INVESTIGATING GI DISEASES Flashcards
What are the routine blood tests?
FBC
U&E
LFT
Clotting /INR
ESR
CRP
B12 and folate
What should you send a stool sample for in pt presenting with diarrhoea?
Microscopy, culture and sensitivities (to rule out infection)
What is faecal calprotectin?
A protein found in stool during intestinal inflammation (IBD and infection)
>200ug/g suggests this
What are the rules of gastroscopy?
Pt should be fasted for at least 4 hrs
Give oxygen and ,monitor sats
Give lidocaine throat spray or sedation
Pass gastroscopy to the duodenum under direct vision
Examine during insertion and withdrawal
Withhold fluid and food until local anaesthetic or sedation wears off
Be aware of over-sedation, perforation and aspiration
Pt must be accompanied home if sedation was given
What are the rules with colonoscopy?
Stop oral iron a week before the procedure
Restrict diet to low-residue foods for 48 hours and clear fluids only for 24hrs
Use a local bowel-cleansing regime 24 hours before hand e.g. sodium picosulfphate with magnesium citrate
Give oxygen and monitor sats
Give sedation if required
Pass colonoscopy to caecum or ileum under direct vision
Examine in detail during withdrawal
Withhold fluid and food until sedation wears off
Observe he patient for at least an hour after sedation has been given.
Complications are rare but beware of over-sedation, perforation and aspiration.
The patient must be accompanied home if sedation has been given.
Whats a proctoscope?
a straight, hollow metal or plastic tube, sometimes with a tiny light at the end, that allows the gastroenterologist to make a detailed examination of the rectum
is performed in all patients with a history of bright red rectal bleeding to look for anorectal pathology such as haemorrhoids; a rigid sigmoidoscope is too narrow and long to enable adequate examination of the anal canal.
What is a sigmoidoscopy and who would have one?
is part of the routine hospital examination in cases of diarrhoea and in patients with lower abdominal symptoms such as a change in bowel habit or rectal bleeding. Rigid sigmoidoscopy can visualize the distal 20–25 cm of large bowel, whereas flexible sigmoidoscopy (FS) can reach up to the splenic flexure (60 cm), and is typically performed in the endoscopy unit after evacuation of the distal colon using an enema or suppository.
What is capsule endoscopy used for?
the evaluation of obscure gastrointestinal bleeding (after negative gastroscopy and colonoscopy) and for the detection of small bowel tumours and occult inflammatory bowel disease. It should be avoided if strictures are suspected.
What are plain x-rays used for?
investigation of an acute abdomen.
Plain films are particularly useful where obstruction or perforation is suspected, to exclude toxic megacolon in colitis, and to assess faecal loading in constipation. Calcification may be seen with gall-bladder stones and in chronic pancreatitis, though computed tomography is more sensitive for both.
Whats the first-line investigation for abdominal distension?
Ultrasound
Whats used as a first-line investigation for acute abdomen?
CT scan
When is MRI useful?
Particularly useful in the evaluation of rectal cancers and of abscesses and fistulae in the perianal region. It is also useful in small bowel disease (MR enteroclysis) and in hepatobiliary and pancreatic disease.
When is PET scans used?
It is used for staging oesophageal, gastric and colorectal cancer and in detecting metastatic and recurrent disease.
What is used in contrast studies?
barium swallow examination, double-contrast barium meal and small-bowel follow through or meal.
Absorbable water-soluble contrast agents should be used in preference to barium when perforation is suspected anywhere in the gut.
When are contrast studies particularly useful?
for the upper GI tract and small bowel but do rely on good technique. They are gradually being superseded by other modalities of imaging, particularly MRI.
