RT Book, Section
A1 Olsen, Keith M.
A1 McCaleb, Rachael V.
A2 DiPiro, Joseph T.
A2 Yee, Gary C.
A2 Posey, L. Michael
A2 Haines, Stuart T.
A2 Nolin, Thomas D.
A2 Ellingrod, Vicki
SR Print(0)
ID 1182435988
T1 Evaluation of the Gastrointestinal Tract
T2 Pharmacotherapy: A Pathophysiologic Approach, 11e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781260116816
LK accesspharmacy.mhmedical.com/content.aspx?aid=1182435988
RD 2024/04/18
AB KEY  CONCEPTS  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.  A  complete  physical  examination  should  be  performed,  the  severity  and  location  of  symptoms  directing  the  focus  of  the  examination.  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 barium  sulfate  and  Gastrograffin®  (diatrizoate  meglumine  and  diatrizoate  sodium  solution),  have  gradually  been  replaced  by  endoscopy,  but  allow  evaluation  of  the  hollow  organs  of  the  digestive  tract  for  mucosally  based  lesions  as  well  as  narrowing  or 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.  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.  Enteroclysis  is  used  to  evaluate  the  small  bowel  by  introducing  contrast  agents  by  tube  through  the  nose  or  mouth  directly  into  the  small  intestine.  Transabdominal  ultrasound,  computed  tomography,  and  magnetic  resonance  imaging  provide  images  of  the  gallbladder,  liver,  pancreas,  and  abdominal  wall.  Radionuclide  imaging  is  sometimes  useful  to  visualize  and  evaluate  the  liver,  spleen,  bile  ducts,  and  gallbladder.  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.  Capsule  endoscopy,  a  newer  less  invasive  endoscopic  technique,  takes  pictures  of  the  GI  tract  in  the  assessment  of  the  small  bowel  in  particular.  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.  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.