GI investigations Flashcards
What are the principles of GI investigation?
Thorough history and exam
Differentiate functional and structural disorders
Start with simple and noninvasive if possible
Justify all investigations requested
What bedside investigations can be done?
BMI Pulse ox ECG Capillary glucose Urinalysis
What are the types of stool analysis?
FOB
Stool culture
Faecal calprotectin
Faecal elastase
When is faecal calprotectin used for?
Raised in inflammatory conditions
Useful for monitoring disease activity
What is faecal elastase used for?
Pancreatic insufficiency
Malabsorption
What blood investigations can be done for GI conditions?
U+E Ca and Mg LFT CRP Thyroid function FBC Coagulation Haematinics Hepatic screen Coeliac serology Tumour markers
What do we check Ca and Mg for?
Malabsorption
What does CRP help us differentiate between?
Rise in Crohn’s
No rise in ulcerative colitis
What does FBC help us check for?
Anaemia
White cell count- rise in IBD
Platelet count- IBD, neoplasia
What do haematinics check for?
B12
Folate
Ferritin
What do we check in a hepatic screen?
Hep B and Cserology Autoantibodies Immunoglobulins Ferritin Alpha 1 antitypsin copper
What tumour marker is checked for and what is the main use?
CEA
Monitoring response to therapy in some colorectal cancers
What physiology investigations can be done?
Urea breath test- H pylori
Hydrogen breath test- bacterial overgrowth
Lactose intolerance
Oesophageal pH and manometry
What endoscopic investigations can be done?
Upper GI endoscopy Colonoscopy ECRP Endoscopic ultrasound Enteroscopy
What does a UGIE examine?
Oesophagus to duodenum
What does a UGIE allow for?
Examination
Biopsy
Theraputic intervention- oesophageal/pyloric stenting
What are the risks of UGIE?
Aspiration
Perforation
Haemorrhage
What does a colonoscopy require?
Bowel prep- give laxative
What does a colonoscopy allow for?
Examine rectum to caecum
Biopsy, polypectomy, EMR
What are the risks of colonoscopy?
Perforation
Haemorrhage
Renal impairment- from laxative prep
What does ECRP allow us to do?
Visialise ampulla, biliary system and pancreatic ducts
Biopsy, cytology, stone removal, stenting, dilatation
What are the risks of ECRP?
Pancreatitis Haemorrhage Perforation Infection Mortality
What is endoscopic ultrasound used for?
Diagnosis and staging of tumour
Biopsy, cat drainage
What does enteroscopy allow us to do?
Visualise small intestine
Biopsy or therapy
What is capsule enteroscopy?
“pill” camera swallowed
Less invasive but doesn’t allow for biopsy
