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  • image The patient history is key to evaluating gastrointestinal (GI) tract disorders and should include the problem onset, the setting in which it developed, and its presentation. Patient warning signs and alarm symptoms should be identified quickly and referral for further evaluation should be obtained in a prompt manner.

  • image A complete physical examination should be performed, the severity and location of symptoms directing the focus of the examination.

  • image Contrast agents, barium sulfate and Gastrograffin® (diatrizoate meglumine and diatrizoate sodium solution), have gradually been replaced by endoscopy, but allow evaluation of the hollow organs of the digestive tract for mucosally based lesions as well as narrowing or strictures involving the GI tract.

  • image The upper GI series involves radiographic visualization of the esophagus, stomach, and duodenum; whereas, the lower GI series involves visualization of the colon and rectum.

  • image Enteroclysis is used to evaluate the small bowel by introducing contrast agents by tube through the nose or mouth directly into the small intestine.

  • image Transabdominal ultrasound, computed tomography, and magnetic resonance imaging provide images of the gallbladder, liver, pancreas, and abdominal wall.

  • image Radionuclide imaging is sometimes useful to visualize and evaluate the liver, spleen, bile ducts, and gallbladder.

  • image The endoscope, an illuminated optical instrument, remains the cornerstone of GI diagnosis and most importantly therapy. Common examples of endoscopic procedures include esophagogastroduodenoscopy, colonoscopy, enteroscopy, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound.

  • image Capsule endoscopy, a newer less invasive endoscopic technique, takes pictures of the GI tract in the assessment of the small bowel in particular.

  • image Ambulatory esophageal pH measurement is an important diagnostic test for gastroesophageal reflux disease and is often performed in conjunction with upper endoscopy. Most systems today are completely wireless and patient friendly.

  • image Multichannel intraluminal impedance and pH monitoring combines acid exposure with impedance changes in resistant flow to aid the diagnosis of reflux in patients receiving a proton pump inhibitor and other antisecretory medications.


The gastrointestinal (GI) tract is an organ system responsible for nutrient absorption, waste excretion, and immunity. It is composed of the upper GI tract (oral cavity, esophagus, and duodenum), lower GI tract (small intestine, cecum, colon, rectum, and anus), and associated glandular organs (gallbladder, pancreas, and liver). A variety of symptoms can arise from GI tract dysfunction, including heartburn, dyspepsia, abdominal pain, nausea, vomiting, diarrhea, constipation, and GI bleeding. Signs and symptoms of malabsorption, hepatitis, and GI infection are also commonly seen. All clinicians must recognize warning symptoms that include weight loss, intractable vomiting, anemia, dysphagia, odynophagia, and bleeding; and a patient presenting with any of these symptoms should be immediately referred for further diagnostic interventions.

Despite the rapid proliferation of technology for the diagnosis of digestive diseases, the patient history and physical examination remain important for initial assessment, triage, and guidance of further diagnostic interventions. When combined with a thorough patient history and physical examination, diagnostic procedures are essential in the evaluation of GI ...

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