Clinical Investigations in Gastroenterology PDF
Preview Clinical Investigations in Gastroenterology
Clinical Investigations in Gastroenterology Clinical Investigations in Gastroenterology M.C. Bateson Consultant Physician and Specialist in Gastroenterology General Hospital, Bishop Auckland, County Durham, UK and I.A .. Bouchier Professor of Medicine, University of Edinburgh, UK KLUWER ACADEMIC PUBLISHERS DORDRECHT/BOSTON/LONDON Distnbutors for the United States and Canada: K1uwer Academic Publishers, PO Box 358, Accord Station, Hingham, MA 02018-0358, USA for all other countries: K1uwer Academic Publishers Group, Distribution Center, PO Box 322, 3300 AH Dordrecht, The Netherlands British Library Cataloguing in Publication Data Bateson, Malcolm C. (Malcolm Cedric), 1945- ainical investigations in gastroenterology. 1. Man. Gastrointestinal tract. Diagnosis I. Title II. Bouchier, Ian A.D. (Ian Arthur Dennis), 1932- 616.3'3075 ISBN-13: 978-94-01 0-7688-3 e-ISBN-13: 978-94-009-2633-2 DOl: 10.1007/978-94-009-2633-2 Copyright c 1988 by K1uwer Academic Publishers Softcover reprint of the hardcover 1s t edition 1988 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the publishers, K1uwer Academic Publishers BY, PO Box 17, 3300 AA Dordrecht, The Netherlands. Published in the United Kingdom by K1uwer Academic Publishers, PO Box 55, Lancaster, UK. K1uwer Academic Publishers BY incorporates the publishing programmes of D. Reidel, Mar tinus Nijhoff, Dr W. Junk and MTP Press. iv Contents Preface Xli 1. Intubation Method 1 Tubes 3 Complications 5 2. Upper digestive endoscopy Instruments 7 Procedure 8 Endoscopic retrograde cholangiopancreatography 13 Cleansing 14 Prophylaxis of SA.B.E. 15 3. Gastrointestinal bleeding Occult blood tests 16 Chemical tests 17 Tests for dietary iron 18 99mtechnetium tests 19 Radiochromate-labelled erythrocytes 19 Radiology 20 Endoscopy 20 Gastrointestintal bleeding in liver disease 21 4. Oesophagus Oesophageal acid perfusion test 22 Oesophagoscopy 23 Histology 23 Radiology 24 Manometry 29 Reflux studies 31 Isotope swallow 32 5. Stomach and duodenum Gastric emptying 34 Isotope tests 34 v CONIENTS Radiology 34 Ultrasonography 34 Dye dilution 35 Gastric acid secretion 35 Short pentagastrin test 36 Basal acid secretion 38 Acid output after surgery 39 Insulin test 39 Deoxy-D-glucose test 40 Pre- and post -operative pentagastrin stimulation 41 Sham-feeding test of gastric secretion 42 Radiotelemetry 42 Intravenous 99mtechnetium 42 Serum gastrin 43 Serum pepsinogen 43 Other gastric secretions 44 Pepsin 44 B12 urinary excretion (Schilling) test 45 Other tests 46 SerumB12 46 Gastric antibodies 46 Gastric cytology 47 Fluorescence cytology 47 Gastric biopsy 48 Radiology 50 Campylobacter-like organisms 52 6. Absorption Fats and related substances 54 Triolein breath test 54 Faecal fat excretion 56 Prothrombin time 58 Serum vitamin D 58 Vitamin A absorption 59 Oxalate loading test 59 Bile acid malabsorption 59 Monosaccharides 60 Xylose excretion 60 Oral glucose tolerance 61 Disaccharide absorption 62 Lactose tolerance test 63 Intestinal disaccharidase activity 63 Other tests 64 Hydrogen breath test 65 Vi CONfENfS Haematinics 65 Vitamin B1G 65 Folic acid a sorption 65 Iron absorption 66 Rare disorders of absorption 68 Dibasic amino acids 68 Tryptophan 68 Methionine 69 7. Small intestine Intestinal biopsy 70 Endoscopic forceps biopsy 70 Crosby-Kugler capsule 70 Rubin suction biopsy tube 73 Interpretation 74 Radiology 77 Small bowel enema 78 Radioisotope studies 79 67Gallium 80 Leukocytes 80 Sucralfate 80 Protein loss 81 51Chromic chloride 81 Radioiodinated serum