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Gastrointestinal pathophysiology > Visualising the bowel > Flashcards

Visualising the bowel Flashcards

1
Q

Give the name of different means for visualising the bowel

A
  1. Barium swallow
  2. Barium enema
  3. Endoscopy
  4. Plain X-ray
  5. Cross sectional imaging: CT, ultrasound, MRI
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2
Q

Barium techniques are used to view which part of the GI tract?

A

Upper

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3
Q

What are the various barium techniques that can be used to view the upper GI tract?

A
  1. Barium swallow
  2. Barium meal (double contrast)
  3. Small bowel barium enema
  4. Double contrast barium enema
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4
Q

Where in the GI tract does the barium swallow method allow you to see?

A

Oesophagus to the stomach

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5
Q

Where in the GI tract does the barium meal method allow you to see?

A

Oesophagus to the small intestine

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6
Q

Where in the GI tract does the small bowel barium enema method allow you to see?

A

Small intestine

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7
Q

Where in the GI tract does the double contrast barium enema method allow you to see?

A

Colon

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8
Q

What is the difference between the single and double contrast barium visualisation techniques?

A
  1. Single contrast:
    - Lumen is distended with barium
    - Gives a large vague image
    - There is poor mucosal detail
    - Less sensitive at detecting polyps
  2. Double contrast
    - Mucosa is coated with barium and the lumen is distended with air
    - There is better mucosal detail with double contrast due to mucosal coating, allowing you to see smaller lesions e.g. adenocarcinomas
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9
Q

What can single contrast barium methods be used for?

A
  1. To check the patient is aspirating (barium swallow)
  2. To check the vague outline of the GI tract
  3. To check for pharyngeal pouching (pseudodiverticulum) or pharyngeal bar (constriction)
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10
Q

How is the double contrast barium method administered?

A

As a barium meal

  1. Patients take carbex with lemon juice which produces gas in the stomach
  2. Patient takes barium, then rolls around on the bed to coat mucosa
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11
Q

What does the double contrast barium meal check for?

A

Stomach and duodenal conditions e.g. ulcers and tumours

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12
Q

What is a barium swallow used for? Give some advantages and disadvantages

A

N.B it is single contrast
- It checks for conditions in the upper GI tract e.g. strictures and pouching

ADV: Good for high dysphagia, motility disorders and assessment of anatomy
ADV: Well tolerated by patients

DISADV: Can miss small lesions
DISADV: Limited sensitivity for cancers and inflammation (will miss early lesions)
DISADV: Patient also needs to be fit and mobile (rolling around)
DISADV: Poorly tolerated by elderly/immobile patients

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13
Q

How is the barium enema method administered?

A

As an injection of very dilute barium via syringe

- Can be followed by water to wash it round

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14
Q

What are the advantages and disadvantages of double contrast barium enema (DCBE)?

A
  1. Advantages
    - Great quality images
    - Can be zoomed in and out of
    - Safe procedure
    - Mostly tolerated well
    - Good for detecting intrinsic and extrinsic disease
  2. Disadvantages
    - Patient must be mobile and able to retain the air
    - Not as sensitive as colonoscopy
    - Not tolerated by some patients
    - Cant take histological samples
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15
Q

What is the gold standard for visualising the large bowel?

A

Colonoscopy

- It is more sensitive than DCBE and you can take histological samples

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16
Q

What does a colorectal adenocarcinoma look like?

A

A lesion which looks like an APPLE CORE

17
Q

What is an endoscopy?

A

Endoscopy is a procedure in which the GI tract is viewed with a lighted, flexible tube with a camera at the end (endoscope).

  1. Tissue samples can be obtained by biopsy
    2 Direct inspection of the mucosa
  2. Detects early pathology
  3. Allows biopsy/therapeutic procedure
18
Q

Endoscopy vs colonoscopy, what is the difference?

A
  • Endoscopy - Includes colonoscopy and upper endoscopy (gastroscopy)
  • Colonoscopy - A type of endoscopy in which the lining of the colon and rectum are viewed by inserting a tube into the rectum
19
Q

What does a gastroscopy (upper endoscopy) allow you to detect?

A
  • Gastritis
  • Gastric ulcers
  • Duodenal ulcers
  • Duodenal erosions
20
Q

What are the limitations of gastroscopies?

A
  1. Not good at assessing anatomy, motility and extrinsic disease
  2. Limited view of the pharynx and oesophagus
  3. Significant complication rate and very slight mortality rate
21
Q

What are complications of a gastroscopy?

A
  1. Sedation (cardiopulmonary problems)
  2. Perforation
  3. Haemorrhage
  4. Infection
  5. Slight mortality risk
22
Q

Why is endoscopy not good for imaging the small bowel?

A

Because it is not easily accessible, it can only get as far as the duodenum
- This is why barium imaging and cross-sectional imaging are better for looking at the small intestine

23
Q

What is capsule endoscopy?

A

Capsule endoscopy is where the patient swallows a small capsule with a camera. This sends images to a monitor on the patient’s waist/shoulder, then the images are reviewed. This is used for visualisation of the small bowel:

  • Cancers
  • Inflammation
  • Parasitic infection
  • Bleeding
24
Q

In which situation would you not give a capsule endoscopy?

A

When there is a stricture, as the capsule would get stuck

25
Q

What are the three types of endoscopy that exist for the large bowel?

A
  1. Colonoscopy (colonoscope) - Requires full prep, camera to cecum and terminal ileum
  2. Flexible sigmoidoscopy (sigmoidoscope) - Shorter and more flexible, enema prior to use, can reach transverse colon
  3. Proctoscopy (proctoscope) - Short and rigid, no prep, able to examine only the rectum
26
Q

Colonoscopies can be therapeutic (intervention) or diagnostic (observation and biopsy), give an example of the use of therapeutic colonoscopy

A

An example of the use of therapeutic colonoscopy is snaring of a colonic polyp - It becomes ischaemic and is cauterised (removed without bleeding)

27
Q

What are examples of cross sectional imaging?

A
  1. CT - has the highest radiation dose
  2. Ultrasound
  3. MRI
28
Q

Which disease can MRI be used to image?

A

IBD

- It can also be used to show extraenteric pathology

29
Q

Explain the process of CT colonoscopy (CTC)

- Give some advantages of CTC

A
  1. Patient CT scanned
  2. Bowel distended with air
  3. Can reconstruct a virtual fly through using 2D and 3D images

ADV - Sensitive at picking up polyps and cancers
ADV - No actual colonoscopy
ADV - Less invasive

However the Cigar trial still proves colonoscopy is the gold standard

30
Q

Why are MRIs and endoscopic ultrasounds unique?

A

They are the only techniques used to demonstrate the wall layers
- They provide high resolution imaging of the bowel wall and can therefore be used in cancer staging

Gastrointestinal pathophysiology (22 decks)

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