Contrast Studies

Investigations of GIT diseases

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



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

Epiphrenic diverticulum as shown by barium swallow

Esophageal carcinoma

Duodenal bulb

Descending duodenum
Ascending duodenum

Gastric ulcer

Duodenal ulcer



Indications:Diarrhea & abdominal pain of small bowel origin Possible obstruction by strictures etc. Major uses:Malabsorption Crohn’s diseaseLimitations:Time consuming Radiation exposureRelative insensitivity.

Chronic intestinal psuedoobstruction

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

Early stenosing Crohn’s disease

Crohn’s disease

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 Megacolon Chronic constipation Suspected colon cancer (but superseded by colonoscopy) Limitations: Difficult in frail elderly or incontinent patients Sigmoidoscopy is also necessary to evaluate rectum Possibly misses polyps 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

Scattered diverticulosis of the left colon

Double contrast barium enema (normal)



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

Pancolonic diverticulosis

Chronic Ulcerative Colitis

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

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

Major uses:Hepatic tumor staging MRCPPelvic/perianal diseaseCrohn’s fistulaeSmall bowel visualisationLimitations: Limited availability Time consuming “Claustrophobic” for some. Contraindicated in presence of metallic prosthesis, cardiac pacemaker, cochlear implants.

Investigations of GIT diseases

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



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 esophareal varices Therapeutic. Duodenal biopsies CONTRAINDICATIONS Severe shock ,Recent MI ,Unstable angina , Arrhythmia Severe respiratory dis., Atlantoaxial subluxation Possible visceral perforation COMPLICATION Cardiorespiratory depression due to sedation Aspiration pneumonia Perforation

Video endoscopy unit

Normal esophagus

Esophageal Diverticulum

Malignant esophageal lesion

Esophageal varices

Barrett’s Esophagus

Achalasia

Esophageal Ulcer HIV patient

Normal Stomach Body

Erosive Gastritis

Capsule Endoscopy

Indication Obscure GI bleeding Small bowel Crohn’s dis ,Coeliac dis, Familial polyposis syndrome Contraindication Small bowel stricture ,pacemaker

Double Balloon enteroscopy

Indication Diagnostic Therapeutics Contraindication Complications: abdominal pain 20% pancreatitis perforation


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


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

Normal Colonscopy

Stool cultures are essential in the investigation of diarrhea, especially when it is acute or bloody, to identify pathogenic organism.
Detection of antibodies plays a limited role in the diagnosis of GIT infection caused by organism like H Pylori, Salmonella species, and E. histolytica.

Gastrointestinal motility

Oesophageal motility: Gastric emptying: Small intestinal transit: Colonic & anorectal motility:

Dynamic test 2

Radioisotope tests
Gastric emptying study. Urea breath test. Meckles scan..

Somatostatin receptor scan.