GASTROINTESTINAL

SYSTEM
Abednego
THE ABDOMEN
 To divide the abdomen there are two verticle lateral lines which pass
through the mid clavicular line through the tip of the 9th intercostal
cartilage to femoral artery. Two horizontal lines-the subcostal lines pass
across the upper abdomen to join the lowest points of costal margin . The
interiliac line passes across the lower portion of the abdomen to antero-
supero iliac spine
PARTS OF THE ABDOMEN
Location of various organs in the Abdomen according
to the region
1. Right Hypochondrium-; Liver, Gallbladder,
2. Left Hypochondrium -; Spleen, Colon,
3. Epigastrium -; Stomach, Pancreas,
4. Right Lumber Region- Right kidney, descending col.
5. Left Lumber Region-; Descending Colon, Left
Kidney
6. Umbilical Region -; Umbilicus, intestines
7. Right Iliac Fossa-; Appendix, Caecum, uterus,
ovaries
8. Left Iliac Fossa -; fallopian, ovaries, uterus
9. Hypogastrium -; Urinary Bladder, Female Reproductive
Symptoms….
 List the symptoms;
Dysphagia, odynophagia, heartburn, indigestion,
flatulence, vomiting, anorexia, constipation, diarrhoea,
abdominal pain, abdominal distension, weight loss,
haematemesis, rectal bleeding, malaena, jaundice,
itching, urinary symptoms.
EXAMINATION
Inspection
 The patient is placed supine on an examining table or

bed or firm couch. It is helpful to place a small pillow

beneath the knees to relax the abdominal musculature.
The head should rest comfortably on a small pillow. The
patient's arms should rest comfortably at the sides.
Drapes should be placed over the breasts and groins
just below the inguinal regions to preserve modesty.
The examiner stands on the patient's right.
 There should be good lighting

 Expose the abdomen upto level of xiphisternum and

upto level of symphysis pubis(from the nipples to the

knees)
Cont,
1.First, check the general contour/shape size of the entire
abdominal wall. whether distended or scaphoid – incases of
starvation, ca.stomach etc. Check carefully for distention and,
the flanks should be checked for any bulging. Stand at the foot
of the bed –this helps to Check whether symmetrical or
asymmetrical like in cases of gross liver enlargement.
 If it is not normal shape and size it could be distended …

Causes of generalized distention- 6FS-;

• Fat,
• Fluid - Ascites,
• Flatus - I.O
• Feaces - Feacal Impaction,
• Fetus,
• Formations - Gross Splenomegally, Hepatomegally.
Cont,
2. Check the umbilicus; usually
inverted/retracted- if everted or flat could
be increased intra-abdominal pr-
hernia( confirmed by expansible impulse
on palpation when patients
coughs),ascites ovarian cyst
 note whether the distention is generalized

or localized to a portion of the abdomen-

could present with asymmetry
Cont,
3.Inspect for the skin and surface of
the abdomen – smooth or shiny , striae
atrophica /gravidarum, linear marks on the
abd.wall prdcd by gross stretching of the
skin with rapture of the elastic fibres (seen
after gross abdominal swelling –
pregnancy, ascites, severe wasting and
severe dieting,) skin abnormalities,
scars –old or recent,
Cont,
4.Prominent/dilated superficial veins and
direction of blood flow in these veins. place the tips
of the index fingers together, compressing a visible
vein. The fingertips are then slid apart, maintaining
compression, producing an empty venous segment
between the fingers. A finger is removed from one
end and the vein is watched for filling. The
procedure is then repeated, but the opposite finger
is removed and the vein again checked for filling.
Above the umbilicus, blood flow is normally upward;
below the umbilicus, it is normally downward.
Obstruction of the inferior vena cava will cause
reversal of flow in the lower abdomen. Also note
any spider angiomas of the abdominal wall skin.
Cont,
 Thin veins over costal margins is insignificant of superior
vena cava obstruction, mostly are found in thin pple.
 Inferior V.C obstruction causes oedema of limbs, buttocks,

