GI Diagnosis Flashcards
Divertuculosis Diagnosis
Barium enema is diagnostic test of choice
Most often found incidentally on colonoscopy done for another reason
Abdominal Xrays are normal
Diagnosis of diverticulitis
Fever, leukocytosis and LLQ pain (no painless rectal bleeding)
CT scan with oral and IV contrast
Abdominal radiographs exclude other causes of LLQ pain
barium enema and colonoscopy are contraindicated
Acute mesenteric ischemia diagnosis
hypotension, lactic acidosis, altered mental status
Mesenteric angiography is definitive diagnosis
Plain film of abdomen to exclude other causes of abdominal pain
Thumbprininting on barium enema due to thickened edematous mucosal folds
chronic mesenteric ischemia diagnosis
Mesenteric arteriography
Pseudomembranous colitis diagnosis
C. difficile toxins in stool is diagnostic (takes 24 hours)
Flexible sigmoidoscopy is most rapid test and is diagnostic-infrequently used
Abdominal radiograph rules out toxic megacolon and peforation
Leukocytosis
Sigmoid and cecal volvulus diagnosis
Plain abdominal film
Sigmoid: bent inner tube shape (omega sign) idnicates dilated sigmoid colon
Cecal: coffee bean sign-distension of cecum and small bowel, large air fluid level in RLQ
Sigmoidoscopy: preferred for sigmoid since also therapeutic
Barium enema reveals narrowing of the colon-not used if possible strangulation
Diagnosis of Cirrhosis
Biopsy is gold standard
Diagnosis of portal hypertension
Bleeding (hematemesis, melena, hematochezia)
Paracentesis can help with diagnosis
Diagnosis of esophageal varices
Emergent upper GI endoscopy (once patient is stabilized)
Diagnosis of ascites
paracentesis:
Serum ascites albumin gradient: greater than 1.1 g/dl=portal hypertension
less than 1.1 then portal HTN is less likely
Diagnosis of Wilson’s disease
Elevated aminotransferases, impaired synthesis of coagulation factor and albumin
Decreased serum ceruloplasmin (normal ranges do not exclude diagnosis)
Livery biopsy: elevated copper concentration
If diagnosed first degree relatives must be screened as well
Diagnosis of hemachromatosis
Elevated serum iron and serum ferritin
Elevated iron saturation
Decreased TIBC
Liver biopsy required for diagnosis!
Genetic testing for chromosomal abnormalities
Screen siblings-early diagnosis improves survival
Pyogenic liver abscess diagnosis
Ultrasound or CT scan
Elevated LFTs
E.coli, klebsiella, proteus, enterococcus, and anaerobes
Patients appear quite ill
Diagnosis of amebic liver abscess
Immunoglobulin G enzyme immunoassay
LFT elevation
stool Ag test is not sensitive
Ultrasound and CT identify abscess
Diagnosis of budd chiari syndrome
hepatic venography
Serum ascites albumin gradient >1.1
Mild (low hundreds) vs. moderate (high hundreds to thousands) vs. severely (>10,000) elevated AST and ALT
Mild: chronic viral hepatitis or acute alcoholic hepatitis
moderate: acute viral hepatitis
severe: extensive hepatic necrosis (ischemia, shock, acetaminophen toxicity, severe viral hepatitis)
Diagnosis of cholelithiasis
RUQ ultrasound for stones >2 mm
CT scan and MRI are alternatives
Diagnosis of acute cholecystitis
RUQ ultrasound is test of choice-thickened gallbladder wall, pericholecystic fluid, distended gallbladder, and presence of stones
CT scan as accurate but better for identifying complications (peforation, abscess, pancreatitis)
HIDA scan used if ultrasound inconclusive-gallbladder not visualized after 4 hours=positive HIDA scan and confirmation of acute cholecystitis
Diagnosis of choledocholithiasis
Total and direct bilirubin are elevated and Alk-phos
Ultrasound is initial but is not sensitive
ERCP is gold standard and also therapeutic
Percutaneous transheptic cholangriography is an alternative to ERCP
Diagnosis of cholangitis
