Investigations of GIT diseases

1. Endoscopy US, CT MRI Contrast studies Plain Radiograph GIT Motility Radioisotope Tests Imaging Histology Investigations of GIT diseases Tests of function Tests of structures Absorption Pancreatic Exocrine function Tests of infection Mucosal Inflammation/ permeability Bacterial culture Serology Breath Tests

2. Contrast Studies

3. Barium Swallow &Meal • Indications: • Possible motility disorder,e.g. achalasia or gastroparesis. • Suspected perforation or Fistula(non-ionic contrast) • Limitations: • Risk of aspiration • Poor mucosal detail • Unable to biopsy • Low sensitivity for early cancer

4. Barium swallow in patient with diffuse esophageal spasm

5. Epiphrenic diverticulum as shown by barium swallow

6. Esophageal carcinoma

7. Normal Barium Meal Duodenal bulb Descending duodenum Ascending duodenum

8. Gastric ulcer

9. Duodenal ulcer

10. Barium follow-through • Indications: • Diarrhea & abdominal pain of small bowel origin • Possible obstruction by strictures etc. • Major uses: • Malabsorption • Crohn’s disease • Limitations: • Time consuming • Radiation exposure • Relative insensitivity.

12. Chronic intestinal psuedoobstruction

13. Intestinal Tuberculosis At diagnosis Intestinal Tuberculosis (after 5 months of therapy)

14. Early stenosing Crohn’s disease

15. Crohn’s disease

16. Barium Enema • Indications and major uses: • Altered bowel habit • Evaluation of strictures or diverticular dis. • Megacolon • Chronic constipation • Suspected colon cancer (but superseded by colonoscopy) • Limitations: • Difficult in frail elderly or incontinent patients • Sigmoidoscopy is also necessary to evaluate rectum • Possibly misses polyps < 1 cm

17. Scattered diverticulosis of the left colon

18. Double contrast barium enema (normal)

19. Barium enema showing familial adenomatosis coli Arrow point to cancer arise in this setting

20. Pancolonic diverticulosis

21. Chronic Ulcerative Colitis

22. US & Doppler CT MRI (CT)-PET

23. Ultrasound • Major uses: • Abdominal masses • Organomegaly • Ascites • Biliary tract dilatation • Gallstones • Guided needle aspiration & biopsy of lesions • Limitations: • Low sensitivity for small lesions • Little functional information • Operator dependant • Gas & obesity may obscure view

24. CT Scan • Major uses: • Assessment of pancreatic disease • Hepatic tumor deposits • Tumor staging • Assessment of vascularity of lesions. • Limitations: • Expensive • High radiation dose • Availability

25. MRI • Major uses: • Hepatic tumor staging • MRCP • Pelvic/perianal disease • Crohn’s fistulae • Small bowel visualisation • Limitations: • Limited availability • Time consuming • “Claustrophobic” for some. • Contraindicated in presence of metallic prosthesis, cardiac pacemaker, cochlear implants.

28. Endoscopy US, CT MRI Contrast studies Plain Radiograph GIT Motility Radioisotope Tests Imaging Histology Investigations of GIT diseases Tests of function Tests of structures Absorption Pancreatic Exocrine function Tests of infection Mucosal Inflammation/ permeability Bacterial culture Serology Breath Tests

29. Upper GIT Endoscopy

30. INDICATIONS. • Dyspepsia over 55 yr or with alarm symptom • Atypical chest pain • Dysphagia ,Vomiting ,Loss of weight • Acute or chronic gastrointestinal bleeding • suspicious barium meal ,C T .SCREENING for esopharealvarices • Therapeutic. • Duodenal biopsies CONTRAINDICATIONS • Severe shock ,Recent MI ,Unstable angina , Arrhythmia • Severe respiratory dis., Atlantoaxialsubluxation • Possible visceral perforation COMPLICATION • Cardiorespiratory depression due to sedation • Aspiration pneumonia • Perforation

31. Video endoscopy unit

32. Normal esophagus

33. Esophageal Diverticulum

34. Malignant esophageal lesion

35. Esophageal varices

36. Barrett’s Esophagus

37. Achalasia

38. Esophageal Ulcer HIV patient

39. NormalStomach Body

40. Erosive Gastritis

41. Capsule Endoscopy • Indication Obscure GI bleeding Small bowel Crohn’sdis ,Coeliacdis, Familial polyposis syndrome • Contraindication Small bowel stricture ,pacemaker

43. Double Balloon enteroscopy • Indication Diagnostic Therapeutics • Contraindication • Complications: abdominal pain 20% pancreatitis perforation

45. Colonscopy

46. colonoscopy Indications Suspected infl.bowl dis. , ch.Diarrhoea Altered bowl habit Rectal bleeding or anemia Assessment of abnormal barium enema Colorectal cancer screening Colorectal adenoma follow-up Therapeutic procedures

47. Contraindications Severe , active ulcerative colitis Recent MI,unstable angina arrhythmia ,severe resp. dis. Atlantoaxialsublax. ,?Visceral perfor. Complication Cardioresp. Dep. Due to sedation Perforation Bleeding

48. Normal Colonscopy

50. TESTS OF INFECTION