Diagnostic Methods for Gastrointestinal Diseases: A Comprehensive Overview

Explore various diagnostic methods for gastrointestinal diseases, including laboratory investigations, abdominal ultrasound features, and radiology techniques. Learn about the significance of different tests such as ESR, blood count, liver tests, and abdominal ultrasound in diagnosing conditions affecting the digestive system. Discover the roles of imaging modalities like Doppler ultrasound, contrast-enhanced ultrasonography, and upper GI barium radiography in evaluating GI disorders. This comprehensive guide provides valuable insights into diagnosing gastrointestinal ailments effectively.

• gastrointestinal diseases
• diagnostic methods
• laboratory investigations
• abdominal ultrasound
• radiology techniques

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1. Diagnostic methods for gastrointestinal diseases

2. Laboratory investigations ESR: increased: inflammation, tumors (but can be normal) Blood count leukocytes: : inflammation eosinophilia: helminthiasis, allergy anemia (Hb, HCT): GI bleeding (manifest or occult) Se Iron : bleeding, malabsorption, chr.infection

3. Laboratory investigations Liver tests: AST(GOT), ALT(GPT): cell damage ALP, GGT, bilirubin: cholestasis prothrombin time , se albumin : liver failure Pancreas: amylase, lipase, functional tests Fecal occult blood test (FOBT) Stool cultures for bacteria and parazites Urine: jaundice, uroinfection, kidney stone

4. Abdominal ultrasound features specific US methods Doppler-ultrasound - for vascular lesions US-guided biopsy Contrast enhanced ultrasonography EUS- endoscopic ultrasound - endosonography

5. Abdominal ultrasound Liver echogenity, masses, cysts, bile ducts, veins Biliary tract gallstones (hyperechoic lesion with acoustic shadow), sludge, CBD stones, cholecystitis Pancreas acute pancreatitis, chr.pancreatitis, pseudocysts, tumors Others ascites, organomegalies, lymph nodes, appendicitis, intraabdominal masses (tumor, abscess, cyst, inflammatory mass), kidneys

6. Radiology Plain abdominal X-ray free air (upright position) gas/fluid levels within dilated loops calcifications Upper GI barium radiography (single or double contrast studies) esophagus (first examination in dysphagia) contour, peristalsis, folds motility disorders, stenoses

7. Radiology Upper GI barium radiography stomach and duodenum peristalsis, emptying, shape, folds, retrogastric space perforation: with water-soluble contrast agent in case of GI hemorrhage: endoscopy Barium study of the small bowel small bowel follow through study enteroclysis stenoses, polyps, mucosal alterations, ileitis terminalis

8. Radiology - angiography diagnosis of vascular diseases, obscure GI bleedings therapeutic angiography is evolving (chemoembolisation of tumors, occluding bleeding vessels, dilation of vessels)

9. Computer tomography features specific CT methods contrast agents (orally administered, iv.) CT-guided biopsy virtual colonoscopy

10. Computer tomography Liver masses (benign, malignant [primary or metastatic neoplasms], hemangiomas, cysts, abscesses) , cirrhosis, ascites and other signs of portal hypertension, lymph nodes Biliary tract dilated bile ducts, imaging of CBD, distal bile duct stones, CBD neoplasms

11. Computer tomography Pancreas neoplasms: diagnosis, staging acute pancreatitis: extent of necrosis, peripancreatic fluid collections, guided biopsies chr. pancreatitis: pseudocysts, calcifications Miscellaneous staging of gastrointestinal malignancies, intra-abdominal masses (abscess, inflammatory, tumors), invasion of adjacent structures

12. Magnetic resonance imaging generally not superior to CT in abdominal diseases sensitive very expensive special methods MR angiography MRCP - magnetic resonance cholangio- pancreatography

13. Endoscopy features diagnostic endoscopy provides histological sampling (biopsy, brush cytology) therapeutic endoscopy

