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Esophageal manometry(esophageal motility study) Esophageal manometry is a test to measure the pressure inside the lower part of the

esophagus. How the Test is Performed An EMS is typically done to evaluate suspected disorders of motility or peristalsis of the esophagus. These include achalasia, diffuse esophageal spasm, nutcracker esophagus and hypertensive lower esophageal sphincter. These disorders typically present with dysphagia, or difficulty swallowing, usually to both solids and liquids even initially. Other patients with spasm disorders may have the test done to diagnose chest pain thought not to be of cardiac cause. The test is not useful for anatomical disorders of the esophagus (that is, disorders that distort the anatomy of the esophagus), such as peptic strictures and esophageal cancer. While the tube is in place, other studies of your esophagus may be done. The tube is removed after the tests are completed. The test takes about 1 hour. How to Prepare for the Test You should not have anything to eat or drink for 8 hours before the test. Why the Test is Performed The purpose of esophageal manometry is to see if the esophagus is contracting and relaxing properly. The test helps diagnose any

swallowing problems. Your health care provider may request that this test be performed if you have symptoms of gastroesophageal reflux disease (GERD). Normal Results The LES pressure and muscle contractions are normal when you swallow. What Abnormal Results Mean Abnormal results may indicate the following: Risks The tube in the esophagus may cause increased salivation, which raises your risk for aspiration. This can lead to lung injury or aspiration pneumonia. In general, people with swallowing difficulty are at higher risk for aspiration. Achalasia Diffuse esophageal spasm Lack of muscle coordination

Diagram of esophageal motility study in nutcracker esophagus. The disorder shows peristalsis with high pressure esophageal contractions exceeding 180 mmHg and contractile waves with a long duration exceeding 6 seconds.

Diagnostic laparoscopy Diagnostic laparoscopy is a procedure that allows a health care provider to look directly at the contents of a patient's abdomen or pelvis, including the fallopian tubes, ovaries, uterus, small bowel, large bowel, appendix, liver, and gallbladder. How to Prepare for the Test Do not eat or drink anything for 8 hours before the test. You must sign a consent form. Why the Test is Performed The examination helps identify the cause of pain in the abdomen and pelvic area. It is done after other, noninvasive tests. Laparoscopy may detect or diagnose the following conditions: Appendicitis Cancer, such as ovarian cancer Ectopic pregnancy Endometriosis Inflammation of the gallbladder (cholecystitis) Pelvic inflammatory disease

Normal Results There is no blood in the abdomen, no hernias, no intestinal obstruction, and no cancer in any visible organs. The uterus, fallopian tubes, and ovaries are of normal size, shape, and color. The liver is normal. What Abnormal Results Mean Abnormal results may be due to a number of different conditions, including: Adhesions Appendicitis Cholecystitis Signs of injury Spread of cancer Tumors

The procedure may also be done instead of open surgery after an accident to see if there is any injury to the abdomen. Major procedures to treat cancer, such as surgery to remove an organ, may begin with laparoscopy to rule out the presence of cancer spread (metastatic disease), which would change the course of treatment.

Endoscopy Endoscopy is a way of looking inside the body using a flexible tube that has a small camera on the end of it. This instrument is called an endoscope. An endoscope is passed through a natural body opening or a small incision. For example, a laparoscope is inserted through small surgical cuts in the pelvic or belly area. In men, a urinary tract endoscope is passed through the opening of the urethra. A gastrointestinal endoscope may be inserted through the mouth or anus. An ultrasound probe can be added to a gastrointestinal endoscope. This is called an endoscopic ultrasound. Depending on the area of interest, this device can also be passed through the mouth or anus. When is upper GI endoscopy used? Upper GI endoscopy can be used to determine the cause of abdominal pain nausea vomiting swallowing difficulties gastric reflux unexplained weight loss anemia bleeding in the upper GI tract

Upper GI endoscopy can be used to remove stuck objects, including food, and to treat conditions such as bleeding ulcers. It can also be used to biopsy tissue in the upper GI tract. During a biopsy, a small piece of tissue is removed for later examination with a microscope.

