Git 4th 1st.
Download as PPT, PDF1 like790 views
This document provides an overview of gastroenterology and hepatology. It discusses common GI diseases and symptoms, as well as various tests used to evaluate GI structure, infections, and function. These include imaging studies, endoscopy, biopsies, bacterial cultures, serology tests, breath tests, and radioisotope tests to assess conditions like gastric emptying, HP infection, Meckel's diverticulum, bleeding, and malabsorption. Therapeutic endoscopy is highlighted as a less invasive alternative to surgery for many GI conditions.
Git 4th 1st.
- 1. Gastroenterology& hepatology: Introduction Dr. Mohammad Shaikhani. Assistant professor Sulaimanyah college of Medicine.
- 2. GI Diseases: Major cause of morbidity & mortality. 10% of GP consultations are for indigestion. ¼ of GP consultations for diarrhea. Infective diarrhea is a major cause of ill heath & death in developing countries. GIT is one of the most common sites for cancer. Major advances had occurred in the field of GE; PUD proved to be an infective condition due to HP & Nobel prize had been given recently to its discoverer, Marshal. Molecular events in the CRC development had been discovered & from this effort became successful in its prevention by NSAIDs. GIT endoscopy made diagnosis of GIT diseases very easy. Therapeutic endoscopy made it possible to replace surgery for many GIT conditions as GI bleeding, bilairy stone removal & stenting, palliative cancer stenting, polyp removal, PEG & endoscopic mucosal resection.
- 3. Clinical exam in GIT:
- 4. GI symptoms: Dysphagia: difficult swallowing Odynophagia: painful swallowing. Aphagia: can not swallow. Heart burn. Non cardiac chest pain. Regurgitation. Aerophagia: eructation. Hematemesis. Melena. Hematochesia: fresh bleeding per rectum. Dyspepsia: abnormal digestion. Anorexia. Flatulence. Alteration in bowel habits. Bleeding per rectum. Abd pain.
- 5. GI Diseases: Investigations Tests of structure. Tests of infection. Tests of function.
- 6. 1.Tests of structure: Imaging Plain radiograph: Show gas within bowel for diagnosis of Int obst if there are dialated loops or fluid levels in the erect position. Soft tissue of the liver, spleen& kidneys & calcifications in these organs, pancrease,blood vessels, LNs,calculi. Chest XR in erect position show air under diaphragm in perforated viscus.
- 7. SBO
- 10. Tests of structure: Imaging Contrast studies: Barium & double-cnotrast barium using air with barium, will show filling defects, strictures, erosions & ulcers & even motlity disorders if under fluroscopy.
- 11. Tests of structure: ENDOSCOPY
- 12. Tests of structure: ENDOSCOPY
- 13. Tests of structure: Imaging Contrast studies: uses & limitations. Time consuming. Radiation exposure. Malabsorption. Chrons. Ba follow through: Diarrhea,abd pain, Obst by stricture Difficult in elderly. incontinance., No biopsy. Ca, diverticuli,stricture,megacolon. Ba enema Abn bowel habit,Rectal bleeding,anemia,abd pain Low sensitivity for early cancer. No biopsy No HP assessment. DU,GU,Gastric Ca,GOO, Gastric emptying disorder. Ba meal: Dyspepsia,epigastric pain,vomiting,anemia,perforation. Aspiration risk Poor mucosal detail No biopsy Stricture, HH,GERD,Achalasia. Ba swallow: Dysphagia,rfelux,chest pain,motility disorder Limitations Major uses Indications
- 14. Tests of structure: Imaging U/S,CT,MRI: Increasingly used for abd diseases, noninvasive & offer detailed images of abd contents. Time consuming. Clusterphobia,role not fully established,limited availability. Tumor stage,MRCP,pelvic/perineal, chrons fistula. MRI: Expensive,high radiation, may underestimate stage of cancers as esophagus. Pancreatic dis,liver tumor deposits, tumor staging, vascular lesions. CT: Low sensitive for small ls. Little functional info. Operator dependent. Gass & obesity interfer with it. Masses,abscess,organs,ascites,biliary dilation,gall stones,guided needle aspiration & biopsy. US: Limitations Major uses Indications
- 16. Tests of structure: endoscopy Endoscpy: UGI, LGI, Enteroscopy, ERCP,EUS , Double balloon endoscopy, capsule video endoscopy. Increasingly used for abd diseases, noninvasive & offer detailed images of abd contents.
