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
What can be done during colonoscopy?
- Biopsy
- Polypectomy
- EMR
What are the risks of colonoscopies?
- Perforation
- Haemorrhage
- Renal impairment
What does ERCP stand for?
Endoscopic retrograde cholangio-pancreatography
How is ERCP carried out?
Under sedation or general anaesthetic
What can be seen on ERCP?
Visualise ampulla, biliary system and pancreatic ducts
What can be done during ERCP?
- Biopsy/cytology
- Stone removal
- Stenting
- Dilatation
What are the risks of ERCP?
- Pancreatitis
- Haemorrhage
- Perforation
- Infection
- Mortality
What is endoscopic ultrasound (EUS) used for?
Diagnosis and staging
What can be done during endoscopic ultrasound?
- Biopsy
- Cyst drainage
What can be visualised during enteroscopy?
Small intestine
What types of enteroscopy are there?
Double or single balloon
What does enteroscopy allow for?
Biopsy or therapy for small bowel pathology
What is the downside of capsule enteroscopy?
Biopsy is not possible despite being less invasive
