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Gastrointestinal (LECTURE NOTES) > Gastronintestinal Investigations > Flashcards

Gastronintestinal Investigations Flashcards

1
Q

What do erect CXR show and what causes this

A

AIr under the diaphragm - perforation

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2
Q

What can be seen in an AXR

A

Dilated bowel loops and fluid level = obstruction or ileus

Calcification - chronic pancreatitis or gallstones (rare)

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3
Q

What percentage of gallstones are radio-opaque

A

10%

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4
Q

What is used as a radio-opaque contrast

A

Insoluble salt such as barium sulphate

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5
Q

What indicates for a contrast swallow

A

Dysphagia (upper endoscopy may be too dangerous due to pharyngeal pouch)
Suspected dysmotility
Size of hiatus hernia

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6
Q

What are the limitations of barium swallow

A

Does not show as good image as endoscopy or allow biopsy

aspiration is a risk

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7
Q

What are the indications for a contrast meal

A

Epigastric pain with normal upper GI endoscopy
Vomiting with normal upper GI endoscopy
Suspected perforation

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8
Q

Waht are the limitations of a contrast meal

A

Poor at detecting early cancer

Upper GI endoscopy shows better mucosal detail and allows for biopsy

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9
Q

What are the indications for a contrast follow-through

A

Crohn’s disease
Diarrhoea or abdominal pain with normal endoscopy and histology
Suspected small bowel obstruction

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10
Q

What are the limitations of a contrast follow through

A

Ionising radiation exposure

Expertise dependent

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11
Q

What are the indications for a contrast enema

A

Altered bowel habit
Suspected diverticulosis where colonoscopy may be dangerous or difficult
Suspected megacolon

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12
Q

What are the limitations of a contrast enema

A

Uncomfortable for the patient
Does not visualise rectal mucosa well
Ionising radiation exposure
poor mucosal definition and cannot biopsy lesions compared to colonoscopy

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13
Q

What are the indications for an ultrasound

A 
Abdominal masses, tumour abscess cyst 
Organomegaly
Jaundice
Gallstones
Biliary tract dilatation
Ascites
Guided procedures
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14
Q

What are the limitations of ultrasound

A

Low sesnitivity for lesions
poor views if obstructed or obese
expertise dependent
poor for imaging retroperitoneal structures

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15
Q

What helps muscosal definition in CT scanning

A

Oral contrast

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16
Q

What helps show vascular lesions in CT scanning

A

IV contrast

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17
Q

What are the indications for a CT scan

A 
Tumour staging
Crohn's disease 
pancreatic disease 
bile duct stones hepatic tumour staging
guided procedures 
CT colonography
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18
Q

What are the limitations of CT scanning

A

Ionising radiation exposure
May under-stage tumours
Expertise dependent

19
Q

What are the indications for MRI scanning

A 
Tumour staging
Crohn's disease
Suspected neuroendocrine tumours
Suspected chronic pancreatitis
Hepatic tumour staging 
MR cholangiopancreatography (MRCP)
20
Q

What are the limitations of MRI scanning

A

Expertise dependent
Claustrophobia for some patients
time consuming
not feasible if metal prostheses in situ

21
Q

What are the indications for mesenteric angiography

A

GI haemorrhage with normal upper and lower GI endoscopy
Recurrent iron deficiency
Suspected arterio-venous malformation
Suspected mesenteric ischaemia

22
Q

What are the limitations of mesenteric angiography

A

Contrast induced nephropathy

Requires sufficiently brisk bleeding to document source

23
Q

What does a video-endoscope enable

A

Passage of flexible instruments into the upper and lower extremes of the gut

24
Q

How is Upper GI endoscopy performed

A

Under sedation with IV benzodiazapine or local anaesthetic throat spray

25
Q

When should upper GI be avoided

A

If perforation is suspected

26
Q

What are the indications for Upper GI endoscopy

A 
Abdominal pain
Haematemesis or melaena
Dysphagia
Weight loss
Iron-defieciency anaemia 
vomiting
gastric ulcer follow up
balloon enteroscopy 
Dilatation of stricture 
Insertion of stenet to palliate strictures 
Placement of PEG tube 
Edoscopic treatment of oesophageal varices
27
Q

What are the complications of endoscopy

A

Perforation
Over-sedation resulting in respiratory depression
Aspiration pneumonia

28
Q

What is examined during a flexible sigmoidoscopy

A

The left colon and rectum

29
Q

Is sedation given for a flexible sigmoidoscopy

A

No

30
Q

What are the indications for a flexible sigmoidoscopy

A

Fresh rectal bleeding

Quantify activity in known UC patient

31
Q

What are the complications of Flexible sigmoidoscopy

A

Perforation and haemorrhage

32
Q

When is a colonoscopy performed

A

After a full bowel perparation and with conscious sedation

33
Q

What is examined during a colonoscopy

A

The whole colon

34
Q

What are the indications for a colonoscopy

A 
Altered bowel habit 
rectal bleeding 
iron - deficiency anaemia 
suspected IBD
Follow up of abnormal barium enema 
Colorectal cancer screening 
Polypectomy 
Dilatation or stent insertion
35
Q

What are the complications fo a colonoscopy

A

Incomplete examination - depending on expertise
Perforation
Haemorrhage
Cariorespiratory depression if over-sedated
Infective endocarditis

36
Q

What are the indications for an endoscopic ultrasound

A

Staging of cancers of oesophagus, rectum and pancreas
Drainage of pancreatic pseudocysts
Lymph node biopsy
Assessment of anal sphincters in faecal incontinence

37
Q

What can be used to visualise the distal small bowel

A

Disposable video-capsule

38
Q

What are the indications for a video-capsule enteroscopy

A

Obscure GI bleeding

Recurrent anaemia

39
Q

What are the limitations of video capsule enteroscopy

A

Caution required if structures are suspected as the capsule can cause an obstruction
Expensive

40
Q

What are the limitations of video capsule enteroscopy

A

Caution required if structures are suspected as the capsule can cause an obstruction
Expensive

41
Q

How is lactose intolerance diagnosed

A

The lactose hydrogen breath test

42
Q

What is the medical term for lactose intolerance

A

Hypolactasia

43
Q

What is used to diagnose small intestine bacterial overgrowth

A

Glucose Hydrogen breath test

Gastrointestinal (LECTURE NOTES) (29 decks)

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