleen, pancreas, and kidneys.
ABDOMINAL ULTRASOUND
CT SCAN

 Computed tomography is commonly referred to as a CT scan. A CT scan is a diagnostic

imaging procedure that uses a combination of X-rays and computer technology to produce
images of the inside of the body. It shows detailed images of any part of the body,
including the bones, muscles, fat, organs and blood vessels.
CT SCAN
USES

 Diagnose cancers.
 CV disease.
 Infectious disease.
 Appendicitis.
 Trauma. And
 Muscular-skeletal disorders.
PROCEDURE

 CT scan: Equipment Large box-like machine with hole in the middle. Pt. lies on narrow
table that slides in and out of this hole. X-ray tube and electronic x-ray detectors rotate
around you (gantry).
 Computer processes the information and is operated by a technologist who works
scanners and monitors the exam.
ADVANTAGES

 Advantages to CT Desired image detail is obtained. Fast image rendering. Filters may
sharpen or smooth reconstructed images. Raw data may be reconstructed post-acquisition
with a variety of filters.
DISADVANTAGES

 Multiple reconstructions may be required if significant detail is required from areas of the
study that contain bone and soft tissue. Need for quality detectors and computer software.
X-ray exposure.
BLOOD TESTS

 Haemoglobin
 Platelet count
 Prothrombin level/time
 Liver function tests
 Serum albumin
 Stool tests
BLOOD TESTS