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Diagnosis/Symptoms

Posted Jun 02 2009 4:41pm

  • Abdominal Pain, Long-Term
Ongoing or recurrent abdominal pain, also called chronic pain, may be difficult to diagnose, causing frustration for both you and your doctor. Do your symptoms fit one of the diagnoses described in this chart?
Keep reading....
  • Abdominal Pain, Short-Term
Just about everyone has had a "stomachache" at one time or another. But sudden severe abdominal pain, also called acute pain, shouldn't be ignored. It often indicates a serious problem. Follow this chart for more information about acute abdominal pain. Or find more information about abdominal pain that has lasted for more than 3 days.
Keep reading....
  • ERCP (Endoscopic Retrograde Cholangiopancreatography)
Endoscopic retrograde cholangiopancreatography (en-doh-SKAH-pik REH-troh-grayd koh-LAN-jee-oh-PANG-kree-uh-TAH-gruh-fee) (ERCP) enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas. The liver is a large organ that, among other things, makes a liquid called bile that helps with digestion. The gallbladder is a small, pear-shaped organ that stores bile until it is needed for digestion. The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine. These ducts are sometimes called the biliary tree. The pancreas is a large gland that produces chemicals that help with digestion and hormones such as insulin.

ERCP is used primarily to diagnose and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP combines the use of x rays and an endoscope, which is a long, flexible, lighted tube. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x rays.

For the procedure, you will lie on your left side on an examining table in an x-ray room. You will be given medication to help numb the back of your throat and a sedative to help you relax during the exam. You will swallow the endoscope, and the physician will then guide the scope through your esophagus, stomach, and duodenum until it reaches the spot where the ducts of the biliary tree and pancreas open into the duodenum. At this time, you will be turned to lie flat on your stomach, and the physician will pass a small plastic tube through the scope. Through the tube, the physician will inject a dye into the ducts to make them show up clearly on x rays. X rays are taken as soon as the dye is injected.

If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove or relieve the obstruction. Also, tissue samples (biopsy) can be taken for further testing.

Possible complications of ERCP include pancreatitis (inflammation of the pancreas), infection, bleeding, and perforation of the duodenum. Except for pancreatitis, such problems are uncommon. You may have tenderness or a lump where the sedative was injected, but that should go away in a few days.

ERCP takes 30 minutes to 2 hours. You may have some discomfort when the physician blows air into the duodenum and injects the dye into the ducts. However, the pain medicine and sedative should keep you from feeling too much discomfort. After the procedure, you will need to stay at the hospital for 1 to 2 hours until the sedative wears off. The physician will make sure you do not have signs of complications before you leave. If any kind of treatment is done during ERCP, such as removing a gallstone, you may need to stay in the hospital overnight.

Preparation

Your stomach and duodenum must be empty for the procedure to be accurate and safe. You will not be able to eat or drink anything after midnight the night before the procedure, or for 6 to 8 hours beforehand, depending on the time of your procedure. Also, the physician will need to know whether you have any allergies, especially to iodine, which is in the dye. You must also arrange for someone to take you home—you will not be allowed to drive because of the sedatives. The physician may give you other special instructions.
Via: NDDIC

  • Esophageal Manometry Testing
What is esophageal manometry?

Esophageal manometry is a test used to measure the function of the lower esophageal sphincter (the valve that prevents reflux of gastric acid into the esophagus) (see diagram). This test will tell your doctor if your esophagus is able to move food to your stomach normally.

The manometry test is commonly given to people who have:

  1. Difficulty swallowing
  2. Pain when swallowing
  3. Heartburn
  4. Chest pain
  5. Chronic cough or hoarseness

The swallowing and digestive processes

To know why you might be experiencing a problem with your digestive system, it helps to understand the swallowing and digestive processes.

When you swallow, food moves down your esophagus and into your stomach with the assistance of a wave-like motion called peristalsis. Disruptions in this wave-like motion may cause chest pain or problems with swallowing.

In addition, the muscular valve connecting the esophagus with the stomach, called the esophageal sphincter, prevents food and acid from backing up out of the stomach into the esophagus. If this valve does not work properly, food and stomach acids can enter the esophagus and cause a condition called esophageal reflux (GERD).

