GI diagnostics

Question 1

What are Abdominal series (plain films) primarily used for?

Answer 1

• Eval of perforation, obstruction, or foreign object
• views are supine and upright
• KUB- kidneys, ureters, bladder

Question 2

What are barium enemas looking for?

Answer 2

• colon polyps, cancer, strictures, diverticula, fissures, ulcers
• mainly used in rural settings, being replaced by colonoscopy and CT colonography

Question 3

What is a barium swallow used for?

Answer 3

• esophageal structure and function that EGD can miss
• -Hypopharyngeal and cricopharyngeal disorders
• delineates strictures, ulcerations, reflux, and hiatal hernia

Question 4

What is an abdominal ultrasound used for?

Answer 4

• liver, gallbladder and ducts, pancreas, spleen, kidneys
• doppler assesses blood flow
• cheap!

Question 5

Endoscopic Ultrasound (EUS) uses?

Answer 5

• cancer staging

- drainage of pancreatic pseudocyst

Question 6

Abdominal CT scan uses?

Answer 6

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.

Question 7

Esophagogastroduodenoscopy (EGD) uses?

Answer 7

• 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

Question 8

Capsule Endoscopy uses?

Answer 8

• evaluate jejunum and ileum beyond EGD

- swallow camera

Question 9

Small Bowel enteroscopy uses?

Answer 9

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.

Question 10

Gold standard exam for lower GI bleeding (GIB)?

Answer 10

Colonoscopy

Question 11

Colonoscopy uses?

Answer 11

Indications: Evaluate diseases of colonic mucosa, colorectal cancer screening, anemia and lower GIB
Risks: perforation, bleeding, discomfort.

Question 12

Virtual colonoscopy:

Answer 12

Air + CT

-downside. if you see something then you have to do a colonoscopy anyway

Question 13

Sigmoidoscopy:

Answer 13

-similar to colonoscopy but doesn’t reach as far.

used in rural areas

Question 14

Endoscopic Retrograde Cholangio Pancreatography (ERCP)

Answer 14

-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.

Question 15

MCC of duodenal ulcers

Answer 15

H. pylori

Question 16

3 proteins the liver makes?

Answer 16

Albumin, globulins and fibrinogen

Question 17

H. Pyloria antibody test

Answer 17

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.

Question 18

H. Pylori Urea breath test:

Answer 18

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.

Question 19

test for detecting and monitoring pancreatitis:

Answer 19

Amylase

Question 20

Used for evaluating pancreatic disease, most commonly acute pancreatitis.

Answer 20

Lipase

Question 21

Is Hep A treated?

Answer 21

no. its self limiting