groin and distention of abd. Veins and chestwall( this

shows dilated anastomostic channels between superficial
epigastric and circumflex iliac veins below and the lateral
thoracic veins above, conveying the diverted blood from
long saphenous vein to axillary vein, hence direction of
flow is upwards .
 Note if dilated vessels originate from the umbilicus

forming caput medusae- due to portal hypertension.liver

cirrhosis-
 the distended veins represent the opening up of

anastomoses between portal and systemic veins and can

occur in other sites like oesophageal and rectum.
5.Pigmentation of abdominal wall in the midline below
the umbilicus – where it forms linea nigra in pregnancy,
erythema ab igne- brown mottled pigmentation produced
by constant application of heat(hot water) on the abd. wall
Cont,
6.Inspect for masses- a mass on abd wall is prominent
when the abd muscles are tense, but intra abdominal
mass become less prominent or disappear.
7.Abdominal wall masses are most commonly hernias
(either umbilical, epigastric, incisional, or spigelian),
neoplasms (benign and malignant), infections, and
hematomas. Describe them in relation the the
quadrants. Examine whether moving with respiration,
pulsation, peristalsis.
8.Scars- surgical/therapeutic, traditional, surgical scars
have specific sites and more linear. Traditional scars-
could be therapeutic/decoration. And could suggest
chronic illness
Cont,
9. Abdominal movement – the abd normally rises gently with inspiration
and falls with expiration. Check for movement whether diminished or
absent- in generalise peritonitis-still abdomen, localised peritonitis-
diminished, perforated PUD -diminished.
10. Visual/visible pulsation – abd aorta is visible may be visible in
epigastric region- found in nervous thin patients. Some might be
transmitted from the heart esp. when the liver is engorged. Differentiate
with aortic aneurysm which is more obvious and widened aorta is felt on
pulsation.
11. Visible peristalsis – In normal circumstances is not visible. seen in;
obstruction of pylorus, obstruction of distal small bowel, normal finding in
elderly due to lax abdomen. You see waves moving from right side of the
epigastric region, becone more prominent after feeding
12. Hernial orifices – inguinal ,femoral regions, umbilicus, inscitional sites.
 Inspect for groin - both groins, penis, scrotum, any swellings, check for

the testes whether in normal position.

PALPATION
 Itis the most important part of abd. exam
 Tell the patient to relax the abdomen as best as

they can and breath quietly assure them you

will be gentle. If not relaxed disrupt with a
discussion
 Enquire on any site of pain & palpate that

region the last.

 Warm the hand-this can be by rubbing the

hands together
 When palpating ensure that the wrist and the

forearm are in the same horizontal plane .

Mount and relax the arm.
Cont,
 The movement should be gentle but with firm
pressure with fingers held almost straight but slightly
flexed at metacarpophalangeal joints, and avoid
poking with fingertips. The patient should feel your
hand as a comforting hand.
 First examine gently/light palpation – to elicit gas