RUQ, fever, jaundice, septic shock, disorientation
Initial study is ultrasound
Hyperbilirubinemia, lekuocytosis, mild elevation in serum transaminases
Cholangiography (Percutaneous transheptic cholangriography or ERCP)-not during acute phase wait until afebrile for 48 hours
PTC when duct is dialted
ERCP when duct system is normal
Diagnosis of primary sclerosing cholangitis
Associated with ulcerative colitis
ERCP and PTC-multiple areas of bead-like stricturing and bead-like dilatations of itnrahepatic and extrahepatic ducts
Cholestatic LFTs
Diagnosis of primary biliary cirrhosis
Cholestatic LFTs (Alk Phos) Antimitochondrial antibodies Confirmational: liver biopsy Elevated cholesterol, HDL Elevated immunoglobulin M Abdominal US to rule out biliary obstruction
Diagnosis of acute appendicitis
CT scan (Sn=98%) ultrasound
Acute pancreatitis diagnosis
Increased amylase and lipase (lipase more specific)
LFTs to identify cause
Hyperglycemia, hypoxemia and leukocytosis
Prognosis get: glucose, age (>55), LDH, AST, WBC
Calcium, hematocrit, PaO2, BUN, Base deficit, fluid sequestration
Radiograph: rules out perforation, calcifications=chronic
ultrasound: identifies cause and can follow up pseudocyst or abscesses
CT: most accurate
pancreatic pseudocyst diagnosis
CT scan
Hematemesis
Upper GI endoscopy
Hematochezia
Colonscopy
Melena
Upper GI endoscopy then colonoscopy if nothing found
Occult blood
Colonoscopy
Upper GI endoscopy if nothing found
Lower vs upper GI bleed
Nasogastric tube
Bile but no blood: upper GI bleeding unlikely source distal to ligament of Trietz
Bright blood or coffee grounds-upper GI bleeding
Nonbloody aspirate: upper G bleeding unlikely
Diagnosis of achalasia
Barium swallow: birds beak, dilated esophagus proximal to the narrowing
Upper GI endoscopy: rule out secondary causes of achalasia
Manometry: confirms the diagnosis
Diffuse esophageal spasm diagnosis
Manometry: simultaneous, multiphasic, repetitie contractions that occur after swallow, normal sphincter response
GI barium swallow: corkscrew esophagus
Esophageal hiatal hernias diagnosis
Sliding: Gastroesophageal junction above the diaphragm-GERD
Paraesophageal: gastroesophageal junction does not cross the diaphragm can become strangulated and should be repaired surgically
Barium Upper GI series, upper endoscopy
esophageal diverticula diagnosis
Barium swallow
Esophageal perforation diagnosis (Boerhaaves)
Water soluble contrast esophagram: gastrografin swallow is definitive
CXR shows air in mediastinum
Peptic Ulcer Disease Diagnosis
Duodenal associated with Type O blood
Gastric associated with Type A blood
Treat empiricallly unless GI bleed is present
Endoscopy: necessary for gastic ulcer for biopsy to rule out malignancy and can be used for H. pylori biopsy
Urease breath test: convenient and can assess the results of antiobiotic therapy
serum gastrin if considering Zollinger-Ellison syndrome
GI perforation diagnosis
CXR: free air under diaphragm
CT scan most sensitive for free abdominal air
GI bleeding diagnosis
Stool guaiac
Upper G endoscopy (diagnostic and therapeutic)
Small bowel obstruction diagnosis
Deyhdration: hypocholremia (vomiting) hypokalemia, metabolic alkalosis
Tachycardia, hypotension, tachypnea, altered mental status and oliguria
Abdominal plain films: dilated loops of small bowel, air fluid levels proximal to pint of obstruction and minimal gas in colon
Barium enema-identifies site of obstruction
Paralytic ileus diagnosis
Failure to pass contrast medium beyond fixed point
Crohn’s disease diagnosis
Endoscopy: sigmoidscopy or colonoscopy with biopsy
apthous ulcerrs, cobblestone apperance, pseudopolyps, pstychy skip lesions
Barium enema
Ulcerative colitis diagnosis
Stool culutres for C. difficile, ova and parasies
Fecal leukocyes
Colonoscopy
