Valuation of The Astrointestinal Ract: Key Concepts

EVALUATION OF THE GASTROINTESTINAL
TRACT
Marie A. Chisholm and Mark W. Jackson
KEY CONCEPTS
1 The patient history is key to evaluating GI problems and
should include the problem onset, the setting in which it

developed, and its presentation.
2 A complete physical exam should be performed with detailed
attention to the overall condition of the patient and
focused attention should be given to the patients abdomen.
3 Contrast agents such as barium sulfate are effective in examining
the GI tract for structural diseases.
4 The upper GI series involves radiographic visualization of
the esophagus, stomach, and small intestine; whereas the
lower GI series involves visualization of the colon and
rectum.
5 Enteroclysis is used to evaluate the small bowel by introducing
contrast agents by tube through the nose or mouth.
6 GI ultrasonography, computed tomography, and magnetic
resonance imaging provide images of the gallbladder, liver,
pancreas, and abdominal wall.
7 Radionuclide imaging is useful to visualize the liver, spleen,
bile ducts, gallbladder, and gut.
8 The endoscope, an illuminated optical instrument, revolutionized
the diagnosis and management of GI disorders
with common endoscopic studies including esophagogastroduodenoscopy,
colonoscopy, sigmoidoscopy, and endoscopic
retrograde cholangiopancreatography.
9 There is an evolving role for capsule endoscopy (an encapsulated
camera swallowed by the patient that takes
pictures of the GI tract) in the assessment of the small
bowel.
The gastrointestinal (GI) tract is composed of organs and tissues that
have diverse forms and functions. It includes the esophagus, stomach,
small intestine, large intestine, colon, rectum, biliary tract, gallbladder,
liver, and pancreas. Despite the rapid proliferation of technology
for the diagnosis of digestive diseases, the patient history and physical
examination still hold central roles. When combined with a thorough
patient history and physical examination, diagnostic procedures are
essential in the evaluation of GI disorders. This chapter describes the
most commonly used tools available in clinical practice to evaluate
patients with GI diseases.
SYMPTOMS OF GASTROINTESTINAL DYSFUNCTION
A variety of symptoms can arise from GI dysfunction. Common

GI symptoms include heartburn, abdominal pain, dyspepsia, nausea,
vomiting, diarrhea, constipation, and gastrointestinal bleeding. Signs
and symptoms of malabsorption, hepatitis, and GI infection are also
commonly seen. The next sections describe methods that are commonly
used to assess patients with GI complaints. For specific details
concerning each GI disease state, please consult that particular chapter
in this book.
PATIENT HISTORY
1 A comprehensive patient history is the cornerstone in the evaluation
of a patient with digestive complaints. A clear, detailed,
chronologic account of the patients problems should be ascertained.

This account should include the onset of the problem, the setting in
which it developed, and its manifestations. The onset of the problem
often provides important information that helps to confirm diagnosis.
For example, biliary pain, such as that encountered with symptomatic
gallstone disease, typically evolves over minutes and lasts for hours,
but pain caused by pancreatitis evolves over hours and lasts for days.
The setting is always relevant as it provides clues to the possible origin
of the disorder. For example, is the patient an alcoholic (liver
disease, esophageal varices, or pancreatitis)? Does the patient have
severe atherosclerosis (mesenteric ischemia)? Is the patient immunosuppressed
(opportunistic infection)? Also aiding in the differential
diagnosis is identification of factors that alleviate or exacerbate the
principal symptom. For instance, ingesting a meal often relieves the
pain of duodenal ulcer, but worsens that of gastric ulcer. The health
care professional should ask questions that address the potential etiologic
possibilities, including motility disorders, structural diseases,
malignancies, infections, psychosocial factors, dietary factors, and
travel-associated diseases.1,2 Questions concerning past medical and
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EVALUATION OF THE GASTROINTESTINAL

should include the problem onset, the setting in which it

SYMPTOMS OF GASTROINTESTINAL DYSFUNCTION

A variety of symptoms can arise from GI dysfunction. Common

chronologic account of the patients problems should be ascertained.

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