within subcutaneous tissues, tenderness, obvious

swelling
 Deep palpation of the abdomen is performed by

placing the flat of the hand on the abdominal wall and

applying firm, steady pressure. You can use two
hands.
Cont,
 This enables to palpate enlarged organs, full bladder,
uterus, ovaries and other masses.
 Intra-abdominal structures are not usually easily
palpated.
 Some pts are not able to relax the abdomen, hence ask
them to breath deeply and bend their knees up.
 Its good to follow a certain order though it might be
altered depending on site of pain.
 Start from lt lower quadrant with light palpation then
repeat with slightly deep palpation.
 Palpate the lt kidney, spleen, rt kidney liver, urinary
bladder, aorta & para aortic glands & common femoral
vessels. palpate both groins, external genitalia.
Cont,
 Note all organs in the upper abdomen liver , (spleen, kidneys,
stomach, pancreas , gallbladder) move downwards with
inspiration . Ask the patient to take a deep breath while
examining to make the detection of these organs easier.
Palpation of the kidneys;
use ballotment /bi manual examination
Lt-place rt hand anteriorly on the lt lumbar region and rt arm is
placed posteriorly on the lt loin ask the pt to take a deep
breath. Press the lt hand forward and lt backward and inwards.
It is usually not palpated not unless it low in position or
enlarged.
Rt- place the right hand horizontally anteriorly on the rt lumbar
region and the lt hand posteriorly in the rt loin.push forward
with the lt hand and ask the patient to take a deep breath in
and press the rt han inwards and upwards. The lower pole is
felt unlike lt kidney in thin patients , it is felt as a smooth
rounded swelling which descends on inspiration and is
ballotable.
The Liver
 Place both hands side by side flat on the abdomenin right subcostal
region lateral to the rectus, with fingers pointing towards the ribs. If
resistance is encountered move the hand downwards till resistance
disappears. Ensure that the tip of the liver is felt. Repeat the maneuver
from the lateral and medial regions to trace the edge of the liver.
 Alt. how to palpate for hepatomegally- start from the rt iliac fossa and
palpate directly upwards towards the rt hypochondrium, if enlarged it
will be felt with the radial border as you palpate upwards. Ms the extent
of the liver below the coastal margin in cm. if no tape ms use the
fingers(know the size of your fingers).
 establish if its tender or not, consistency- hard or soft, in few cases stony
hard.
 Establish the surface rugged or nodular, whether the edges are well
defined or irregular.
 In cirrhosis – edges are nodular, hard in consistency & rough edges &
non tender; hepatomegally due to cirrhosis the liver tends to shrink
intestinal obstruction, leukemia, SCD.
 Hepatomegally may be due to; tumour-hepatoma, Hodgkin's lymphomas,
hepatitis, hepatoma.
The Spleen
 It is usually non palpable. It has to enlage two to three times its
size before it becomes palpable. The spleen enlarges inferiorly
and medially.
 Place the flat of the lt hand over lowermost ribcage
posterolaterally, restricting the expansion of the lt lower ribs on
inspiration, the rt hand is placed beneath the costal marging
exerting pr medially and downwards with lt hand. If not
palpated and you have high index of suscipition turn patient on
right side and ask the pt to relax and repeat the exam.
 To palpate for splenomegally place the rt hand on the rt iliac
fossa and palpate towards the lt hypochondrium. If it is grossly
enlarged you feel the splenic notch on the lower medial quarter.
 Splenomegally may be due to; chronic malaria-tropical
splenomegally syndrome, lymphomas,schistosomiasis, SCD.
Gall Bladder
 It is palpated same way as the liver. Normally it is not felt. If enlarged
it feels elongated but the lateral and lower borders are well defined.
 When distended is palpated as firm, smooth, or globular with distinct
borders, just lateral to the edge of the rectus abdominis near the tip of
the 9th costal cartilage. Upper border is not palpable coz it merges
with lower lobe of the liver.
 Painless gallbladder is found in; ca. head pancreas, mucocele of the
gallbladder- gallstone impacted in the neck of empty gbladder, ca.of
the gallbladder.
 Acute inflammation of the gallbladder, severe pain is elicited
murphy’s sign – ask the patient to breath in deeply as you palpate at
the height of inspiration patient holds breath as the mass if felt. This
represents +ve murphy’s sign. Commonly found in acute
cholecystitis.
 Courvoisier’s law –states that presences of jaundice in a palpable
gallbladder makes gallstone obstruction of the common bile duct an
unlikely cause
The Urinary Bladder
 Usually it is not palpable. But palpable in urine retention.
 You feel a smooth firm regular oval-shaped swelling on the
suprapubic region.
 Lower border is not felt as it arises from the pelvis.
 In women differentiate from gravid uterus(firm and mobile),
uterine fibroids