How to Prepare for the Test The upper GI tract must be empty before upper GI endoscopy. Generally, no eating or drinking is allowed for 4 to 8 hours before the procedure. Smoking and chewing gum are also prohibited during this time. Ask your health care provider if you need to do anything to prepare for your endoscopy. You may be asked not to eat or drink before most types of endoscopy. Before an examination of the lower gastrointestinal tract, you may be asked to use enemas or laxatives to clear out the large intestine. Why the Test is Performed There are many different reasons to perform an endoscopy. For example, your doctor may order an endoscope if you have bleeding, pain, difficulty swallowing, and a change in bowel habits. Colonoscopy is also be done to screen for colon polyps and colon cancer.

Normal Results The endoscopy should reveal normal function and appearance of the area being examined.

Scintigraphy Scintigraphy ("scint," Latin scintilla, spark) is a form of diagnostic test used in nuclear medicine, wherein radioisotopes (here called radiopharmaceuticals) are taken internally, and the emitted radiation is captured by external detectors (gamma cameras) to form two-dimensional images. In contrast, SPECT and positron emission tomography (PET) form 3-dimensional images, and are therefore classified as separate techniques to scintigraphy, although they also use gamma cameras to detect internal radiation. Scintigraphy is unlike a diagnostic X-ray where external radiation is passed through the body to form an image. For example, scintigraphy of the biliary system (cholescintigraphy) is done to diagnose obstruction of the bile ducts by a gallstone, a tumor, or another problem; disease of the gallbladder; and bile leaks. For cholescintigraphy, a radioactive chemical is injected intravenously into the patient. The chemical is removed from the blood by the liver and secreted into the bile that the liver makes. The chemical then goes everywhere that the bile goes: into the bile ducts, the gallbladder, and the intestine. By placing over the abdomen a camera that senses radioactivity, a picture of the gallbladder; and bile leaks. For cholescintigraphy, a radioactive chemical is injected intravenously into the patient. The chemical is removed from the blood by the liver can be obtained that corresponds to where the radioactivity is within the bile-filled liver, ducts, and gallbladder. Other scintigraphic tests are done similarly. Cholescintigraphy A cholescintigraphy or Hepatobiliary Imino-Diacetic Acid scan, (HIDA scan) is a nuclear imaging procedure to evaluate the health and function of the gallbladder. A radioactive tracer, usually technetium-99m, is injected through any accessible vein, then allowed to circulate to the liver, where it is excreted into the biliary system and stored by the gallbladder and biliary system. In the absence of disease, the gallbladder is visualized within 1 hour of the injection of the radioactive tracer. If the gallbladder is not visualized within 4 hours after the injection, this indicates either cholecystitis or cystic duct obstruction. Cholescintigraphy has sensitivity of 95%, Specificity of 90%

Sigmoidoscopy Sigmoidoscopy is the minimally invasive medical examination of the large intestine from the rectum through the last part of the colon. There are two types of sigmoidoscopy, flexible sigmoidoscopy, which uses a flexible endoscope, and rigid sigmoidoscopy, which uses a rigid device. Flexible sigmoidoscopy is generally the preferred procedure. A sigmoidoscopy is similar but not the same as a colonoscopy. A Sigmoidoscopy only examines up to the sigmoid, the most distal part of the colon, while colonoscopy examines the whole large bowel. Preparation The colon and rectum must be completely empty for flexible sigmoidoscopy to be thorough and safe, thus the patient must drink only clear liquids for 12 to 24 hours beforehand. This includes bouillon or broth, gelatin, strained fruit juice, water, plain coffee, plain tea, or diet soft drinks. The night before or right before the procedure, the patient receives a laxative and an enema, which is a liquid solution that washes out the intestines. No sedation is required during this procedure as long as the examination does not exceed the level of the splenic flexure. How to Prepare for the Test You must sign an informed consent form. You will wear a hospital gown. On the morning of the procedure, eat a light breakfast and then use a cleansing enema about 1 hour before the sigmoidoscopy. Why the Test is Performed This test can help diagnose: Bowel obstruction Causes of diarrhea Colon polyps Diverticulosis (the presence of abnormal pouches on the lining of the intestines) Inflammatory bowel disease

This test can also be used to: Determine the cause of blood, mucus, or pus in the stool Confirm findings of another test or x-rays Take a biopsy of a growth To screen for colorectal cancer

Normal Results Normal findings show that the lining of the sigmoid colon, rectal mucosa, rectum, and anus appear normal in color, texture, and size. What Abnormal Results Mean Abnormal results can indicate: Anal fissures Anorectal abscess Bowel obstruction Cancer Colorectal polyps Diverticulosis Hemorrhoids Inflammatory bowel disease Inflammation or infection (proctitis)