Manometry will indicate not only how well the esophagus is able to move food down the esophagus but also how well the esophageal sphincter is working to prevent reflux.

Before the test

Special conditions

  • Tell the physician if you have a lung or heart condition, have any other diseases, or allergies to any medications.

Medications
Please follow the instructions below (unless told otherwise by your doctor):

  1. One day (24 hours) before the test, stop taking: Calcium channel blockers: such as Calan, Isoptin (verapamil); Adalat, Pro-cardia (nifedipine); Cardizem (diltiazem). Nitrate and Nitroglycerin products: such as Isordil (isosorbide); Nitrobid, Nitrodisc, Nitrodur, Nitrogard, Transderm-Nitro, Tridil,
  2. Twelve hours before the test, do not take sedatives: such as Valium (diazepam), Xanax (alprazolam)
  3. Do not stop taking any other medication without first talking with your doctor.

Day of test

Eating and drinking

  • Do not eat or drink anything 4 to 6 hours before the test.
  • Do not wear perfume or cologne.

During the test

  1. You are not sedated. However, a topical anesthetic (pain-relieving medication) will be applied to your nose to make the passage of the tube more comfortable.
  2. A small (about 1/4 inch in diameter), flexible tube is passed through your nose, down your esophagus and into your stomach. The tube does not interfere with your breathing. You will be seated while the tube is inserted.
  3. You may feel some discomfort as the tube is being placed, but it takes only about a minute to place the tube. Most patients quickly adjust to the tube’s presence. Vomiting and coughing are possible when the tube is being placed, but are rare.
  4. After the tube is inserted, you will be asked to lie on your left side. The end of the tube exiting your nose is connected to a machine that records the pressure exerted on the tube. The tube is then slowly withdrawn. Sensors at various locations on the tubing sense the strength of the lower esophageal sphincter. During the test, you will be asked to swallow a small amount of water to evaluate how well the sphincter is working. As the tube is pulled into the esophagus, the sensors measure the strength and coordination of the contractions in the esophagus as you swallow.
  5. The test lasts 20 to 30 minutes. When the test is over, the tube is removed. The gastroenterologist will interpret the recordings that were made during the test.

After the test

  1. Your physician will notify you when the test results are available or will discuss the results with you at your next scheduled appointment.
  2. You may resume your normal diet and activities and any medications that were withheld for this test.
  3. You may feel a temporary soreness in your throat. Lozenges or gargling with salt water may help.
  4. If you think you may be experiencing any unusual symptoms or side effects, call your doctor.

This information is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

Via :clevelandclinic
  • Flexible Sigmoidoscopy
Flexible Sigmoidoscopy
Illustration of the digestive system with the rectum and sigmoid colon highlighted.

The digestive system

Flexible sigmoidoscopy (SIG-moy-DAH-skuh-pee) enables the physician to look at the inside of the large intestine from the rectum through the last part of the colon, called the sigmoid or descending colon. Physicians may use the procedure to find the cause of diarrhea, abdominal pain, or constipation. They also use it to look for early signs of cancer in the descending colon and rectum. With flexible sigmoidoscopy, the physician can see bleeding, inflammation, abnormal growths, and ulcers in the descending colon and rectum. Flexible sigmoidoscopy is not sufficient to detect polyps or cancer in the ascending or transverse colon (two-thirds of the colon).

For the procedure, you will lie on your left side on the examining table. The physician will insert a short, flexible, lighted tube into your rectum and slowly guide it into your colon. The tube is called a sigmoidoscope (sig-MOY-duh-skope). The scope transmits an image of the inside of the rectum and colon, so the physician can carefully examine the lining of these organs. The scope also blows air into these organs, which inflates them and helps the physician see better.

If anything unusual is in your rectum or colon, like a polyp or inflamed tissue, the physician can remove a piece of it using instruments inserted into the scope. The physician will send that piece of tissue (biopsy) to the lab for testing.

Bleeding and puncture of the colon are possible complications of sigmoidoscopy. However, such complications are uncommon.

Flexible sigmoidoscopy takes 10 to 20 minutes. During the procedure, you might feel pressure and slight cramping in your lower abdomen. You will feel better afterward when the air leaves your colon.