Aorta and Common Femoral Vessels

 Aorta might not be felt. Though with deep palpation it can be
felt, above the umbilicus. In thin pts esp in marked lordosis it
is easily palpable. Press using the tip of fingers above the
umbilicus on left side deeply and feel for its pulsation.
 Femoral vessel is felt below the inguinal ligament at midpoint
between the anterior superior iliac spine and symphysis pubis.
Abdominal Mass
1. Site
2. Size and shape-
3. Surface, edges and consistency-irregular, hard
nodular, solid, illdefined,
4. Mobility and attachment-
5. Bimanually palpable, pulsatile
6. Movement with respiration
7. Whether tender or not.
8. You can get all borders clearly
SITE;-
 Note the region occupied by the swelling think of the

organs in that site. If in the upper abdomen determine if

you can go above it (if you cant go above; hepatic
splenic,renal, gastric), similarly if in the lower
abdomen( if you cant go below it; ovary, uterus, bladder,
upper rectum).
SIE & SHAPE
 Helps in diagnosis

 The larger the swelling from stomach, small bowel,

pancreas etc the more it tends to distort the outline

unlike swellings from liver, spleen, bladder…
SURFACE EDGE AND CONSISTENCY
 Pathological nature of a mass is suggested by number of

features. Solid ill defined and tender masssuggests

inflammatory mass. Hard irregular and nodular mass is
suggestive of a malignancy.
 Regular smooth round tense mass is suggestive of a

cystic mass.
MOBILITY AND ATTACHMENTS;
 Swellings from the liver, spleen, kidneys, gallbladder

and distal stomach allow downward diaphragmatic

movement and cannot be moved with examining
hand. Tumors of small bowel and transverse colon,
cysts in mesentry and large secondary deposits on the
omentum are not usually influenced by respiration,
but easily moved on palpation.
 If swelling is completely fixed it signyfies;

◦ Retroperitoneal mass
◦ Part of an advanced tumour with extension to abdominal
walls
◦ From severe chronic inflammation involving organs like;
sigmoid colon etc
BIMANUALLY PALPABLE OR PULSATILE
 Bimanually masses in lumber region are of renal

origin, occ from posteriorly situated gallbladder.

 Pulsatile – not whether the mass is pulsatile or is

transmitted through it.

Cont,
Rebound Tenderness
Apply pr at a local site and release the pt will jump up as
if to follow your hand. It is commonly elicited at the
mc Bourne point this is usually due to inflamed
appendix. It can also be associated with ectopic
pregnancies.
Fluid Thrill
 Used to detect fluid in the peritoneal cavity.
 Ask the patient to lie down on supine position, place hand on

lateral aspect of the abdomen using the other arm tap on the
opposite side, ask an assistant to place hand on the midline
of the abdomen you will perceive waves on palpation. The
hand on the midline is to prevent perception of the waves by
the muscles of the abdomen. Useful in gross ascites.
Dipping /Ballotment
 Used in palpating for enlarged organs in ascites- liver and

spleen.
Differentiate intra-abdominal and extra-abdominal masses
 Make the patient tense the masses, by asking patient to rise

up while applying pressure on the forehead this tenses the

abdominal muscles. If the mass is intra-abdominal it
disappears as opposed to extra.
PERCUSSION
 Its done to;
◦ to confirm liver enlargement/liverspan, spleenomegally, full
bladder
◦ Detect presence of air in the abd. Cavity
◦ Shifting dullness
◦ Differentiate a mass arising from lt kidney and spleen(when in
doubt)
-The normal tone may vary from resonant to tympanic depending
with amount of air in the abd, cavity. In presence of food –
reasonant, in absence of food-tymphanic note.
-Generalized typhanic note suggests a pathology
-Enlarged liver – dull note
Liver – liver span
 To ditermine whether the liver is enlarged. Liver
dullness starts from 5 I.C.S, and extends to the right
lower border , below the costal margin. When
percussing start at the 4th ICS. This gives the
lenth/height of the liver 12-15cm. If the liver is
discplaced the dullness might start below 5th ICS, and
goes beyond the subcostal margin but size could be 12-
15cm. But if enlaged the height is increased.
 The dullness might be starting from the 7 th ICS and

ends above the subcostal margin this implies the liver

is small-liver cirrhosis or atrophy.
 The normal liver dullness might be reduced in

emphysema, pneumothorax,
Spleen
 Enlarged spleen gives a dull note
Full bladder
 Gives a dull note