Proctoscopy

Proctoscopy is a common medical procedure in which an instrument called a proctoscope (also known as a rectoscope, although the latter may be a bit longer) is used to examine the anal cavity, rectum or sigmoid colon. A proctoscope is a short, straight, rigid, hollow metal tube, and usually has a small light bulb mounted at the end. It is approximately 5 inches or 15 cm long, while a rectoscope is approximately 10 inches or 25 cm long. During proctoscopy, the proctoscope is lubricated and inserted into the rectum, and then the obturator is removed, allowing an unobstructed view of the interior of the rectal cavity. This procedure is normally done to inspect for hemorrhoids or rectal polyps and might be mildly uncomfortable as the proctoscope is inserted further into the rectum. Modern fibre-optic proctoscopes allow more extensive observation with less discomfort.

Disposable proctoscopes without light are also available. The proctoscope also has a hollow channel through which other instruments may be inserted. For example, another instrument may be used to take a biopsy of a small amount of tissue for examination under a microscope. Also, air may be injected through the proctoscope to help make viewing easier. Similar instruments, the sigmoidoscope and colonoscope may be used to visualize more proximal parts of the bowels.

Defecography Defecography uses an x-ray to look at the shape and position of the rectum as it empties. The anal canal is lubricated and a soft plastic tip is inserted through the anal canal into the rectum. The rectum and anal canal are filled with barium paste and the tip is removed. X-ray dye is placed in the urinary bladder and the vagina. The person drinks barium about one hour before the test so the small intestine shows up. This way everything in the pelvis can be seen when the person strains. The person sits on a toilet-like seat, called a defecography chair, which is attached to the x-ray table. The table is tilted into the upright position. The person puts their elbows on their knees. The person is asked to squeeze, to push and to empty the rectum. The x-ray of these maneuvers is recorded on videotape. Defecography shows the rectum as it empties. Defecography reveals rectoceles and signs of rectal descent. In women with rectal descent, there is more rectal length down in the bottom three inches of the pelvis. Two proctoscopes A normal rectum should empty in just a few seconds. In rectal descent it may take 30, 60 or even 90 seconds to empty, and the rectum may not empty completely. The lower end of the rectum may close before the upper rectum is empty (flap valving). People with a tight internal anal sphincter have a big bowlshaped rectum that empties slowly through a narrow, short anal opening that never opens up. People with non-relaxing puborectalis muscles have rectums that do not empty because the pelvic floor muscles do not relax. Defecography findings of rectal descent are: Rectocele Horizontal rectum during push Delayed or incomplete rectal emptying Delayed or incomplete rectocele emptying Rectum protruding into anal canal Long rectum in the bottom three inches of the pelvis

small bowel enteroscopy A small bowel enteroscopy allows a physician to navigate the entire small bowel from either an oral or rectal approach, enabling them to perform both diagnostic and therapeutic techniques within the small bowel without the need of an open surgical procedure. Doctors use a special endoscope that, when inflated with air, can expand sections of the small intestine to enable the camera to get a closer view. It is generally used for investigating suspected small intestinal bleeding in persons with objective evidence of recurrent, obscure gastrointestinal bleeding (e.g., iron-deficiency anemia, positive fecal occult blood test or visible bleeding), who have had upper and lower gastrointestinal endoscopies that have failed to identify a bleeding source. It also is used for initial diagnosis in persons suspected to have Crohn's disease (abdominal pain, diarrhea, fever, elevated white blood cell count, elevated erythrocyte sedimentation rate, weight loss or bleeding) and for treating patients with gastrointestinal bleeding when the small intestine has been identified as the source of bleeding. How do you prepare for a small bowel enteroscopy? An empty stomach allows for the best and safest examination, so you should have nothing to eat or drink, including water, for approximately 12 hours before the examination. Your doctor will tell you when to start fasting. Speak with your doctor in advance about any medications or supplements you take, including iron, aspirin, bismuth subsalicylate products (e.g., Pepto-Bismol) and other overthe-counter medications. You might need to adjust your usual dose prior to the examination. What should you expect on the day of your small bowel enteroscopy? After you check in, one of our nurses will meet with you to review your medical conditions and medications. An IV line will be placed in a vein in your arm. You will proceed to the procedure room, where your blood pressure, pulse and oxygen level will be carefully monitored. A sedative will also be administered through your IV, and you may need general anesthesia. The test itself usually takes about an hour to two hours. After the test, you will rest until the effects of the medicine wear off. You will not be able to drive following the procedure, so plan on having someone with you to take you home. Before leaving, our staff will speak with you about the preliminary results of your test and will let you know when you can go back to eating your regular diet.

