Abdomen- Investigations

Question 1

List the investigation of a patient with suspected Inflammatory Bowel Disease

Answer 1

• Bloods (FBC, U&E, CRP/ESR, LFT) (serum iron/ B12/ folate if anaemia)
• Stool studies (stool chart) (MCS x 3 to exlude infective causes) (Calprotectin- IBD increases Calprotectin)
  Radiology (AXR/CXR in acute disease) (CT in Crohn’s to look for complications)
• Endoscopy (Rigid/ Flexi sigmoidoscopy in UK)
• Colonoscopy
• Endoscopic rectal biopsy

Question 2

Describe the Investigation Used to Confirm a diagnosis of GORD

Answer 2

1) Barium swallow if suspected hiatus hernia

2) 24hr luminal pH monitoring and manometry (measures competence of sphincter) to diagnose GORD if endoscopy is normal

Question 3

List the diagnostic methods used to investigate patients with suspected gastric neoplasia

Answer 3

• OGD and multiple ulcer edge biopsy
• Endoscopic USS and CT for staging
• Staging laproscopy for locally advance tumours if no other metastases are detected.

Question 4

Discuss the investigation of Peptic Ulcer Disease and the role of Endoscopy

Answer 4

• Urgent OGD if it fits the ALARM 55 criteria (multiple biopsies taken from the rim/base as well as brushings)
• No investigation if less that 55 yrs, no ALARM symptoms and it resolves on anatacid/ GORD treatment
• If symptoms persist on treatment, investigate for H.pylori.
• ## If previous ulcer, assume H.pylori infection and eradicate.

Question 5

Outline the staging system of carcinomas of the colon, rectum and anus.

Answer 5

Duke’s Staging:
- Duke’s A: tumours invade submucosa +- muscularis propria
- Duke’s B: Tumours invade the muscularis propria (into subserosa/ directly into other organs), but no lymph node involvement
Duke’s C: Regional lymph node involvement
Duke’s D: Distant metastases

Question 6

Describe the physical examination of a patient with haemorrhoids, inlcuding Protoscopy

Answer 6

• Abdominal examination (palpable mass, enlarged liver)
• Rectal Examination ( prolapsing piles are obvious)
• Protoscopy/ Rigid Sigmoidoscopy (can visualise the piles, and assess for a lesion higher up in the rectum)
• Colonoscopy/ Flexi- Sigmoidoscopy (if symptoms suggest a more sinister pathology)

Question 7

Describe the findings on physcial examination of patients with perianal infections

Answer 7

• Diagnosis is usually straightforward, however deep sepsis higher up the anal canal may require EUA or imaging
• Any discharging area near the anus should be assumed to communicate with the ano rectum until proven otherwise
• Operative exploration is often the first diagnostic test, although MRI can be used.