ASCITES
 There are three major causes of diffuse abd. enlargement.;
Presence of free fluid in the peritoneum
Massive ovarian cyst
Obstruction of large bowel, distall small bowel-
 Percussion differentiates the three.
 Shifting dullness confirms ascites, though it is unwise to diagnose ascites
with this sign alone – ask the pt to lie supine, place your fingers in
longitudinal axis on the midline near umbilicus percuss moving your
fingers to the lumbar region. When dullness is first detected keep your
fingers in that position ask the patient to turn/rol on the opposite side, wait
for few second for any peritoneal fluid to redistribute the percuss , if tone
changes to reasonant , this shows that there is ascites. This shift can be
confirmed by finding dullness on opposites side if pt lies on the side, by
confirming whether it shifts when the patient returns to supine position. Or
repeat the procedure on the other side.
 Assignment – how to differentiate gross ascites, massive ovarian cyst and
Difference btn splenic mass and left kidney
mass
 Enlarged spleen-dull note while enlagement of kidney
– hyperreasont/reasont note on percussion
 Spleen enlarge inferiorly and medially while left

kidney the reasonant note is in left lumber region

 Spleen has splenic notch in the medial border, kidney

doesn’t have.
 You can elicit upper border of the spleen which is

possible with the kidney.

 Spleen is not bimanually palpable unlike kidney
 During inspiration spleen moves further from kidney
Auscultation.
 It done to detect the bowel sounds- to ditermine peristalsis, vascular bruits.
 The normal bowel sounds- are heard as intermittent low- or medium pitched
sounds/gurgles interpersed with occasional high-pitched noise. Place the
stethescope on one site on the abdominal wall right to the umbilicus untill you
hear the sounds.
 In simple acute mechanical obstr. Of small bowel- excessive
 Colicky abdominal pain- increased b/sounds- frequent loud low pitched
gurgles (borborygmi) are heard.
 If obstruction progresses – bowel necrosis, peristalsis decreases/ceases and
sounds lessen in volume and frequency
 With generalized peritonitis – bowel sounds rapidly disappears. Leading to
paralytic ileus with gradually increasing abd, distension. (Listen for a longer
time to ensure that no sounds coz abdomen is usually silent)
 Succussion splash pt lies in supine place stethescope over epigastrium roll the
pt from side to side, if abdomen is distended with fluid you will hear splashing
sound.
 Vascular bruits place the stethescope slightly above the umbilicus on the left
side(aorta)., iliac arteries, epigastrium(coeliac and superior mesenteric), lateral
in mid abdomen(renak art,) over the liver- if a bruit is heard – turbulent bld
THE GROINS
 After inspection of groin. Ask the patient to cough and look at
both inguinal canals for expansile impulse.
 Place left hand(fingers) on the lt groin over the inguinal canal as

well as rt hand on the rt groin. The ask the pt to cough and loudly
and feel for any expansile with each hand.
 Palpate for inguinal l/nodes(feeling with fingers of right hand)