Stool Tests

Transport vials filled with human feces for stool testing. Yellow and blue tops for parasite testing, red top for stool cultures and the white top was provided by the patient with the sample. A stool test is one where fecal matter is collected for analysis to diagnose the presence or absence of a medical condition. Microbiology tests Parasitic diseases such as Ascariasis, Hookworm, Strongyloidiasis and Whipworm can be diagnosed by examining stools under a microscope for the presence of worm larvae or eggs. Some bacterial diseases can be detected with a stool culture. Toxins from bacteria such as Clostridium difficile ('C. diff.') can also be identified. Viruses such as rotavirus can also be found in stools. Chemical tests A fecal pH test may be used determine lactose intolerance or the presence of an infection.[3] Steatorrhea can be diagnosed using a Fecal fat test that checks for the malabsorption of fat.

Stool guaiac test The stool guaiac test finds hidden (occult) blood in the stool (bowel movement). It is the most common form of fecal occult blood test (FOBT) in use today.

How the Test is Performed If the test is performed in an office or hospital, stool may be collected by a doctor during an examination. If the test is performed at home, a stool sample from three consecutive bowel movements is collected, smeared on a card, and mailed to a laboratory for processing. How to Prepare for the Test Do not eat red meat, any blood-containing food, cantaloupe, uncooked broccoli, turnip, radish, or horseradish for 3 days prior to the test. You may need to stop taking medicines that can interfere with the test. These include vitamin C and nonsteroidal antiinflammatory medicines such as ibuprofen and aspirin. Why the Test is Performed This test is a screening test to detect blood in the digestive tract. Normal Results A negative test result means that there is no blood in the stool. Abnormal results may indicate: Angiodysplasia of the GI tract Colon cancer or other gastrointestinal (GI) tumors Colon polyps Esophageal varices and portal hypertensive gastropathy Esophagitis Gastritis GI trauma or bleeding from recent GI surgery Hemorrhoids Inflammatory bowel disease Peptic ulcer

Breath alcohol test A breath alcohol test determines how much alcohol is in your blood by measuring the amount of alcohol in the air you breathe out (exhale). How the Test is Performed There are various brands of breath alcohol tests. Each one uses a different method to test the level of alcohol in the breath. The machine may be electronic or manual. One common manual tester requires you to blow up a balloon in one continuous breath until it is full, then release the air into a glass tube. The tube is filled with bands of yellow crystals. The bands in the tube change colors (from yellow to green), depending on the alcohol content. If an electronic alcohol meter is used, follow the instructions that come with the meter. How to Prepare for the Test Wait 15 minutes after drinking an alcoholic beverage and 1 minute after smoking before starting the test. Why the Test is Performed When you drink alcohol, the amount of alcohol in your blood goes up. This is called your blood-alcohol level. When the amount of alcohol in the blood reaches 0.02 - 0.03%, you may feel a relaxing "high.".0.05 - 0.10%, you have reduced muscular coordination, a longer reaction time, and impaired judgment. Driving under the influence of alcohol is dangerous. A person with an alcohol level of 0.08% and above is considered legally intoxicated (drunk) in most states. Normal Results Normal is when the blood alcohol levels are not elevated. What Abnormal Results Mean When one band is green, it means that the blood-alcohol level is 0.05% or lower. Two green bands mean levels of 0.05% to 0.10%. Three green bands indicate levels between 0.10% and 0.15%.

Urea breath test The urea breath test is a rapid diagnostic procedure used to identify infections by Helicobacter pylori, a spiral bacterium implicated in gastritis, gastric ulcer, and peptic ulcer disease. It is based upon the ability of H. pylori to convert urea to ammonia. Urea breath tests are recommended in leading society guidelines as a preferred non-invasive choice for detecting H. pylori before and after treatment. Hydrogen breath test The hydrogen breath test is used to identify one of two conditions: lactose intolerance or an abnormal growth of bacteria in the intestine. Day of the test DO NOT smoke. Avoid second-hand smoke. DO NOT chew gum. DO NOT use mouthwash. Use only a small amount of water when you brush your teeth. 8 hours before the test DO NOT eat or drink anything (including water) for 8 hours before the test.