Preparation

The colon and rectum must be completely empty for flexible sigmoidoscopy to be thorough and safe, so the physician will probably tell you to drink only clear liquids for 12 to 24 hours beforehand. A liquid diet means fat-free bouillon or broth, gelatin, strained fruit juice, water, plain coffee, plain tea, or diet soda. The night before or right before the procedure, you may also be given an enema, which is a liquid solution that washes out the intestines. Your physician may give you other special instructions.

Via: NDDIK

  • Laparoscopy
Keep Reading....
  • Lower GI Series (Barium Enema)
Lower GI Series
Illustration of the digestive system with the colon and rectum highlighted.

The digestive system

A lower gastrointestinal (GI) series uses x rays to diagnose problems in the large intestine, which includes the colon and rectum. The lower GI series may show problems like abnormal growths, ulcers, polyps, diverticuli, and colon cancer.

Before taking x rays of your colon and rectum, the radiologist will put a thick liquid called barium into your colon. This is why a lower GI series is sometimes called a barium enema. The barium coats the lining of the colon and rectum and makes these organs, and any signs of disease in them, show up more clearly on x rays. It also helps the radiologist see the size and shape of the colon and rectum.

You may be uncomfortable during the lower GI series. The barium will cause fullness and pressure in your abdomen and will make you feel the urge to have a bowel movement. However, that rarely happens because the tube used to inject the barium has a balloon on the end of it that prevents the liquid from coming back out.

You may be asked to change positions while x rays are taken. Different positions give different views of the colon. After the radiologist is finished taking x rays, you will be able to go to the bathroom. The radiologist may also take an x ray of the empty colon afterwards.

A lower GI series takes about 1 to 2 hours. The barium may cause constipation and make your stool turn gray or white for a few days after the procedure.

Preparation

Your colon must be empty for the procedure to be accurate. To prepare for the procedure you will have to restrict your diet for a few days beforehand. For example, you might be able to drink only liquids and eat only nonsugar, nondairy foods for 2 days before the procedure; only clear liquids the day before; and nothing after midnight the night before. A liquid diet means fat-free bouillon or broth, gelatin, strained fruit juice, water, plain coffee, plain tea, or diet soda. To make sure your colon is empty, you will be given a laxative or an enema before the procedure. Your physician may give you other special instructions.

Via: NDDIK

  • Stool Color: When to Worry
Stool color: When to worry
Q.
Lately, my stool has been bright green. Should I be concerned?
A.
Stool comes in a range of colors. All shades of brown and even green are considered normal. Only rarely does stool color indicate a potentially serious intestinal condition.

Stool color is generally influenced by what you eat as well as by the amount of bile — a yellow-green fluid that helps digest fats — in your stool. As bile pigments travel through your gastrointestinal tract, they are chemically altered by enzymes — changing the pigments from green to brown.

Consult your doctor if you're concerned about your stool color. If your stool is bright red or black — which may indicate the presence of blood — seek prompt medical attention.

Stool colorWhat it may meanPossible dietary causes
GreenFood is moving through the large intestine too quickly, such as due to diarrhea. As a result, bile doesn't have time to break down completely.Green leafy vegetables, green food coloring, such as in Kool-Aid or popsicles.
Pale or clay-coloredA lack of bile. This may indicate a bile duct obstruction.Certain medications, such as large doses of Kaopectate and other anti-diarrheal drugs.
Yellow, greasy, foul-smellingExcess fat in the stool, such as due to a malabsorption disorder.Sometimes the protein gluten, such as in celiac disease. But see a doctor for evaluation.
BlackBleeding in the upper intestinal tract, such as the stomach.Iron supplements, Pepto-Bismol, black licorice.
Bright redBleeding in the lower intestinal tract, such as the large intestine or rectum.Red food coloring, beets, tomato juice or soup, red Jell-O.
Via: Mayoclinic
  • Stool Tests

Stool, also called feces, is usually thought of as nothing but waste — something to quickly flush away. But bowel movements can provide doctors with valuable information as to what's wrong when your child has a problem in the stomach, intestines, or another part of the gastrointestinal system.

