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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
Lower Gastrointestinal Series
• Barium used to contrast large intestine and rectum
• Evaluates obstruction, lesions, Crohn’s disease, ulcerative colitis, cancers, diverticulitis
Ultrasonography (US)
• Provide images of deeper structures– Pancreas– Gallbladder
• Limited by the presence of gas or obesity
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
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 is white to tan smooth mucosa
• Transition from white squamous mucosa to pink columnar mucosa
Esophagogastric Junction
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
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