Imaging the gut

Question 1

what are barium swallow used for?
what are barium meal used for?
what are barium enema used for?

Answer 1

barium swallow

investigates: helps to find level of obstruction in oesphagus or abnormal peristalsis of oesphagus.
- sometimes used before endoscopy

barium meal:
- barium goes to stomach: assess for gastric cancers and peptic ulcers

barium enema:
- barium enters colon: obstruction & polyps found

Question 2

endoscopy
- function (4)?

Answer 2

Endoscopy:

function:

a) diagnosis
i) macroscopic - e.g can see tumor
ii) histological
iii) mamometry - assesses pressure
iv) endomicroscopy

b) therapy: e.g. removal of polyp
c) surveillance: e.g. assess for reoccurence of cancers
d) screening

Question 3

advantage (4) vs disadvantage (4) of endoscopy vs radiology?

Answer 3

• *advantages:**
• macroscopic & real time
• obtain histology
• visualise entire bowel
• therapeutics
• *disadvantages:**
• sometimes need sedation
• technically demanding
• complications (e.g. perforation)
• limited to luminal views

Question 4

what is real time histology aka?

Answer 4

Chromoendoscopy:

• involves the realtime topical application of stains or pigments to improve tissue localization, characterization, or diagnosis during endoscopy
• detect lesions

Question 5

when do u gastroscopy for upper GI diagnostic investigations? (8)

Answer 5

• *gastroscopy:**
• dysphagia
• odynophagia (painful swallowing)
• epigastric pain
• haemetemesis (vom blood) / meleana (black stool)
• weight loss
• anaemia
• diarrhoea / malabsorption
• surveillance

Question 6

what treatments can you do with upper GI tract endo / gastroscopy?

Answer 6

1. dilatation: e.g. obstruction in oesphagus. e.g. use stent

2. haemostasis: stop bleeding

3. variceal management: Variceal haemorrhage is defined as bleeding from an oesophageal or gastric varix at the time of endoscopy

4. gastrostomy injection: flexible feeding tube is placed through the abdominal wall and into the stomach. PEG allows nutrition, fluids and/or medications to be put directly into the stomach, bypassing the mouth and esophagus.

5. botox injection: relax sphincter

6. polypectomy

Question 7

what is an enteroscopy?
what is a capsule endoscopy? whats an ad? what are two disadvantages?

which one is ideal?

Answer 7

enteroscopy: procedure used to examine the small intestine

capsule endoscopy: swallow a capsule that contains a small disposable camera. The capsule is the size of a large pill. The camera takes thousands of pictures as it travels along your gut.

i) advantage:
a) minimally invasive

ii) disadvantages:
a) cannot take biopsies
b) may get stuck - so initally do a trial run with similar, but digestiable version

capsule endoscopy is ideal

Question 8

when do you want to undertake enterscopy / capsule endoscopy? (5)

Answer 8

• investigate anaemia / bleeding
• diarrhoea
• abnormal x-ray
• small bowel samples
• therapy

Question 11

what is a double balloon endoscopy?

Answer 11

We put a long, thin, flexible tube called an enteroscope into your mouth and down into your intestine. It is just thinner than your little finger and has a camera in the tip which sends video images to a screen

. Because your small bowel is floppy, it is difficult to pass the enteroscope all the way along it. So we inflate and deflate two balloons on the outside of the enteroscope in sequence, to keep it steady and allow us to fully examine this part of your body. This is why it is called a double balloon enteroscopy

• **invasive
• long procedure**

Question 12

what is an ERCP?

where does is investigate?

therapeutically used for?

Answer 12

ERCP = Endoscopic retrograde cholangiopancreatography

investigates: biliary tree: a system of vessels that directs these secretions from the liver, gallbladder, hepatic ducts, duodenal papilla and pancreas through a series of ducts into the duodenum. specifically obstructions

therapeutically used for:

• gall stone removal
• tumour stenting
• manometry

Question 13

why do a colonscopy (3)

Answer 13

diagnosis:

• rectal bleeding
• altered bowel habit
• abdominal pain

surveillance

therapy:

• polypectomy
• EMR (Gastrointestinal endoscopic mucosal resection (EMR) is a procedure to remove precancerous, early-stage cancer or other abnormal tissues (lesions) from the digestive tract)
• dilatation
• stent insertion

Question 14

what is virtual colonoscopy / Computed tomography (CT) colonography (CTC)

Answer 14

Virtual colonoscopy is a special X-ray examination of the colon using low dose computed tomography (CT). It is a less invasive procedure than a conventional colonoscopy. A radiologist reviews the images from the virtual colonoscopy to look for polyps on the inside of the colon that can sometimes turn into colon cancer.

BONUS:
can review extra-colonic organs (i.e. liver, spleen, bladder, uterus etc) - can see things here that wouldnt have seen with just colonscopy.