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Chapter 039. Nausea, Vomiting, and Indigestion (Part 4)

Diagnostic Testing For intractable symptoms or an elusive diagnosis, selected diagnostic tests can direct clinical management. Electrolyte replenishment is indicated for hypokalemia or metabolic alkalosis. Detection of iron-deficiency anemia mandates a search for mucosal injury. Pancreaticobiliary disease is indicated by abnormal pancreatic enzymes or liver biochemistries, whereas endocrinologic, rheumatologic, or paraneoplastic etiologies are suggested by specific hormone or serologic testing. If luminal obstruction is suspected, supine and upright abdominal radiographs may show intestinal air-fluid levels with reduced colonic air. Ileus is characterized by diffusely dilated air-filled bowel loops. . | Chapter 039. Nausea Vomiting and Indigestion Part 4 Diagnostic Testing For intractable symptoms or an elusive diagnosis selected diagnostic tests can direct clinical management. Electrolyte replenishment is indicated for hypokalemia or metabolic alkalosis. Detection of iron-deficiency anemia mandates a search for mucosal injury. Pancreaticobiliary disease is indicated by abnormal pancreatic enzymes or liver biochemistries whereas endocrinologic rheumatologic or paraneoplastic etiologies are suggested by specific hormone or serologic testing. If luminal obstruction is suspected supine and upright abdominal radiographs may show intestinal air-fluid levels with reduced colonic air. Ileus is characterized by diffusely dilated air-filled bowel loops. Anatomic studies may be indicated if initial testing is nondiagnostic. Upper endoscopy detects ulcers or malignancy while small-bowel barium radiography diagnoses partial small-bowel obstruction. Colonoscopy or contrast enema radiography can detect colonic obstruction. Abdominal ultrasound or computed tomography CT defines intraperitoneal inflammatory processes while CT or magnetic resonance imaging MRI of the head can delineate intracranial disease. Mesenteric angiography or MRI is useful when ischemia is considered. Gastrointestinal motility testing may detect a motor disorder that contributes to symptoms when anatomic abnormalities are absent. Gastroparesis commonly is diagnosed using gastric scintigraphy by which emptying of a radiolabeled meal is measured. Isotopic breath tests and telemetry capsule methods also have been validated. Electrogastrography a noninvasive test of gastric slow-wave activity using cutaneous electrodes placed over the stomach has been proposed as an alternate means of diagnosing gastroparesis. The diagnosis of intestinal pseudoobstruction often is suggested by abnormal barium transit and luminal dilation on small-bowel contrast radiography. Small-intestinal manometry can confirm the diagnosis .