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GI Studies 1b


Gold standard for dx appendicitis CT (>7 mm & >2mm thick = appy)
Imaging used for appy in kids: US
Gall stones: dx imaging US best; plain films only 15%; CT; HIDA (dye)
Acute panc: plain films calcified gall stone/panc; sentinel loop of sm bowel; colon cut-off sx (no air distal to splenic flexure)
Acute panc: US/CT US: enlarged hypoechoic pancreas; CT: enlarged panc, peripancreatic edema
Imaging of choice for panc parenchyma CT
Chronic panc: dx no lab tests (amy/lipase usu not inc); fecal fat/elastase; secretin stim test
Chronic panc: Abd plain film: Pancreatic calcifications (classic finding)
Chronic panc: CT Pancreatic calcifications, atrophied pancreas
Chronic panc: MRCP/ERCP Chain of lakes (areas of dilation / stenosis along pancreatic duct)
Panc ca: labs Alk Phos; Bilirubin, CA 19-9
Panc ca: dx modalities CT; MRI; EUS (if no lesion on CT/MRI & still have high suspicion)
Colon ca: gold standard of dx eval: colonoscopy
Dx giardiasis with: giardia antigen stool assay
HP dx serology; bx w/histo; bx w/urease test; urease breath test; stool antigen; PPI, Abx, or bismuth gives false neg (except serology or bx w/histo)
PUD dx EGD & bx (4% PUD become malig); HP test
Gastric ca: imaging EGD; EUS; Barium Swallow (Upper GI); CT/MRI
Achalasia: dx gold standard = manometry; see complete absence of peristalsis, with simultaneous, low amplitude waves; very tight LES, lack of contractions in esophagus
Achalasia imaging CXR (air fluid level in enlarged fluid filled esoph); Barium esophagography (birds beak: smooth symmetric tapering; esophageal dilatation; loss of peristalsis); upper endoscopy
Diffuse esophageal spasm dx Barium Esophagography: corkscrew contraction, rosary; manometry: intermittent simultaneous contraction
Esophageal ca eval CXR (mediastinal widening, lung or bony mets); barium esophagram (polypoid, infiltrative, or ulcerative lesion); EGD w/ bx (gold standard); Chest CT/EUS for staging
Liver dz lab w/u Hep A, B, C; ANA; ASMA; IgG; Anti-mito Ab (primary biliary cirrhosis)
ALT & AST >1000 = >1000: hepatitis, shock, toxins (Tylenol); hepatocellular injury: correlates w/degree of cell death
Abnormal AST/ALT ALT: liver injury > cirrhosis/obstruction; AST: cell necrosis; ALT:AST >1.0 = infxs hep; AST:ALT >2:1 = alcoholic hep; <500: EtOH; poss normal in cirrhosis
Albumin = part of total protein formed in liver; 14-20 d half life; in liver damage, levels drop slowly; prealbumin more sensitive to rapid damage
ALT: where found ALT: high in liver (mod in kidney, heart, sk mx)
ALT is more specific than AST or alk phos for: Liver damage
Alk phos liver, bone, intestinal tract, placenta, kidney; elevated in liver damage/obstruction; if elevated more than AST/ALT, more likely biliary disorder
Hep C dx labs ELISA (pos in 8-10 wks; good screen for chronic); HCV RNA; HCV genotype
Serum ascites albumin gradient paracentesis; if gradient >1.1: portal HTN
IBD dx/ eval: endoscopy, histology, radiography, labs & clinical data; Colonoscopy with ileal intubation & bx (should see chronic colitis/enteritis); Small bowel follow-through, enteroclysis (+/- CT), MR enterography
IBD labs often anemic (Fe def & chronic dz), leukocytosis, elevated CRP (CD); DO NOT ORDER serologies (ASCA, Cbir, OmpC & Crohns; p-ANCA & UC)
Amylase: pronounced elevation in: acute pancreatitis, pancreatic pseudocyst
Amylase: Moderate elevation in: panc ca, mumps, salivary gland inflam, perforated peptic ulcer
Lipase: fn & dx utility breaks down TGs; very specific for panc dz (> amylase); pronounced elevation in acute pancreatitis, pancreatic pseudocyst; mod elev in panc ca
Liver enzymes AST, ALT, GGT, Alk phos
Biliary enzymes Alk phos; GGT, (bilirubin)
GGT highest in liver/biliary tract; assess cholestasis & biliary obstruction (d/t mets?); elevated d/t EtOH
Alk phos: where found: rapidly div/metab active cells; high in PG, bone formation, intestinal dz
LFTs: hepatitis pattern A/G ratio >1; ALT >1000; ALT > AST; GGT high if EtOH hep; Bili D>I
LFTs: cirrhosis pattern A/G ratio <1; AST > ALT; GGT high if EtOH/biliary cirrhosis; Bili I > D
ALT/AST elevation: defns mild elev <5x ULN; mod elev 5-10 x nml; marked elev >10 x nml
If alk phos high out of proportion to ALT/AST: evaluate cholestasis with US/CT
UC labs Anemia; Low serum alb; Elevated ESR; Neg stool cx
Normal peritoneal fluid: 50 ml vol; straw-colored & clear; < 100,000 RBCs/microL; <300 WBCs/microL
Study of choice to dx panc ca EUS (if not avail: CT) (may also do MRI/ERCP)
Study of choice: staging of rectal, esophageal and gastric tumors and identification of pancreatic tumors: EUS (also used for aspirational bx)
Gold std to visualize small bowel VCE
Role of trans-abd US often TOC in liver, biliary dz; TOC in pediatric appendicitis
Liver bx: usu percutaneous; 1.5 cm x 2 mm (6-8 portal triads) gold std to eval liver inflam +/- fibrosis; usu O/P
FOBT guidelines CLIA waived; 3 serial stools; avoid red meat & >250 mg vitamin C x 3 days; avoid ASA >325 mg x 7 days
FOBT other sources of false pos EtOH, anticoag, steroids, CTx, iodine prep
C diff toxin assay specimen criteria specimen >5 ml (fridge if >1 hr); pt 5 soft/liquid stools /24 hr; submit 3 specimens on 3 different days
Gold std for pseudomembranous colitis tissue cx (rarely done; usu do toxin assays); if done, need bx and anaerobic cx
Hyperbili: conj vs unconj unconj 15-20% of TBil (accelerated RBC hemolysis, hepatitis, drugs); conj >50% TBil (intrahepatic cholestasis: biliary cirrhosis, drugs; hepatocellular damage: drugs, sepsis, inflam, scarring; obstruction: GS)
Serologic tests for celiac: anti-endomysial Ab (Most specific); TOC (cheaper, less tech difficult): anti-tGA (total IgA & genetic tests may also be indicated)
Gold std for celiac testing mucosal bx (even if pos serologies); pathognomonic: villous atrophy; lymphocytic infiltration of lamina propria; crypt hyperplasia; inc intraepithelial lymphocytes
Pathognomic for celiac dz: Villous atrophy on mucosal bx
AST: where found: AST: high in liver, heart, brain, sk mx
Esophageal ca on CXR mediastinal widening, lung or bony mets
barium esophagram: polypoid, infiltrative, or ulcerative lesion = esophageal ca
Created by: Adam Barnard Adam Barnard