LUMP IN THE GROIN

 COULD BE DUE TO; enlargement l/nodes, hernia-inguinal, in

scrotum-hydrocele, lymphoma,
 Ask pt to stand in front of you, ask him to point the site if

swelling note whether it extends to the scrotum, ask the pt to

cough loudly- e-impulse. Note whether it is above or below the
inguinal ligament.
Cont,
 Stand beside the patient and slightly behind. If inspecting the rt groin
place the lf hand on the rt buttock and fingers of the rt hand are placed
obliquely over the inguinal canal ask the pt to cough again if impulse
is felt the lump is said to be hernia.
 Note whether it is inguinal or femoral- determine the relationship of

the sac to pubic tubercle. To locate this push gently upwards from
beneath the neck of the scrotum with the index finger but don’t
navigate the neck of scrotum its painful. If the hernial sac passes
medial to and above the index finger placed on the pubic tubercle-
inguinal hernia., if its lateral to and below – femoral hernia.
NOTE contents of the sac- bowels doughy and peristalsis activity
reducible or not – lie pt down to decide .try to reduce if irreducible its
painful
indirect or not- ask pt to lie down, direct hernia bulges out straight
thro’ the posterior wall of the inguinal canal, indirect travels obliquely
down inguinal canal. Place a finger above mid inguinal ring. If hernia
is fully controlled by the finger its indirect
Cont;

 Check for undescended test

Anus and rectum
 Examine at left lateral position, the buttocks should project

over side of the bed . Glove and stand behind the pt’s back,
facing pt’s feet. Explain what you what to do.
 Separate the buttocks, carefully, the perianal and anus.- skin

abnormalities- inflammations, chronic thickened skin,

exaggerated anal folds, skin/anal tags, anal warts(pedunculated
papilloma with red base and white surface), fistula in
ano(dimple or hole near the anus)(pilonidal sinus-opening lies
in the midline posterior to the anus), anal feasure-tear in the
anal lining, perianal haematoma-collection of blood on one
aspect of anus, prolapsed strangulated piles- gross swelling of
anal/perianal skin, perianal abscess, any ulcerations, rectal
prolapse- if suspected ask the patient to bear down and note
whether the pink rectal mucosa appears or bulging of the of the
perinium which indicates weakness of pelvic floor
DIGITAL EXAM,
 To check; prostrate gland, as part of gynaecological exam to check the uterus
and overies, bladder can also be felt.
 Glove /remain gloved
 Lubricate the index finger of the right hand , place the pulp of the finger flat on
the anus and press firmly and slowly in slightly backward direction. Don’t
proceed with the exam if it painful. Elicit-the thickening, irregularities, turn the
finger in 180 degrees, asses the tone, feel for the shallow groove which marks
the dividing line betwwen the external and internal sphincter. in incontinence
no contraction is felt.
 Pass the finger to rectum, place the left hand on patients right hip and on the
supra-pubic especially when you want to feel the sigmoid colon. Examine in
relation to the anterior wall, turn finger at 360degrees. – ditermine; ulcers
stenosis, polyps,
 In men seminal vescicles and prostrate should not be felt . The prostrate gland
forms a rubbery, firm swelling size of a large nut. Feel the lateral lobe –smooth
and regular . If its hard in consistency , irregular and nodular suspect cancer.
 Repeat the movements as the finger is being removed/ withdrawn .
 Examine the finger on withdrawing- mucus, pus, blood( you can wipe the
finger on white swab if on doubt)
 Wipe the patient on completion of the examination.
ACUTE ABDOMEN
 The approach of history taking
SITE
 Ask the site of maximal pain; if in upper abdomen –gastric

perforation/ DU, cholecystitis, pancreatitis. If in mid abdomen-

perforated DU/GU. Right iliac fossa – appendicitis, left diverticulitis.
Lower abdomen salphingitis. Ruptured ectopic pregnancy.
Coexistence of severe back and abdominal pain may indicate
raptured abdominal aneurysm/ discecting aneurysm.
SEVERITY
 Ask whether it keeps the pt awake

RADIATION
 Ask where it radiates. Whether to the subcostal ,shoulder, or

interscapular region, this could be cholecystitis(inflammation of

gallbladder)
 Pain from the loin radiating to the groin – ureteric

 Umbilical pain radiating to the rt iliac is usually due to appendicitis.

