Overview: Evaluation of the Gastrointestinal Tract

Diagnostic Tests

• Radiology– Plain radiology– Upper GI series– Lower GI series

• Imaging– Ultrasonography (US)– Computed tomography

(CT)– Magnetic resonance

imaging (MRI)

• Endoscopy– Esophagogastro-

duodenoscopy (EGD)– Colonoscopy– Sigmoidoscopy– Endoscopic retrograde

cholangiopancreato-graphy (ERCP)

Plain Radiology

• Abdominal x-ray– Kidney, ureters, and

bladder (KUB)– Other: esophagus,

stomach, intestine

• Often used to evaluate abdominal pain

Upper Gastrointestinal Series

• Focus on esophagus, stomach, and small intestine

• Often called ‘barium swallow’

• “Small bowel follow-through”– Includes small intestine

• Evaluates obstruction, tumors, ulcers, cancer, PUD, GERD

Upper Gastrointestinal Series

Gastric Ulcer

Lower Gastrointestinal Series

• Barium used to contrast large intestine and rectum

• Evaluates obstruction, lesions, Crohn’s disease, ulcerative colitis, cancers, diverticulitis

Lower Gastrointestinal Series

Ultrasonography (US)

• Provide images of deeper structures– Pancreas– Gallbladder

• Limited by the presence of gas or obesity

Ultrasonography (US)

Computed Tomography (CT) Scan or Computed Axial Tomography (CAT) scan

• Transverse planes of tissue by radiography

• Not limited by the presence of gas or obesity

Computed Tomography (CT) Scan or Computed Axial Tomography (CAT) scan

Computed Tomography (CT) Scan or Computed Axial Tomography (CAT) scan

Magnetic Resonance Imaging (MRI)

• High-strength magnetic field creates radiofrequency irradiation that ‘excites’ cells

• Greater sensitivity to identify liver tumors

Endoscopy

• Illuminated optical instrument– Biopsy forceps– Cytology brushes– Electrocautery probes

• Medications used– Topical anesthetic– ‘Conscious sedation’

• Contraindicated in severe respiratory or cardiac failure, perforation

EGD - Esophagogastroduodenoscopy

Normal Esophagus

EGD - Esophagogastroduodenoscopy

• Normal esophagus is white to tan smooth mucosa

• Transition from white squamous mucosa to pink columnar mucosa

Esophagogastric Junction

EGD - Esophagogastroduodenoscopy

Normal Stomach

EGD - Esophagogastroduodenoscopy

Normal Pyloric Junction

Reflux Esophagitis

Barrett’s Esophagus

• Replacement of squamous mucosa with columnar epithelium

Esophageal Varices

Gastric Ulcers

NSAID-induced Gastritis

Helicobacter pylori

Helicobacter pylori

• CLO test– ‘Campylobacter Like Organism’ test• Campylobacter means

“curved bacteria”• Helicobacter means “spiral

or helical bacteria”

– Urease enzyme of H. pylori causes medium to change to red

Top - negative or unused testMiddle - red around a biopsy infected with H. pyloriBottom - final result of biopsy infected with H. pylori

Colonoscopy

Normal Cecum

Colonoscopy

Normal Ascending Colon

Colonoscopy

Normal Transverse Colon

Colonoscopy

Normal Sigmoid Colon

Colonoscopy

Normal Rectum

Clostridium difficile

Nifedipine (Procardia XL®)

Sigmoidoscopy

Endoscopic retrograde cholangiopancreatography (ERCP)

Endoscopic retrograde cholangiopancreatography (ERCP)

Esophageal Manometry

• Evaluates esophageal motor functions– Lower esophageal

sphincter– Delayed gastric emptying

• Measures esophageal pressure and peristalsis

• Quantifies esophageal competence and body motor activity

Ambulatory pH Monitoring

• Best method to determine the actual amount of reflux

• Links esophageal acid exposure with patient symptoms

• pH probe placed above the distal esophagus

Summary