- 17. Tests of structure: endoscopy Endoscpy: UGI: Indications: Dyspepsia sp > 45. Abd pain. Atypical chest pain. Dysphagia Vomiting. Wt loss. Acute or chronic GIB. Suspicious Ba meal.
- 18. Tests of structure: endoscopy Endoscpy UGI: contraindications: Severe shock. Recnet AMI, Unstable angina or arrhythmia. Severe resp dis. Atlanto axial sublaxation. Suspected perforated viscus. These may be relative in experienced hands. Endoscpy UGI: Complications: Cardiorespiratory depression due to sedation. Aspiration pneumonia. Perforation. Bleeding. SBE( needs prophylaxis in those at risk).
- 19. Tests of structure: endoscopy Colonoscopy: indications: Suspected IBD. Altered bowel habits. Rectal bleeding or anemia. Suspected abn Ba enema. CRC screening. Therapeutic procedure. C/Is: Severe shock, Recent AMI, unstable angina & arrhythmias,Severe resp disease,Suspected perforation,severe active UC. Complications: As for upper GI endoscopy.
- 20. Examples of therapeutic techniques in endoscopy.
- 22. ERCP – DILATED COMMON BILE DUCT DUE TO MULTIPLE GALLSTONES
- 24. Tests of structure: Biopsy Obtained through endoscpy or percutanously & sent for histopath exam. Reasons for biopsy or cytological exams: Brash cytology of suspected malignant lesions. Histological assessment of mucosal abns. Diagnosis of infections( candida, HP,Giardia). Measure enzymes as disacharidases. Analysis of genetic mutations as oncogenes , tumor suppressor genes.
- 25. 2.Tests of infection: Bacterial cultures For identifying causes of diarrhea sp if acute or bloody. Causes of infective diarrhea: Viruses: Rota, adeno, entero, requires EM or viral cultures. Bacteria: Campylo jej, EC,Salmonella,clostridium difficile( ned toxine isolation). Protozoa: Giardia,ameba, cryptosporidium & moicrospora.
- 26. Tests of infection: serology Sp for HP, Salmonella, hydatid liver & ameba.
- 27. Tests of infection: radioactive breath tests For diagnosis for HP & small intestinal bacterial overgrowth.
- 28. 3.Tests of function: blood tests for malabsorption S.B12, folic acid, iron, Ca, alumin, phosphate,stool fat, endoscopic DU biopsy. Tests for diagnosing fat, lactose,bile acids malabsorption. Tests of pancreatic exocrine function
- 29. Tests of function: GIT motility Esophageal motlity: Eso manometry with 24 hour Ph monitoring: for diagnosing refractory GERD, Achalasia & noncardiac chest pain. Gastric motility: Assessment of gastric emptying in patients with gastropariesis, is best evaluated by radioisotope studies by a test meal of solid & liquid labeled with different radioisotopes. Small intestine transit: Difficult & rarely needed. Ba follow through can measure SI transit to reach TI( 90 min). Orocecal transit is measured by lactulose-hydrogen breathtest. Colonic & anorectal motility: Assessed by anorectal manometry, EP tests, defecating proctography. Plain Abd XR taken on day 5 after ingestion of different-shaped inert plastic pellets on day 1-3 gives estimate of whole gut transit time. Help to diagnose chronic idiopathic constipation from mechanical or obstructed defecation.
- 30. Tests of function: Radioisotope tests Gastric emptying study: by Tc. Urea breath test: by radioactive Carbon: for HP diagnosis as HP have urease which split radioactive urea into amonia & CO2 measured in the breath. Meckels sacn: TC. Labeled RBC scan FOR DETECTING BLEEDING. Labled WBC scan: for detecting infection or inflammation. Triolin test: C14 labeled trioliln: for fat malabsorption. Labelled albumin: to detect protein-losing enteropathy.