 Central pain later radiating to through the back - pancreatitis

Cont,
Character and constancy
 Costant(pain lasting for many hrs), colicky pain,sudden pain, piercing,

burning etc
Mode of onset
 Sudden, slow onset, is related to food intake, drug intake/alcohol,

Relieving factors
 Rest(inflammatory), sitting down(pancreatic pain),

Vomiting
 Effortless projectile pain-pyloric stenosis, persistent vomiting-

peritonitis, feaculent vomitus- low small bowel obstruction. Persistent

vomiting associated with diarrhoea – G/E,
Micturition
 Frequency- UTI nad PID, ureteric stones

Appetite and weight

 Pt with chronic disorders – usu. Are wasted.

Otherr features
 Gurding, rigidity,rebound tenderness, percussion-tympanicity -gas,
Investigations
Abdominal fluids
 Vomitus-the character varies with the nature of food ingested,

presence of bile, blood or I.O.

 Note – copious in amount, sour, smelly, contains food eaten,

presence of mucus, bloody- bright red/dark/ground coffee

appearance., green apperance, feaculent, formed feaces
 Formed feaces- indicates obstruction of large gut, or

communication between the stomach and transverse collon- rare

 Dark green- cotains bile
 Pyloric stenosis-copious,contains food eaten many hours

previously, sour and smelly

 Upper GI bleeding- ground coffee(due to mixing of blood with

gastric juices)
 Oropharynx, nasopharynx bleeding- bright red
 Feaculent- I.O(brown in colour)
Faeces
 Amount-copious/scanty, hard, formed, semiformed, liquid.

 Feacal odour- offensive smell- jaundice,

 Bacillary disentry, cholera stool are odourless, amoebic

dysentry- semen, malaena stool- a charistic smell,like

rusty/bloody.
Faecal colour
Black –ingestion of iron/alterd blood, haemorrgage high up int
intestines- dark stools tarry lookingwith offensive smell. Pale
stool due to lack of of entry of bile esp in obstructive
jaundice.
Feacal odour
In jaundice stools are offensive. Cholera stools have very small
content\ organic matter and almost free from odour.
Amoebic dysentry- odour…semen
Melaena stools characteristic smell like rust, bloody.
Occult blood
Done by use of filter paper with guaiac – turns
blue in presence of hb when added hydrogen
peroxide.
Tests for fecal fat
Stool microbiology- chronic diarrhoeas

OTHER TEST
Upper GI Endoscopy –able to visualize the
duodenal loop. Samples can also be taken for
examination.
It can be both diagnostic and therapeutic- assists
in repair of bleeding esophageal varices, PU,
esophageal stricture,…
Esophageal fxn studies
Barium swallow- can assess the swallowing
phase. Check abnormalities in coordination
od peristalisis eg achalasia , o.spasms
Gastric secretory studies and serum
gastrin levels
done in patients with PUD. And diagnosis of
gastrin producing tumours (check the
normal aci and base production)
H.Pylori testing –can be ditected through=
microscopy, cultures of gastric mucosal
biopsies, stool
RADIOLOGICAL TESTS

Plain radiographs- chest and abdomen in erect and

supine position
Barium swallow- radio opaque solution os passed
through esophagus to the stomach. Most done in
dysphagia….xray are then taken and observe for any
abnormality.
Barium follow through
Small bowel enema alt. to b.follow through. Intubate
the duodenum by inserting non-flocculating barium
suspension to the intestines through the tube take x-
rays to detect any anomalies.
Small intestine endoscopy and biopsy
Proctoscopy – visualize the anal canal and rectum with
a proctoscope
Barium enema-
LIVER
 HSaG – A, B, C
 Needle biopsy- sample for histological exam
 Ultrasound scan.- non invasive, echos are
detected—incase of stones echo dense areas
are seen,….
 CT –scan
 MRI
 Angiography………

 Read on;
◦ ERCP(Endoscopic Retrograde
Cholangiopancreatography)
◦ Percutaneous transhepatic cholangiography
◦ Pancreatic function tests..
◦ Abdominal US..LIVER.