Clinical Investigations in Gastroenterology

255 Pages·1988·15.145 MB·English

by  M. C. Bateson, I. A. Bouchier (auth.)

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