Digestive system diseases are common and frequent diseases in the clinic, so it is very important to choose the right examination items according to the needs of the disease. With the application of high-tech and large medical equipment in diagnosis and treatment, there are now many common clinical examination items, but not new equipment and high prices are the best examination items, only for specific conditions, choose the appropriate examination items to achieve the best results.
I. Laboratory tests
Fecal occult blood test and urinary triple bile test are simple and valuable tests. Gastric fluid analysis and duodenal drainage can provide a basis for diagnosis of gastric and biliary tract diseases. Liver function tests have many items with different meanings and should be selected appropriately. Cytological examination is helpful for the diagnosis of esophageal, gastric and colon cancer. Tumor marker examination such as AFP, CEA and CA19-9 are of certain value. Autoantibody tests such as anti-mitochondrial antibodies are helpful for the diagnosis of autoimmune diseases of digestive system.
Endoscopic examination
Gastroscopy
The role of gastroscopy has two main aspects: diagnosis and treatment. Because of its direct, repeatable observation and the necessary biopsy, it can confirm the diagnosis of almost all gastric mucosal lesions. However, gastroscopy has strict indications and contraindications.
1) Indications. Anyone who has upper abdominal discomfort, suspected of having gastric disease, but cannot be diagnosed after examination; those who cannot clearly identify the nature of ulcers, swellings and other lesions found by X-ray examination; those with acute gastric bleeding and chronic blood loss of unknown origin; various gastric diseases such as gastritis, post-gastric surgery, follow-up of gastric ulcer; polyp treatment, foreign body removal, etc.
2) Contraindications. Acute pharyngitis, esophageal chemical burns, shock, severe heart and lung disease, mental illness or uncooperative patients are not suitable for gastroscopy. Although gastroscopy is relatively safe, it can also risk perforation of the posterior pharyngeal wall, esophagus and stomach and induce complications such as angina pectoris or myocardial infarction.
Colonoscopy
Colonoscopy is mainly performed on the large intestine, and full colonoscopy can also be performed on part of the ileum. This examination also has indications and contraindications.
1) Indications. Abdominal masses, especially the lower abdominal masses need to be clearly diagnosed; blood in the stool; chronic diarrhea or long-term progressive constipation; wasting, anemia; colon, rectal postoperative follow-up; X-ray barium enema suspected of colon lesions; the need for intra-colonic surgery, laser treatment.
2) Contraindications. Peritonitis, intestinal perforation, extensive intra-abdominal adhesions; advanced cancer with extensive intra-abdominal metastasis; active bacterial dysentery; acute inflammatory lesions in the rectum, anal canal and perianal area; severe cardiovascular and cerebrovascular disease, intolerant to the examination. Complications of e-colonoscopy are more common than gastroscopy, mainly intestinal perforation, intestinal bleeding, intestinal lacerations, cardiovascular accidents, etc., but they are related to the operating experience of doctors.
Ultrasound examination
Ultrasound is easy to operate and has the advantages of no damage to the patient, no pain, rapid and timely examination results, and can be repeatedly examined for several times, etc. Ultrasound examination is mainly suitable for liver, bile, pancreas and kidney.
1) Liver. Observe the morphology, size, margin condition and location of liver; intrahepatic occupying lesions, such as diffuse damage of liver parenchyma, such as hepatocellular carcinoma, hepatic steatosis, fatty liver; differential diagnosis of perihepatic abscess, hematoma, obstructive jaundice; ultrasound-guided hepatic puncture.
2) Gallbladder. Acute and chronic cholecystitis, cholelithiasis, polyps, tumors, etc;
3) Pancreas. Acute and chronic pancreatitis, pseudocysts, true cysts, pancreatic cancer, metastatic tumors, islet cell tumors, etc.
4) Kidney. Such as renal cancer, renal cyst, hydronephrosis, etc.
IV. X-ray examination
Barium meal and barium enema examination of the digestive tract can help to understand the dynamic state of the entire gastrointestinal tract, which is helpful for the diagnosis of tumors, ulcers and diverticula, and the recent application of air-barium double imaging has improved the positive rate. Biliary cholangiography helps to understand the concentrated function of the gallbladder and determine the presence of stones; percutaneous hepatic cholangiography can distinguish the cause of obstructive jaundice. CT and MRI have been used to diagnose intra-abdominal tumors and are readily accepted by patients. Hepatic vein and inferior vena cava manometry and angiography, blood flow and oxygen consumption measurement are useful for the diagnosis of Kashiwa Icha syndrome and hepatocellular carcinoma.
V. CT examination
CT is a more advanced examination method in clinical practice. It is characterized by high sensitivity and can reflect slight density changes for the purpose of early diagnosis. CT abdomen mainly examines parenchymal mass lesions of substantive organs and cavity organs, such as liver cancer, liver cyst, liver sclerosis; spleen size and splenic tuberculosis; cholecystitis, cholelithiasis, polyps and tumors; pancreatitis, pancreatic cancer and cysts and a few cavity organ lesions (such as small intestine lymphoma). However, CT has no significance in the examination of hollow organ lesions of stomach, small intestine and large intestine, such as inflammation, ulceration and bleeding.
VI. Pressure measurement
Determination of esophageal pressure and vitality and bile duct pressure measurement: the pressure in the lumen of the lower esophagus is valuable for the diagnosis of reflux esophagitis. Understanding the vitality of each segment of the esophagus is helpful in diagnosing and identifying esophageal motility disorders such as esophageal cardia achalasia. Bile duct manometry by endoscopic cannulation is helpful in the diagnosis of incomplete biliary obstruction, sclerosing cholangitis, biliary atresia, and papillary sphincter dysfunction.
VII. Biopsy
Liver aspiration biopsy is one of the most valuable methods to determine the diagnosis of chronic liver disease. Currently, fine needle aspiration is mostly used, which rarely causes the risk of bleeding. Small intestine biopsy, the small intestine biopsy device is sent to the jejunum or ileum through the mouth (can be guided by endoscopy through the pylorus) to take mucosal tissue for pathological examination, which is of great diagnostic value for diarrhea and small intestine malabsorption. The indications should be strictly controlled during the examination. In addition, direct endoscopic biopsy, fine needle percutaneous biopsy cytology of substantial masses under B-type ultrasound guidance and surgical biopsy can make pathological diagnosis.