Digestive Issues Diagnostic Tests

Diagnostic Tests and Procedures for Digestive Issues

• Ascites (fluid buildup in the abdomen): Perform paracentesis (peritoneal aspiration) and analyze the fluid using gram staining. Look for more than 250 white blood cells per high-powered field (HPF) to assess severity.

• Dysphagia (difficulty swallowing):

  • Solids and liquids: Possible neurogenic cause like achalasia—this also could be related to esophageal cancer
  • Solids progressing to liquids: Suspect esophageal cancer.
  • Solids first and then liquids: Possible Zenker diverticulum with halitosis (bad breath), gurgling sounds, or undigested food regurgitation. A barium swallow is initial diagnostic test. Monometry is used to confirm achalasia if the barium swallow shows the bird’s beak appearance.
  • GERD history with dysphagia: Endoscopy is necessary to rule out cancer.
  • Diabetes with new-onset GERD: Suspect diabetic gastroparesis. Metoclopramide, not PPIs, is the preferable treatment.
  • Diabetes with gastroparesis: Endoscopy is crucial first to rule out physical obstructions; if negative, consider gastric-emptying scintigraphy.

Conditions Related to Eating Disorders

• Anorexia nervosa/Bulimia nervosa: Avoid bupropion (potential for seizures). Hypokalemia (low potassium) is a common electrolyte abnormality. Arrhythmias, resulting from hypokalemia, is a leading cause of death. Refeeding syndrome complications could include hypophosphatemia. Mirtazapine may be considered to aid appetite stimulation and depression treatment for anorexia nervosa.

• Anorexia with amenorrhea: Low levels of follicle-stimulating hormone (FSH) and estrogen (hypogonadotropic) are often observed.

Conditions Related to Reproductive Health

• Premature Ovarian Failure/Turner Syndrome/Menopause: Individuals with these conditions often display elevated FSH (follicle-stimulating hormone) and low estrogen. (note: normal FSH and low inhibin levels)

Biliary Tract Conditions

• Cholelithiasis (gallstones): Abdominal ultrasound is the first-line diagnostic test. Risk factors include female sex, middle age, excess fat, and fertility.

• Cholelithiasis and Cholecystitis (inflammation of the gallbladder): Fever and biliary colic symptoms suggest cholecystitis. Treatment typically includes cholecystectomy (surgical removal).

• Alternative treatment for symptomatic cholelithiasis or in pregnancy: Ursodiol (ursdeoxycholic acid) as an alternative to surgery.

• Cholecystitis Diagnostic Evaluation (if ultrasound is unrevealing): HIDA (hepatobiliary iminodiacetic acid) scan to visualize the gallbladder function and to confirm cholecystitis.

• Cholelithiasis in Pregnancy: Pregnancy-related hormonal changes (estrogen affecting HMG-CoA reductase, progesterone slowing biliary peristalsis) can affect gallstone development and treatment.

Other Digestive Issues

• Trichotillomania (hair-pulling disorder) with GI symptoms: Gastric bezoar (hairball) is a possible cause.

• History of surgery + high-pitched bowel sounds/acute-onset symptoms: Consider small bowel obstruction (SBO).