14. Upper GI endoscopy Esophagogastroduodenoscopy (EGD) Diagnostic GI bleeding refractory vomiting dysphagia, odynophagia gastroesophageal reflux ulcers suspicion of neoplasm (weight loss, etc.) surveillance of healing lesions surveillance of polyps, tumors

15. Upper GI endoscopy Therapeutic treatment of variceal and nonvariceal GI bleeding injection technics, hemoclip, ligation, thermal technics (electrocoagulation, heat probe, laser, argon plasma) removal of polyps, early neoplasms dilation of strictures placement of feeding gastrostomy tube removal of foreign bodies

16. Lower GI endoscopy Colonoscopy, rectosigmoidoscopy, rectoscopy Diagnostic Bleedings (occult or hematochezia, iron deficiency) Chronic diarrhea Suspicion of cancer Suspicion of inflammatory bowel disease Screening for cancer (altered bowel habits, risk groups for colon cancer)

17. Lower GI endoscopy Colonoscopy, rectosigmoidoscopy, rectoscopy Therapeutic Removal of polyps, early cancers Dilation of stenoses Decompression

18. Endoscopic retrograde cholangio- pancreatography - ERCP Diagnostic suspicion of choledocholithiasis unexplained jaundice and cholestasis acute biliary pancreatitis some cases of chr. pancreatitis Therapeutic endoscopic sphincterotomy - EST endoscopic biliary/pancreatic drainage endoscopic biliary/pancreatic stenting dilation of strictures endoscopic lithotripsy

19. Miscellaneous diagnostic methods Biopsies (US/CT-guided)- liver, pancreas, masses Punctions - ascites, cysts Percutaneous transhepatic cholangiography (PTC) or drainage (PTD) Laparoscopy Helicobacter pylori diagnostics stains, rapid urease-test, urease breath test (UBT) 24h pH monitoring Manometry (esophageal, rectal, Oddi-sphincter, bowel)

20. Common abdominal syndromes

21. Gastroesophageal reflux disease - GERD History: Esophageal: heartburn, chest pain, regurgitation, acidic taste in mouth, dysphagia, odynophagia, Extraesophageal: chr.cough, asthma, noncardiac chest pain, dental erosions Characteristics: increase in laying position night symptoms resolve after antacids Physical findings: Diagnosis: history, endoscopy, pH-monitoring, barium swallow

22. Esophageal cancer History: dysphagia, odynophagia, pain, vomiting, weight loss Characteristics: older males, alcoholics, smokers progressive dysphagia (solid vomiting just after meals Physical finding: general tumor signs Diagnosis: barium swallow, endoscopy softer liquid)

23. Peptic ulcer (duodenal, gastric) History: epigastric pain Characteristics: radiates to the back duodenal: younger people, hyperacid symptoms, relapsing disease, more symptoms in spring and fall, pain resolves after meals and recur after 2 hours, night pain, resolve using antacids gastric: older people, pain just after meals, weight loss smokers NSAID (aspirin) use

24. Peptic ulcer (duodenal, gastric) Physical finding: epigastric/RUQ tenderness Diagnosis: endoscopy

25. Peptic ulcer - complications Bleeding: melena, hematemesis, (rarely: hematochezia) rectal digital examination Perforation: acute onset very sharp pain (knife-like) liver/splenic dullnes: absent peritoneal signs: defence (guarding), rebound tenderness, no bowel sounds Dg: abdominal plain film study with water-soluble contrast agent

26. Gastric cancer History: epigastric pain, fullness, vomiting, weight loss Characteristics: older people, pain arise at meals dull, progressive pain Physical findings:epigastric pain, epigastric mass Virchow s lymph node general tumor signs occult bleeding Diagnosis: endoscopy, US

27. Acute appendicitis History: first periumbilical, later ileocecal pain nausea subfebrility Characteristics: invariable first colicky, than steady pain Physical findings: ileocecal tenderness (McBurney s point) ileocecal guarding rebound tenderness obturator sign: pain rotating the right hip psoas sign: pain raising against resistance the straightened right leg Diagnosis: physical examination, US, laboratory