protein 82 Alpha-1-antitrypsin clearance 83 Intestinal bacteria 84 Intubation 84 14C-glychocholate acid breath test 85 Urinary indican 86 Breath hydrogen 86 Biopsy 86 Intestinal motility and manometry 87 Markers 88 Crohn's disease 89 Metabolic disorders 91 Carcinoid syndrome 91 Phaemochromocytoma 93 Porphyria 93 Lead intoxication 94 Imim.inology 94 Food allergy and intolerance 95 V11 CONTENTS 8. Colon and rectum Rectal examination 97 Anoscopy (proctoscopy) 98 Proctosigmoidoscopy 99 Flexible sigmoidoscopy 102 Rectal biopsy 105 Radiology 108 Arteriography 112 Colonoscopy 113 Manometry 120 Immunology 121 Inflammatory bowel disease 121 Carcinoembryonic antigen 121 Amoebiasis 122 9. Stool examination and microbiology Macroscopic appearance 124 Protozoa and helminths 125 Bacteria 127 Viruses 128 10. Pancreas Ultrasonography 129 Endoscopic retrograde cholangiopancreatography 131 Computed tomography 132 Angiography 133 Other radiology 134 Peritoneoscopy 135 Cytology 135 Hormonal tests of pancreatic exocrine function 136 Secretin test 136 Augmented secretin test 138 Continuous secretin infusion 139 Lundh test 139 Tubeless oral pancreatic function tests 142 Bentiromide 14C_PABA test 142 Fluorescein dilaurate test 143 Alternatives 144 Oral glucose tolerance test 145 Digestive enzymes outside the gut 145 Serum amylase 145 Urinary amylase 146 Amylase in other fluids 147 Serum lipase 147 YIll CONfENTS Serum trypsin 147 Other blood tests 148 Stool examination 149 Macroscopic and microscopic examination 149 Stool trypsin 150 Sweat electrolytes 150 Pilocarpine iontophoresis 150 Skin chloride assay 151 Gut endocrinology 152 Insulinoma 153 Gastrinoma (Zollinger-Ellison syndrome) 155 Glucagonoma 155 Vipoma (WDHA ir Verner-Morrison syndrome) 155 Pancreatic cancer 156 11. Liver biochemistry Blood and urine tests 157 Serum bilirubin 157 Urine bilirubin 158 Urine urobilinogen 158 Serum enzymes 159 Proteins 162 Albumin 162 Globulins 163 Immunoglobulins 163 Other tests 164 Coagulation tests 164 Blood ammonia 164 Bile acids 165 Lipids 165 Others 166 Alcoholic liver disease 166 Immunology 168 Tumour antigens 168 Tissue antibodies 168 Viral liver disease 170 Kinetic tests 174 Bromsulphthalein retention 174 Indocyanine green clearance 175 Aminopyrine breath test 176 Ammonia tolerance test 176 Protein load test 177 Electroencephalography 178 Gilbert's syndrome - reduced calorie intake test 178 IX CONTENTS Idiopathic haemochromatosis 179 Wilson's disease (hepatolenticular degeneration) 180 Hyatid disease 181 12. Liver biopsy Preparation 183 Procedure 183 Aftercare 189 Complications 189 Indications 189 Contradictions 190 Interpretation 191 Liver aspiration 194 13. Liver imaging and manometry Ultrasonic scanning 1% Isotope scanning 198 Radiology 200 Plain abdominal X-ray 200 Barium studies 200 Percutaneous transhepatic cholangiography 201 Computed tomography 204 Nuclear magnetic resonance imaging 205 Arteriography 206 Diagnosis of cholestasis 206 Portal manometry and splenoportography 207 Portography 210 Scintisplenoportography 212 Hepatic venography 212 14. Gallbladder and bile ducts Plain abdominal radiograph 214 Oral cholecystography 215 Ultrasonography 218 Iodine cholangiography 220 Bile duct ultrasound 221 Computed tomography 222 Isotope scanning 222 Operative and post -operative cholangiography 224 Biliary physiology 225 Bacteriology 225 x CONTENTS 15. Ascites and the peritoneum Abdominal paracentesis 226 Diagnostic paracentesis in the acute abdomen 228 Chylous ascites 229 Peritoneal biopsy 229 Peritoneoscopy 230 Further reading 234 Index 235 xi
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