GI investigations Flashcards
What pathological investigations might be done when a patient presents with jaundice?
Urinary bilirubin levels Liver function tests: - levels of conjugated/unconjugated bilirubin - Alkaline phosphatase (ASP) - ALT/AST - GGT Full blood count Liver screen: - hepatitis serology - autoantibody profile, serum immunoglobulins - ferritin and transferin saturation - alpha-1 antitrypsin Prothrombin time
What imaging investigations might be done when a patient presents with jaundice?
Abdominal ultrasound - most important!
CT scan or MRI (not first choice)
Endoscopic ultrasound
- often take a biopsy with EU
What are the main uses/advantages of an abdominal ultrasound?
Differentiate between extrahepatic and intrahepatic obstruction
Delineates the site and cause of obstruction - can see dilatation proximal to the obstruction
Shows evidence of portal hypertension
Useful in preliminary staging of extent of disease e.g. cancer spread
Gallstones
No radiation - safe
What is ERCP?
Endoscopic retrograde cholangio-pancreatography
Endoscopy is used to inject contrast into the biliary system, then x-rays are taken of the abdomen
Used to study the bile ducts, pancreatic ducts and gallbladder
Describe the clinical uses of ERCP
Can be used as a diagnostic tool but this is very rare
Usually used as a therapeutic procedure:
- endoscopic sphincterotomy
- removal of gallstones of other biliary debris
- insertion of bile stents
- dilation of strictures
What are the potential complications of ERCP?
Sedation-related complications (respiratory/cv)
Pancreatitis
Cholangitis
Perforation and/or bleeding (mainly associated with sphincterotomy)
What procedure would be used if ERCP is not possible? Why is this procedure not first choice?
Percutaneous transhepatic cholangiogram
More invasive than ERCP
What are the main uses of endoscopic ultrasound?
Characterising pancreatic masses (take biopsy)
Staging of tumours
Fine needle aspiration (FNA) or tumours and cysts
Excluding biliary microcalculi
