1. 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

2. Contrast Studies

3. Barium Swallow &Meal Indications: Limitations:
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. diffuse esophageal spasm
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
(after 5 months of therapy)

14. Early stenosing Crohn’s disease

15. Crohn’s disease

16. Barium Enema Indications and major uses: Limitations:
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Suspected colon cancer (but superseded by colonoscopy)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: Limitations: 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: Limitations: Assessment of pancreatic disease
Hepatic tumor deposits
Tumor staging
Assessment of vascularity of lesions.
Limitations:
Expensive
High radiation dose
Availability

25. MRI Major uses: Limitations: 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. 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

29. Upper GIT Endoscopy

30. INDICATIONS. CONTRAINDICATIONS COMPLICATION
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

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. Normal Stomach
Body

40. Erosive Gastritis

41. Capsule Endoscopy Indication Obscure GI bleeding
Small bowel Crohn’s dis ,Coeliac dis,
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.
Atlantoaxial sublax. ,?Visceral perfor.
Complication
Cardioresp. Dep. Due to sedation
Perforation
Bleeding

48. Normal Colonscopy

50. TESTS
OF INFECTION

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

52. Gastrointestinal motility
Oesophageal motility:
Gastric emptying:
Small intestinal transit:
Colonic & anorectal motility:

54. Dynamic test 2

55. Radioisotope tests Gastric emptying study. Urea breath test.
Meckles scan..
Somatostatin receptor scan.