Your child's doctor may order a stool collection to test for a variety of possible conditions, including:

  • allergy or inflammation in the body, such as part of the evaluation of milk protein allergy in infants
  • infection, as caused by some types of bacteria, viruses, or parasites that invade the gastrointestinal system
  • digestive problems, such as the malabsorption of certain sugars, fats, or nutrients
  • bleeding inside of the gastrointestinal tract

The most common reason to collect stool is to determine whether a type of bacteria or parasite may be infecting the intestine. Many microscopic organisms live in the intestine that are necessary for normal digestion. Sometimes, however, the intestine may become infected with harmful bacteria or parasites that cause a variety of conditions, such as certain types of bloody diarrhea. It may then be necessary to examine the stool under a microscope, culture the stool, and perform other tests to help find the cause of the problem.

Stools are also sometimes analyzed for the substances they contain. An example of stool analysis includes examining the fat content of stools. Normally, fat is completely absorbed from the intestine, and the stool contains virtually no fat. In certain types of digestive disorders, however, fat is incompletely absorbed and remains in the stool.

Collecting a Stool Specimen

Unlike most other lab tests, stool is sometimes collected by the child's family at home, not by a health care professional. Here are some tips for collecting a stool specimen from your child:

  • Collecting stool can be messy, so be sure to wear latex gloves and wash your hands and your child's hands well afterward.
  • Many children with diarrhea, especially young children, can't always let a parent know in advance when a bowel movement is coming. Sometimes a hat-shaped plastic lid is used to collect the stool specimen. This catching device can be quickly placed over the toilet bowl or your child's rear end to collect the specimen. Using a catching device can prevent contamination of the stool by water and dirt. If urine contaminates the stool sample, it will be necessary to take another sample. Also, if you're unable to catch your child's stool sample before it touches the inside of the toilet, the sample will need to be repeated. Fishing a bowel movement out of the toilet does not provide a clean specimen for the laboratory to analyze.
  • Another way to collect a stool sample is to loosely place plastic wrap over the lid of the toilet. Then place the stool sample in a clean, sealable container before taking to the laboratory. Plastic wrap can also be used to line the diaper of an infant or toddler who is not yet using the toilet.

The stool should be collected into clean, dry plastic jars with screw-cap lids. You can get these from your doctor or through hospital laboratories or pharmacies, although any clean, sealable container could do the job. For best results, the stool should then be brought to the laboratory immediately.

If it is impossible to get the sample to the laboratory right away, the stool should be refrigerated, then taken to the laboratory to be cultured as soon as possible after collection. When the sample arrives at the laboratory, it is either examined and cultured immediately or placed in a special liquid medium that attempts to preserve potential bacteria or parasites.

Your child's doctor or the hospital laboratory will usually provide written instructions on how to successfully collect a stool sample; if written instructions are not provided, take notes on how to collect the sample and what to do once you've collected it. If you have any questions about how to collect the specimen, be sure to ask. The doctor or the laboratory will also let you know if a fresh stool sample is needed for a particular test, and if it will need to be brought to the laboratory right away.

Most of the time, disease-causing bacteria or parasites can be identified from a single stool specimen. Sometimes, however, up to three samples from different bowel movements must be taken. Your child's doctor will let you know if this is the case.

Testing the Stool Sample

In general, the results of stool tests are usually reported back within 3 to 4 days, although it often takes longer for parasite testing to be completed.

Examining the Stool for Blood

Your doctor will sometimes check your child's stool for blood, which may be caused by certain kinds of infectious diarrhea, bleeding within the gastrointestinal tract, and other conditions. However, most of the time, blood streaking in the stool of an infant or toddler is from a slight rectal tear, called a fissure, which is caused by straining against a hard stool (this is fairly common in infants and children with ongoing constipation).

Testing for blood in the stool is often performed with a quick test in the office that can provide the results immediately. First, stool is smeared on a card, then a few drops of a developing solution are placed on the card. An instant color change shows that blood is present in the stool. Sometimes, stool is sent to a laboratory to test for blood, and the result will be reported within hours.

Culturing the Stool

Stool can be cultured for disease-causing bacteria. In a culture, a sample of the stool is placed in an incubator for at least 48 to 72 hours and any disease-causing bacteria are identified and isolated. Remember that not all bacteria in the stool cause problems; in fact, over 80% of stool is bacteria, most of which live there normally and are necessary for digestion. In a stool culture, lab technicians are most concerned with identifying bacteria that cause disease.