28. Intestinal obstruction (ileus) 1. Mechanical History: altered bowel habits, constipation, fullness, meteorism, cramping pain, vomiting (bile, fecal material) Characteristics: variable or progressive Physical finding: meteorism increased bowel sound(early phase ) splash signs of underlying disease Diagnosis: plain abdominal x-ray, CT searching for the cause

29. Intestinal obstruction (ileus) 2. Paralytic History: signs of the underlying disease, constipation, fullness, meteorism, cramping pain, vomiting Physical finding: meteorism absent bowel sound splash signs of the underlying disease Diagnosis: plain abdominal x-ray searching for the cause

30. Colorectal cancer History: altered bowel habits bleeding (occult or manifest) late: signs of obstruction cramping pain general tumor signs positive family history Physical finding:rectal digital examination late: mass, ileus Diagnosis: endoscopy, US, CT

31. Acute hepatitis History: asymptomatic after flu-like symptoms jaundice anorexia, dyspepsia RUQ pain Physical finding: jaundice enlarged liver: smooth, soft, round, tender Diagnosis: liver tests, virus tests

32. Chronic hepatitis History: symptoms: not characteristic anorexia, dyspepsia later: symptoms of cirrhosis Physical finding: enlarged liver (can be normal) Diagnosis: US, liver biopsy, serology

33. Liver cirrhosis History: alcohol consumption, chr. hepatitis (HBV, HCV, HDV, HGV, autoimmune), anorexia, dyspepsia, nausea ascites, edemas, portal encephalopathy jaundice, bleeding Physical findings: first: enlarged liver micronodular: alcoholic macronodular: chr. virus or autoimmune hepatitis- postnecrotic cirrhosis end stage: small liver

34. Liver cirrhosis Physical findings: skin: palmar and plantar erythema paper money skin spider naevi icterus (scratching) gynecomasty testicular atrophy signs of portal hypertension: ascites (transsudate) caput Medusae splenomegaly edema Diagnosis: US, liver biopsy, laboratory

35. Symptoms Signs Delirium, Coma Encephalopathy Xanthelasma Jaundice Anorexia Spider naevi Nausea Hematemesis Excoriations Axillar hair loss Jaundice , Itching Gynecomasty Hepatomegaly Dull pain Delayed bleeding Abdominal distension Splenomegaly Ecchymosis Ascites Tremor Caput Medusae Tremor Decreased libido Palmar erythema Pubic hair loss Testicular atrophy Swelling Oedema

36. Biliary colic History:pain after fatty meals nausea, vomiting (often bile) fullness, meteorism Characteristics: RUQ-pain, radiates to the back (scapula, right shoulder) mostly females Physical finding: RUQ tenderness Diagnosis: US

37. Acute cholecystitis History: like in biliary colic + fever Physical finding: Murphy s sign Diagnosis: US, laboratory: signs of inflammation Choledocholithiasis (Common bile duct stone) History: like in biliary colic + obstr. jaundice Diagnosis: US, ERCP, CT

38. Acute pancreatitis History: gallstone disease,alcohol, fatty meal epigastric pain fullness, nausea, vomitus fever jaundice hypotony, shock Characteristics: band-like, cramping pain radiates to the back

39. Acute pancreatitis Physical findings: epigastric tenderness/guarding peritoneal signs signs of paralytic ileus (meteorism, no bowel sounds) skin signs: Cullen s sign-periumbilical ecchymoses Grey-Turner s sign- lumbar ecchymoses Diagnosis: pancreatic enzimes, US, CT

40. Chronic pancreatitis History: cramping pain anorexia, dyspepsia, nausea, vomitus gallstone or alcohol consumption weight loss steatorrhea Characteristics: pain in the back increases after meals Physical finding: epigastric tenderness epigastric mass (pseudocyst) sometimes jaundice Diagnosis: plain abd. X-ray, US, CT, ERCP