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GI Investigations 2 Flashcards

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1
Q

When would we use an MRI over a CT? (In general)

A

MRI for pelvis, brain (posterior fossa), joints, spine

This is because CTs show artefacts (shadows caused by bones)

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2
Q

Contraindications and problems with MRIs

A

Contraindications: metal objects (pacemakers, clips) and claustrophobia

Problems: time consuming and has limited availability

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3
Q

What is Magnetic resonance cholangio-pancreaticography (MRCP)

A

Uses MRI to view bile ducts, pancreas in detail

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4
Q

What is a Defecating proctogram?

A

evaluates completeness of stool elimination, identifies anorectal abnormalities

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5
Q

Colonoscopy views the entire colon upto the ________

A

caecum

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6
Q

How is bowel screening performed and to whom is it offered?

A

Recommended for pts at high risk of colon CA and for everyone ≥ 60 yr

check

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7
Q

What is Gastroparesis?

How is it diagnosed, treated and monitored?

A

Condition where the stomach cannot empty. food passes through the stomach slower than usual

Gastric Emptying Scan helps diagnose and monitor response to motility drugs → metoclopramide, erythromycin

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8
Q

How may we evaluate patients with chronic constipation or IBSc?

What are the 2 types of IBSc shown on the image below?

A

Colorectal transit study -uses markers to monitor movement through the colon over 7 days with serial abdominal X-rays

  • Left - slow transit constipation
  • Right - anorectal diregulation / pelvic floor dyssynergia
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9
Q

How are contrast studies performed?

List one contrainidication and one challenge

A

Barium (single contrast) or Barium + Gas (double contrast) are given to pt.

  • Contraindication - suspected perforation or obstruction, as Ba is highly irritating
  • Challenge- Patients need to turn themselves to properly distribute barium, older patients may have difficulty with this
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10
Q

a) How do we assess oropharyngeal motility?
b) What parts of the GIT can this study assess
c) List 4 instances we may require this

A

a) Ba swallow
b) Oesophagus, stomach & duodenum
c) GORD, achalasia, stricture, ulcers

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11
Q

When do we use CT Enteroclysis?

A

Visualization of S bowel

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12
Q

GI Indications for Ultrasound

A
  1. Masses
  2. Abscess
  3. Organs
  4. Free fluid
  5. Biliary dilatation
  6. GB stones
  7. Guided FNAC & biopsy
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13
Q

What non-invasive test helps us quantify liver fibrosis?

A
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14
Q

What can CTs help diagnosis of?

A
  1. Tumours
  2. Vascular lesions
  3. Infection
  4. Collections or traumatic injuries
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15
Q

What is CT enterography and colonography

Incl indications for these

A

CT enterography: visualization of S bowel

CT colonography: generates 3D and 2D images of colon

Indications: obscure GI bleed, S bowel tumors, ischemia

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16
Q

List 4 uses of Endoscopy (there are many)

A
  1. Malignancy
  2. Infections (Candida, H. pylori, Giardia)
  3. Removal of foreign bodies
  4. Hemostasis
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17
Q

List 2 absolute and 2 relative contraindications to Endoscopy

A

Absolute: Shock, acute MI, perforation, toxic megacolon, severe RA of Cx spine (Atlanto-axial subluxation)

Relative: poor patient cooperation, coma, arrhythmias

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18
Q

What can we visualise with a Oesophagogastroduodenoscopy (OGD)

List 4 indications for this

Study These Flashcards
A

Visualise oesophagus, stomach & duodenum (D2)

Indications: Dyspepsia, Dysphagia, Wt loss, Anaemia

19
Q

What does a Sigmoidoscopy allow us to view?

List 4 indications

Study These Flashcards
A

Endoscope is inserted through the anus to view left colon

Indications: diarrhea, LIF pain, constipation, abnormal growths, bleeding PR

20
Q

When may Proctoscopy be used?

Study These Flashcards
A

Limited exam of anal canal and rectum

Used in OPD to look for haemorrhoids and/or fissures

21
Q

Indications + Theraputic Indications for a colonoscopy

Study These Flashcards
A

Indications: chronic diarrhea, Fe deficiency anemia, unexplained abdo pain, change in bowel habits (esp looser), weight loss

Therapeutic Indications: control bleeding, polyp removal, tumour ablation, stricture dilation, reduction of sigmoid volvulus

22
Q

What is ERCP

List 4 indications

Study These Flashcards
A

Contrast injected into CBD and/or pancreatic duct, through upward viewing scope

Indications

  1. Obstructive jaundice - insert stents
  2. CBD stones - removal
  3. Ascending cholangitis
  4. Bile duct injury
23
Q

When may we use video capsule endoscopy?

