GI pt 2 Flashcards
What are the noninvasive labs for H pylori?
urea breath test, stool antigen test, serologic test
What are the invasive tests for H pylori?
If patient is having an EGD, testing can be done on biopsy samples
- CLO test aka rapid urease test
- PCR detection of H. pylori DNA
- Histological examination/staining
- Culture
What are the tests we can do for the SI?
gastrin, fecal fat, sudan III, anti-tissue transglutaminase Ab, and anti-endomysial ab
With a gastrin test, what are we looking for?
duodenal ulcers
With a fecal fat test, what are we looking for?
malabsorption of fat or pancreatic insufficiency
With a sudan III test, what are we looking for?
malabsorption of fat
With an anti-tissue transglutaminase ab test, what are we looking for?
celiac disease
With an anti-endomysial ab test, what are we looking for?
celiac disease
What are the tests for the large intestine?
Fecal occult blood test, stool culture, ova and parasites, stool WBCs, lactoferrin, fecal calprotectin, and specific pathogen testing
What are the tests we can for the pancreas?
Amylase, Lipase, fecal elastase, and fecal fat test
With a fecal occult blood test, what are we looking for?
aka Guaiac
stool specimen needed
With an ova and parasites test, what are we looking for?
microscopic evaluation
With a stool WBCs test, what are we looking for?
infectious process
With a lactoferrin test, what are we looking for?
inflammatory processes
nonspecific
With a fecal calprotectin test, what are we looking for?
Crohn’s disease
With an amylase test, what are we looking for?
looking for it to be high
could indicate pancreatitis but is non specific
With a lipase test, what are we looking for?
THIS IS THE TEST OF CHOICE FOR PANCREATITIS
we are looking for it to be high
With a fecal elastase test, what are we looking for?
pancreatic insufficiency
we are looking for it to be low
With a fecal fat test, what are we looking for?
we use this more in clinical practice and it is more specific
can indicate pancreatic insufficiency
we are looking to see if it is high
Which bacterial pathogens TEST OF CHOICE is a stool culture?
Salmonella
Shigella
Campylobacter
Shiga Toxin (E. coli)
Which bacterial pathogens TEST OF CHOICE is antigen detection?
E. coli
C Diff (GDH antigen, Toxin A and Toxin B)
Which bacterial pathogens have bloody diarrhea?
Shiga, Campylobacter, Salmonella, and E. coli
what is the test of choice for rotavirus?
rapid antigen test
What is the test of choice for norovirus?
PCR testing available
usually a CLINICAL diagnosis
What are the Protozoan pathogens?
Entamoeba histolytica
Giardia
Cryptosporidium
What are the nematode pathogens?
Ascaris lumbricoides
Nectar americanus
Strongyloides
Enterobius vermicularis
What protozoan or nematode infections cause bloody diarrhea?
Entamoeba histolytica
What is the test of choice for Entamoeba histolytica?
ova and parasites
antigen detection or PCR testing
What is the test of choice for Giardia?
ova and parasites
antigen detection
What is the test of choice for cryptosporidium?
antigen or PCR testing
What nematode pathogens have a microscopic evaluation as their test of choice?
Ascaris lumbricoides
Nectar americanus
Strongyloides
What is the test of choice for Enterobius?
scotch tape test
What labs can we order to assess the function of the liver?
albumin
PT/INR
Bilirubin
platelets
cholesterol
BUN
glucose
ammonia
What labs can we order to assess injury/insult of the liver?
AST, ALT, Alk Phos, GGT
What labs can we order to assess infection of the liver?
hepatitis
What are some other niche liver tests we can do to assess processes in the liver?
ascitic fluid analysis, SAAG, de Ritis ratio, anti-mitochondrial Ab, anti-smooth muscle Ab
Describe the functions of the liver, the corresponding lab, and the lab abnormality in liver disease
Describe what it means to be prehepatic, hepatic, and post-hepatic with associated lab values and examples
positive IgM would indicate?
active infection
positive IgG would indicate?
either active infection or past infection
positive antigen would indicate?
active infection
positive antibody would indicate?
past infection or vaccination
positive DNA would indicate?
active infection
In hepatitis B, C, and D, because of there blood and sexual contact route of transmission, what other disease are they more likely to get?
They are more likely to develop chronic hepatitis and it may lead to hepatocellular carcinoma
Describe the incubation, transmission, chronic infection and risk of liver cancer for the hepatitis’
What are the labs and treatments for Hep A?
Acute Infection: positive IgM
Past Infection: positive IgG
TX: self-limiting
What are the labs and treatments for Hep B?
Acute Infection
- positive antigen
- positive DNA
- positive Ab
- positive IgM
Chronic Infection
- positive antigen
- positive DNA
- positive Ab
- positive IgG
Past infection
- positive antibody
- positive IgG
TX: vaccine available
What are the labs and treatments for Hep C?
