✓Broadly classified as
1.Test of structure
2.Test for infection
3.Test of function
Imaging:
✓Plain Xary: important for diagnosis of intestinal obstruction, perforation,paralytic ileus.Calcified lymph node,Gall stones,renal stone can be detected.
✓Contrast studies:X-ray contrast usually done to assess anatomical abnormality and motility.It can detect filling defect such in tumors,structures,ulcer and motility disorders.
Common contrast X-ray include
•Barium swallow/meal Xary to assess motility disorders (Achalashia,gastroparesis),For perforation or fistula(Non ionic contrast used)
Limitations of it:
Risk of aspirations
Poor mucosal detail
Low sensitivity for early cancer
Inability to perform Biopsy
•Barium follow-through:It can be done in Diarrhoea,abdominal pain of suspected small bowel origin,Suspected malabsorption, Assessment of Crohn's disease,Possible obstruction obstruction by stricture.
Limitations include:
Time consuming
Radiation exposure
Relative insensitivity
•Barium Enema: Done in altered bowel habit, evaluation of stricture or diverticular disease,Megacolon,Chronic constipation.
Limitations are:
Difficulty in frail or incontinent patient
Low sensitivity for lesion less than 1 cm
✓Contrast Xary are not superior than Endoscopy,colonoscopy or CT,MRI etc.
✓Ultarsonogarm: Indication includes to detect Abdominal masses,Organomegaly, Ascites,Billiary tract dilatation,Guided biopsy of lesion,Also imaging of small bowel,Gall stones
Limitations are it is operator dependent,gas and obesity can obscure visualisation,Low sensitivity for samll lesion and gives little information about function.
✓Computed tomography:It is used for assessment of pancreatic disease, Hepatic tumor deposits,Tumor staging, Assessment of lesion vascularity,To see abscess and collection.
It has radiation exposure and cost is anothy limitation.
✓Magntic Resonance Imaging:Can be used for Hepatic tumor staging,MRCP,Pelvic or perianal mass,Crohn's fistula,Small bowel visualisation.
Limitations in claustrophobic patients,contraindicated in presence of metalic prostheses,cardiac pacemaker, cochlear implant.
✓CT-positron emission tomography (PET-CT)
Used to detect metastasis not seen in Ultrasound or CT images.
Limitations is signal detection detection of metabolic activity of tumor, but Al tumors are not metabolically active.
✓Endoscopy:It includes
1.Upper GIT Endoscopy
2.Enfoscopic Ultrasound (EUS)
3.Capsule Endoscopy
4.Double ballin enteroscopy
5.Sigmoidoscopy and Colonoscopy
6.Magnetic Resonance cholangiopancreatography
7.Endoscopic Retrograde cholangiopancreatogarpahy
✓Upper GIT Endoscopy:It is performed under light IV benzodiazepine sedation or lacal anesthesia as spray.Patient should be faster at least 4 hour.By this upto first part of Duodenum can be seen.
Indications:
a) Dyspepsia inmore than 55 year age
b) Dyspepsia less than 55 year age but having alarming symptoms such as weight loss,Anemia, vomiting,hematemesis and/or melena, Dysphagia,Palpable abdominal mass
c) Atypical chest pain
d) patient with Dysphagia,vomiting,weight loss,Acute or chronic GIT bleeding
e) Screening for oesopageal varices
f) Abnormal city or barium meal
g) Dudenal biopsy in malabsorption
h) Therapeutic: treatment of bleeding lesion,banding/injection of varices, dilatation of stricture,insertion is stent, placement of percutaneous gastrostomies,ablation in Barret esophagus and reaction of high grade dysplastic lesions and early neoplasia in Upper GIT.
Contraindication of it:
a) Severe shock
b) Recent Myocardial Infarction,unstable angina,cardiac arrythmia (These are relative contraindication,can be performed by experienced hand safely)
c) Severe respirator disease
d) Atlantoaxial subluxation
e)Possible visceral perforation
c,d also relative contradiction,can be performed in experienced hand.
Complications:
a) Cardiorespiratory depression due to sedation
b)Aspiration pneumonia
c) Perforation
✓Endoscopic Ultrasound: It combines with Endoscopy with intarluminal ultrasonography using high frequency transducer.It allows visualization of wall GIT and surrounding structure.It is useful to diagnose Pancreatic tumor,chronic pancreatitis, pancreatic cyst,cholangiocarcinoma,CBD stones, ampullary and submucosal tumors.Therapetic use of it in drainage of pancreatic fluid collections,Coeliac plexus block for pain management.Complication may be perforation,bleeding,cardiopulmonary events.
✓Capsule Endoscopy: Uses a capsule containing Ang imaging device, battery, transmitter and antenna.A battery powered recorded worn by the patient on a belt round the waist.Campsule transmit image and captured by the recorder.After about 8 hours capsule excreted.Images from the capsule analysed to localise the bowel segment where lesion seen then enteroscopy is usually require for confirmation and therapy.
Indications includes obscure GIT bleeding,Samll bowel Crohn's disease, Assessment of Coeliac disease,Screening and surveillance for Familial polyposis syndromes
Suspected stricture,obstruction are contarindication as capsule retention can occur.
✓Double balloon Enteroscopy:It uses long endoscope with a flexible overtube.Sequential inflation and deflation done which allows the performer pushing and pulling along the whole length of the small intestine upto terminal ileum.
No comments:
Post a Comment