GI Investigation Flashcards
What are the principles of investigation?
- Begin with thorough history and examination
- Differentiate functional disorders from organic pathology
- Start with simple and non-invasive investigation where possible
- Justify all investigations requested
What bedside investigations are there for GI?
- BMI
- Pulse oximetry
- ECG
- Capillary glucose
- Urinalysis
What investigations can be carried out as part of stool analysis?
- FOB testing
- Stool culture
- Faecal calprotectin
- Faecal elastase
What is faecal calprotectin used for?
- Raised level in inflammatory conditions
- Quantitative analysis useful for monitoring disease activity
What is faecal elastase used for?
Investigation of pancreatic insufficiency/ malabsorption
What investigations are carried out as part of blood analysis?
- U+Es
- Calcium/ magnesium
- LFTs
- CRP
- Thyroid function
- FBCs
- Coagulation
- Haematinics
- Hepatitic screen
- Coeliac serology
- Tumour markers
What may LFTs show?
- Hepatitic (high ALT, GGT): disorder of the hepatocytes
- Obstructive (high Alk Phos, bilirubin): disorder of bile exiting the liver
What may FBCs show?
- Anaemia: microcytic/macrocytic
- White cell count e.g IBD
- Platelet count e.g IBD/neoplasia
What may coagulation tests show you?
Hepatic dysfunction
What may haematinics show?
- B12
- Folate
- Ferritin
What does a hepatitic screen include?
- Haepatitis B and C serology
- Autoantibodies (esp ANA, AMA)
- Immunoglobulins
- Ferritin
- Alpha 1 antitrypsin
- Caeuloplasmin, copper
- Alpha fetoprotein
What coeliac serology can be carried out?
- Tissue transglutaminase
- Endomysial antibody
- Check IgA levels
What may CEA (tumour marker) be useful in?
Monitoring response to therapy
What other investigations are there?
- Urine collections (5HIAA, catecholamines)
- Nutrition screen (trace elements, vitamins)
- Laxative screen (identify misuse)
What GI physiology investigations are there?
- Breath testing
- Oesophageal pH and manometry
What breath tests are available?
- Urea breath test: H pylori
- Hydrogen breath test: bacterial overgrowth
- Lactose intolerance
What is oesophageal pH and manometry used for?
- Assessment for oesophageal dysmotility
- Assess reflux
What are the risks of upper GI endoscopy?
- Aspiration
- Perforation
- Haemorrhage
How is upper GI endoscopy carried out?
-Under sedation of local anaesthetic
What does upper GI endoscopy examine?
Oesophagus to the duodenum
What can be done during upper GI endoscopy?
- Biopsy
- Therapeutic intervention
- Oesophageal/pyliruc stenting
How are colonoscopies usually carried out?
With sedation
What is required before a colonoscopy?
- Bowel preparation e.g picolax
- Renal testing
What does a colonoscopy examine?
Rectum to caecum/terminal ileum