Acute Infection:
- positive antibody
- positive RNA
Past Infection
- positive antibody
- positive RNA
TX: no vaccine, anti-viral therapy
What are the labs and treatments for Hep D?
requires coinfection with Hep B. Cannot replicate on its own.
Acute infection:
- positive antigen
- positive antibody
- positive IgM
TX: HepB vaccine
What are the labs and treatments for Hep E?
Typically diagnosed w/ sx. Need to rule out Hep A.
Increased mortality in pregnant females
TX: self-limiting
With a SAAG, what are we looking for?
used to distinguish cause of ascites
based on the difference between the albumin level of serum and of ascitic fluid
With de Ritis ratio, what are we looking for?
used to distinguish between different types of hepatitis (AST/ALT)
With an anti-mitochondrial antibody, what are we looking for?
primary biliary cholangitis/ cirrhosis
With an anti-smooth muscle antibody, what are we looking for?
autoimmune hepatitis
What is the cancer marker for colorectal cancer?
CEA (carcinoembryonic antigen)
What is the cancer marker for pancreatic cancer?
C19-9
What is the tumor marker for liver cancer?
AFP (alpha fetoprotein)
What are the types of abdominal x-rays?
Plain Films
- acute abdominal series
- KUB
With contrast
- barium swallow
- upper GI series
- upper GI series w/ small bowel follow thru
- lower GI series
- barium enema
What is the technique for looking at abdominal x rays?
ABDO X
Air, Bowel, Dense stuff, organs, and extra
What is the pathology? What is the type of image?
normal
abdominal x ray
What is the pathology? What is the type of image?
Normal but we can see the bladder where the arrow is.
abdominal x-ray
What is the pathology? What is the type of image?
free air under the diaphragm
abdominal x-ray
What is the pathology? What is the type of image?
dilated loops of bowel and air fluid levels are indicative of an obstruction
abdominal x-ray
What is the pathology? What is the type of image?
gastric outlet obstruction/ syndrome
abdominal x ryay
What is the pathology? What is the type of image?
air fluid levels and hip replacement artifact on left lateral decubitus abdominal x-ray
What is the pathology? What is the type of image?
free air indicated where the white arrow is. dilated loops of bowl and air fluid levels indicative of an obstruction on cross table view on abdominal x-ray
What is the pathology? What is the type of image?
mass and narrowing of the GE junction
barium swallow
What is the pathology? What is the type of image?
polyp
do EGD next
Contrast should turn everything white in the stomach.
barium swallow
What is the pathology? What is the type of image?
balloon appearance or “birds beak” or “rat tail”
stricture at the bottom
this is indicative of achalasia
barium swallow
What is the pathology? What is the type of image?
normal small bowel follow-through
What is the pathology? What is the type of image?
noraml barium enema
What is the 3-6-9 rule?
SI less than 3 cm
LI less than 6 cm
cecum less than 9 cm
What is the pathology? What is the type of image?
normal SI on the right, then the red and green arrows indicate an obstructive process.
We should definitely be sending this patient for CT after this GI x-ray w/ contrast
What is the pathology? What is the type of image?
the transverse colon is not normal in diameter and it is severely narrowed. Sometimes referred to as an “apple core” lesion
What are the types of abdominal CTs?
abdomen only
abdomen and pelvis
What are the types of contrast for abdominal CT?
IV contrast only
Oral contrast only
IV and oral contrast
No contrast
When would we do IV contrast only?
masses, acute mesenteric ischemia
When would we do Oral contrast only?
if the patient has kidney disease
When would we do IV and Oral contrast?
wanna see what lights up and what doesn’t
When would we use no contrast?
bones and stones
What are the special types of CT and what would they show?
- Angiography: mesentery ischemia (THIS IS GOLD STANDARD)
- Enterography: look more specifically at the walls of intestines
- Chest: esophagus (maybe, more helpful to get CT abd)
What is the pathology? What is the type of image?
normal abdominal CT
What is the pathology? What is the type of image?
pancreatic mass on abdominal CT
What is the pathology? What is the type of image?
dilated loops of bowel and abdominal distension on abdominal CT of the intestines
What is the pathology? What is the type of image?
dilated loops of bowel on abdominal CT of the intestines
What is the pathology? What is the type of image?
ascites
oral contrast in stomach
Abdominal CT (liver/gallbladder/pancreas)
What is the pathology? What is the type of image?
echogenicity of the liver (is isn’t all the same color) It should be consistent. This indicates metastasis
Abdominal CT (liver/gallbladder/pancreas)
What is the pathology? What is the type of image?
distension of the gallbladder with pancreatic mass.
we can see the aorta and kidney light up a ton so we know they used IV contrast
Abdominal CT (liver/gallbladder/pancreas)
What is the pathology?