For a stool culture, the lab will need a fresh or refrigerated sample of stool. The best samples are of loose, fresh stool; well-formed stool is rarely positive for disease-causing bacteria. Sometimes, more than one stool will be collected for a culture.

Swabs from a child's rectum can also be tested for viruses. Although this procedure is not done routinely, it can sometimes give clues in the case of certain illnesses, especially in newborns or very ill children. Viral cultures can take a week or longer to grow, depending on the virus.

Testing the Stool for Ova and Parasites

Stool may be tested for the presence of parasites and ova (the egg stage of a parasite) if a child has prolonged diarrhea or other intestinal symptoms. Sometimes, the doctor will collect two or more samples of stool to successfully identify parasites. If parasites — or their eggs — are seen when a smear of stool is examined under the microscope, the child will be treated for a parasitic infestation. Your child's doctor may give you special collection containers that contain chemical preservatives for parasites.

Via: kidshealth
  • Upper Endoscopy
Upper Endoscopy
Illustration of the digestive system with the stomach and duodenum highlighted.

The digestive system

Upper endoscopy enables the physician to look inside the esophagus, stomach, and duodenum (first part of the small intestine). The procedure might be used to discover the reason for swallowing difficulties, nausea, vomiting, reflux, bleeding, indigestion, abdominal pain, or chest pain. Upper endoscopy is also called EGD, which stands for esophagogastroduodenoscopy (eh-SAH-fuh-goh-GAS-troh-doo-AH-duh-NAH-skuh-pee).

For the procedure you will swallow a thin, flexible, lighted tube called an endoscope (EN-doh-skope). Right before the procedure the physician will spray your throat with a numbing agent that may help prevent gagging. You may also receive pain medicine and a sedative to help you relax during the exam. The endoscope transmits an image of the inside of the esophagus, stomach, and duodenum, so the physician can carefully examine the lining of these organs. The scope also blows air into the stomach; this expands the folds of tissue and makes it easier for the physician to examine the stomach.

The physician can see abnormalities, like inflammation or bleeding, through the endoscope that don't show up well on x rays. The physician can also insert instruments into the scope to treat bleeding abnormalities or remove samples of tissue (biopsy) for further tests.

Possible complications of upper endoscopy include bleeding and puncture of the stomach lining. However, such complications are rare. Most people will probably have nothing more than a mild sore throat after the procedure.

The procedure takes 20 to 30 minutes. Because you will be sedated, you will need to rest at the endoscopy facility for 1 to 2 hours until the medication wears off.

Preparation

Your stomach and duodenum must be empty for the procedure to be thorough and safe, so you will not be able to eat or drink anything for at least 6 hours beforehand. Also, you must arrange for someone to take you home—you will not be allowed to drive because of the sedatives. Your physician may give you other special instructions.

Via: NDDIK

  • Upper GI Endoscopy
Keep reading....
  • Upper GI Series
Upper GI Series
Illustration of the digestive system with the stomach, duodenum, and small intestine highlighted.
The digestive system

The upper gastrointestinal (GI) series uses x rays to diagnose problems in the esophagus, stomach, and duodenum (first part of the small intestine). It may also be used to examine the small intestine. The upper GI series can show a blockage, abnormal growth, ulcer, or a problem with the way an organ is working.

During the procedure, you will drink barium, a thick, white, milkshake-like liquid. Barium coats the inside lining of the esophagus, stomach, and duodenum, and makes them show up more clearly on x rays. The radiologist can also see ulcers, scar tissue, abnormal growths, hernias, or areas where something is blocking the normal path of food through the digestive system. Using a machine called a fluoroscope, the radiologist is also able to watch your digestive system work as the barium moves through it. This part of the procedure shows any problems in how the digestive system functions, for example, whether the muscles that control swallowing are working properly. As the barium moves into the small intestine, the radiologist can take x rays of it as well.

An upper GI series takes 1 to 2 hours. X rays of the small intestine may take 3 to 5 hours. It is not uncomfortable. The barium may cause constipation and white-colored stool for a few days after the procedure.

Preparation

Your stomach and small intestine must be empty for the procedure to be accurate, so the night before you will not be able to eat or drink anything after midnight. Your physician may give you other specific instructions.

Via: NDDIK

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