Study These Flashcards
A

In patients with occult GI bleed for detecting S bowel polyps and detection of mucosal abnormalities

24
Q

What is a Gastric Emptying scan?

Study These Flashcards
A

Nuclear Isotope Scan

Radiolabeled meal ingesting and observed as it passes out of stomach

25
What condition is significantly associated with Gastroparesis and why?
Diabetes Gastropares is sign of autonomic neuropathy as ↑blood glucose has caused damage to the vagus nerve
26
Clinical use of Gastric Emptying Scan?
1. To diagnose gastroparesis + 2. Monitor response to motility drugs (metoclopramide, erythromycin)
27
What is a Meckle scan? How is it used clinically?
Identifies ectopic gastric mucosa Used to diagnose Meckels diverticulum
28
List the 4 types of Manometry used in the GIT and where each measures
Oesophageal: effectiveness & coordination of peristalsis Gastroduodenal: dysmotility with normal gastric emptying or unresponsive to therapy Barostat: measures gastric accommodation with distension in stomach Anorectal: contractility of anal sphincter
29
What is 24 Hour Oesophageal pH Monitoring List 2 Indications
Measures amount of acid that enters oesophagus during 24-hour period Indications: refractory acid reflux symptoms, non-cardiac chest pain
30
What is Gastric Fluid Analysis? How is it used clinically?
NGT to measure gastric acid output in basal & stimulated state (Pentagastrin) Used to test for ZES, pernicious anemia, atrophic gastritis, with PPIs. Sometimes used for AFB staining for abdominal TB
31
What does **Hypo**chlorhydria in presence of elevated gastrin indicate on gastric fluid analysis?
Impairment of acid output eg. pernicious anemia, atrophic gastritis & with PPIs
32
What does **Hyper**chlorhydria in presence of elevated gastrin indicate on gastric fluid analysis?
ZES
33
List 4 diseases associated with malabsorption
1. Chronic pancreatitis 2. Cancer 3. ZE syndrome, 4. Chronic liver disease 5. Coeliac
34
List 4 Diagnostic Procedures in GI Diseases
1. Ascitic tap 2. Nasogastric tube insertion 3. PEG tube insertion 4. Liver Bx 5. Diagnostic laparoscopy
35
What is Meckel's diverticulum and what is its associated rule of 2s? What scan is used to detect this?
Congenital outpouching/malformation of the distal ileum (persistent yolk sac?) * 2% of the population * 2 feet from the ileocecal valve * 2 inches long * usually detected in under 2’s * 2:1 male:female Detected using Meckel scan
36
What is Manometry and list 4 indications for oesophageal manometry
Measurement of pressure using pressure transducers Indications: 1. dysphagia 2. Nutcracker oesophagus 3. achalasia 4. scleroderma 5. amyloidosis
37
What is Nutcracker oesophagus?
Hypercontracting oesophagus
38
What is the H2 breath test? List 2 indications for this
When sugars (lactose, glucose) are not completely absorbed by S intestine, bacteria within GI produce H2 gas from them Indications: lactose intolerance, bacterial overgrowth
39
What is Zollinger-Ellison syndrome
Gastrin secreting tumour of the pancreas
40
How do we test pancreatic function using an oroduodenal tube? (Invasive test)
Tube placed to collect pancreatic secretions after a hormonal secretagogue is given * When CCK is administered → output of lipase measured * When secretin is administered → output of HCO3 is measured
41
How can we non-invasively test for pancreatic insufficiency?
**Faecal elastase** levels of \< 100 μg/g of stool are seen in patientss with advanced chronic pancreatitis
42
How can we non-invasively test for pancreatic insufficiency?
**Faecal elastase** levels of \< 100 μg/g of stool are seen in patientss with advanced chronic pancreatitis
43
How can we non-invasively test for pancreatic insufficiency?
**Faecal elastase** levels of \< 100 μg/g of stool are seen in patientss with advanced chronic pancreatitis

Gastrointestinal Block (26 decks)

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