Blood clot or narrowing due to atherosclerosis.
blockage in the blood flow that will lead to mesentery ischemia
What is the pathology?
IVC filter
What is the pathology? What is the type of image?
normal gastric emptying study
moves through the SI to Li
30-120 mins
What organs can we evaluate with US?
- Esophagus: endoscopic otherwise not used
- Liver
- gallbladder
- pancreas
What are the different types of US?
- RUQ (limited)
- Complete Abdomen
- Renal/Bladder
- Pelvic
When is abdominal US most helpful?
most useful in evaluation of solid organs and biliary tree.
- not helpful in tube like organs
- endoscopic US can be used to evaluate some esophageal issues
What is one of the biggest perks of US?
it has no radiation, so it is safe and very important for pregnant patients
What are the different types of US special tests?
- Modified Barium Swallow
- Manometry
- Pressure: esophagus, stomach, and sphincter of Oddi
- pH: esophagus, stomach - gastric emptying study
- tagged RBC scan
- elastography
- MRCP
- HIDA scan
What is the pathology? What is the type of image?
dysfunction of the pyloric sphincter.
doesn’t move from space so concerned for gastroparesis on this gastric emptying study
What is the pathology? What is the type of image?
normal tagged RBC scan
What is the pathology? What is the type of image?
abnormal- blood flow connections occur outside where they are meant to
tagged RBC scan
What is the pathology? What is the type of image?
normal
should see movement form gallbladder to SI
MRCP
What is the pathology? What is the type of image?
obstruction gallstone blocking contrast into SI
MRCP
What pathology can HIDA scans indicate?
Sphincter of Oddi dysfunction
What is the pathology? What is the type of image?
Normal
HIDA scan
What is the pathology? What is the type of image?
gets into gallbladder, but doesn’t go anywhere else.
chronic cholecystitis
HIDA scan
What are the different scope procedures?
Endoscopic US
EGD
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
VCE
Enteroscopy
Colonoscopy
Sigmoidoscopy
ERCP
Percutaneous transhepatic cholangiography
Biopsy
Why do we typically like to do scopes first?
direct visualization
What four scope procedures, do we do most often?
EGD
colonoscopy
sigmoidoscopy
ERCP
What are the indications for the endoscopic US?
esophageal issues in the walls of the esophagus
What are the indications for VCE and Enteroscopy?
reserved for the worst-case scenario where we know something is going on in the SI.
Enteroscopy has the greater risk for perforation.
Which four scope procedures require anesthesia?
colonoscopy
sigmoidoscopy
ERCP
Enteroscopy
What are the indications for a scope?
need for direct visualization
some therapuetic
What are the greatest risks with a scope?
perforation
bleeding
introduction of infection
anesthesia
What is the pathology?
normal
What is the pathology?
barret’s with mass
What is the pathology?
esophagitis
What is the pathology?
esophageal varices
What is the pathology?
normal
What is the pathology?
gastric mass with retropulsion of the scope
What is the pathology?
gastric ulcer
What is the pathology?
bleeding gastric ulcer
What is the pathology?
normal colonoscopy
What is the pathology?
diverticulum
What is the pathology?
internal hemorrhoids with the scope in the top right corner
What is the pathology?
mass in the colon
What kind of complications occur at the fundus of the stomach? and what sx would be associated with it?
hiatal hernia
epigastric pain, heartburn, regurgitation, nausea
What kind of complications occur at the body of the stomach?
Ulcers
What kind of complications occur at the pylorus of the stomach? and what sx would be associated with it?
bloating, distension, N/V
ulcer sx
What kinds of things are we looking for on imaging of the SI?
start with an x-ray. but strong suggestion of SI issues, a CT will show the “transition zone”
multiple surgeries may be seen
strictures
adhesions
N/V
abdominal pain
masses
What kinds of things are we looking for on imaging of the LI?
issues with defecation
patient may have N/V
What kinds of things are we looking for on imaging of the liver?
acute hepatitis
RUQ pain
jaundice (bilirubin above 6)
- will show first in sclera of the eyes and mouth
- hard to see if different skin tones
What are the ranges of the de ritis ratio?
Acute viral hepatitis: AST and ALT VERY elevated, ALT>AST, ratio < 1
Chronic hepatitis: AST and ALT elevated, AST> ALT, ratio 1 to about 2
Alcoholic hepatitis: AST»ALT ratio > 2, GGT also elevated
What kinds of things are we looking for on imaging of the gallbladder?
issues with gallstones
painless jaundice = pancreatic mass/cancer
What kinds of things are we looking for on imaging of the pancreas?
- Sphincter of Oddi dysfunction may be caused by biliary sludge, a mass, or stone
- Epigastric pain with radiating to the back would indicate pancreatitis
- Things that cause pancreatitis: alcohol, gallstones, autoimmune disease, fatty diets (overworking), ERCP may cause inflammation and introduce bacteria causing pancreatitis
