Question

Use the application of Medical Terminology to answer the following questions: 1. How is a digestive disorder diagnosed? When a patient comes in to the doctor and complaining of dyspepsia what diagnostic and laboratory tests would the physician perform ?The physician would need to rule out anemia, check electrolytes nausea, emesis or epigastric fullness may also have generalized electrolyte imbalances) investigate the esophagus (GERD); evaluate the hepatobiliary system if gallstones are suspected; investigate pancreatitis; investigations to confirm or exclude ulcers, reflux disease and malignancies; confirm or rule out H. pylori Example: In a patient with dyspepsia, belching will be a symptom. However, in this assignment I would expect the term "eructation" to be used instead of belching." FI 2. How would a Urologist investigate and diagnose hematuria. Hematuria can be microscopic or gross. Include test for renal clearance, and imaging studies of the kidney bladder, ureters, urethra.

Answer 1

1. How is a digestive disorder diagnosed?

• There are three parts to making a correct diagnosis of digestive disorders.
• These include a scrutiny of the medical history of the patient, a physical examination, possibly also a psychological evaluation, and doing appropriate tests to obtain tissue samples, images or stool samples from the patient.

Medical history

These would include questions about exact symptoms, general lifestyle choices, diet, previous gastro-intestinal disorders, and any systemic disorders, such as diabetes.

Specific questions can relate to the nature of the pain or discomfort experienced by the patient, where it is located, and whether there are certain actions or foods which make it worse. The doctor will ask about bowel movements and the type of stools produced.

Physical examination

A physical examination would entail the following:

• Observation of the abdomen from different angles to see if any swelling is visible
• A stethoscope is used to auscultate for any sounds emanating from the abdomen
• The doctor feels for tenderness or enlarged organs or abnormal masses
• Pain caused by gentle pressure could indicate inflammation or infection of the lining of the abdominal cavity

Your doctor will also do a rectal examination if indicated. This might be uncomfortable.

A psychological evaluation is sometimes done, as there can be a close connection between digestive problems and psychological conditions such as depression and anxiety. Psychological factors play a role in as many as 50% of people with digestive disorders.

Tests to diagnose digestive disorders

Some tests need the digestive system to be empty, some require nil per oral for eight to 12 hours before the test, and others require no preparation. Many of these tests make use of sophisticated equipment and can be very expensive.

Stool tests: This test is used to check for the presence of blood in the stool, or the presence of parasites, fungi, viruses, bacteria, white blood cells, bile, or cancer. It can also be used to check whether a patient is experiencing poor absorption of nutrients.

Endoscopes: An endoscope is a device with a light attached that is used to look inside a body cavity or organ. The scope is inserted through a natural opening such as the mouth or in the region of the opening of the rectum to the outside of the body.

Intubation of the digestive tract: A small flexible tube is passed through the nose or mouth into the stomach or the small intestine. This can be used to diagnose or treat disorders, or to obtain a sample of stomach fluid. These stomach secretions can be tested for the presence of blood, acid levels or enzyme levels can also be tested.

Laporoscopy describes an examination of the abdominal cavity using an endoscope that is inserted through a small incision in the navel. This is used to look for tumours or other abnormalities, take tissue samples, examine surrounding organs, and to do surgery.

Paracentesis (Insertion of a needle): This is done to get a sample of fluid from the abdominal cavity or other parts of the digestive system.

Tests for acid and reflux: A small tube is placed in the oesophagus to test acid reflux into the oesophagus.

Different types of imaging techniques

Normal X-rays: These can show a blockage or a paralysis in the digestive system.

Barium X-rays: The patient swallows barium before the X-ray is taken. The barium shows up white on the X-rays and can show whether the oesophagus and stomach function normally. Barium can also be used to look for polyps or tumors or structural abnormalities in the lower intestine.

Computed Tomography Scan (CT scan) and Magnetic Resonance Imaging (MRI): These are used to assess the size and the location of organs in the abdominal cavity. These tests can also detect tumours (both malignant and benign) and changes in the blood vessels. CT scans create two-dimensional and three-dimensional images of the abdominal area, the colon or the small inetsine, making detection of abnormalities easier.

Ultrasound scanning: This technique uses sound waves to produce images of internal organs and any abnormalities present in them.

When a patient comes into the doctor and complaining of dyspepsia what diagnostic and laboratory tests would the physician perform?

Your doctor diagnoses dyspepsia based on your medical history, a physical exam, upper gastrointestinal (GI) endoscopy, and other tests.

• Medical history

Your doctor will review your symptoms like eructation, bloating, pyrosis, nausea or vomitingand medical history. He or she will ask you about your eating and drinking habits, your use of over-the-counter and prescription medicines, and whether you smoke.

• During a physical exam, your doctor may check for bloating, auscultate abdomen using a stethoscope, percussion of abdomen is done to check for tenderness, pain, and lumps, look for yellowing of your eyes or skin.
• Upper GI endoscopy

Your doctor may perform an upper GI endoscopy to diagnose diseases and conditions that may be causing dyspepsia, such as gastritis, peptic ulcer disease, stomach cancer .

A doctor may recommend an upper GI endoscopy for people with indigestion who are older than 55 or for people with indigestion of any age who have a family history of cancer, Dysphagia, evidence of bleeding in the digestive tract, frequent vomiting, weight loss.

During an upper GI endoscopy, your doctor can use tiny tools passed through the endoscope to take small pieces of tissue from the lining of your stomach and duodenum. This procedure is called an upper GI biopsy. A doctor will examine the tissue samples to look for digestive tract diseases and conditions, including Helicobacter pylori (H. pylori) infection.

Other tests

Imaging tests: The doctor may use imaging tests such as x-rays , computed tomography (CT) scans , or ultrasound to look for diseases and conditions in your digestive tract that may be causing dyspepsia.

H. pylori testing: It can detect an H. pylori infection by using blood, stool, or breath tests or by performing an upper GI biopsy.

Blood test: A health care professional may take a blood sample and send the sample to a lab to test for signs of H. pylori infection.

Stool test: The doctor may use stool tests to look for signs of H. pylori infection. And he may also use a stool test to see if treatment has worked to get rid of H. pylori.

Urea breath test: Urea breath test is done to check for H. pylori infection. You will swallow a capsule, liquid, or pudding that contains urea—a waste product the body produces as it breaks down protein. The urea is “labeled” with a special carbon atom. If H. pylori are present, the bacteria will convert the urea into carbon dioxide. After a few minutes, you will breathe into a container, exhaling carbon dioxide. A health care professional will test your exhaled breath for labeled carbon dioxide. If the test detects the labeled carbon atoms, the health care professional will confirm an H. pylori infection in your digestive tract.

2. How would a urologist investigate and diagnose hematuria.Hematuria can be microscopic or gross.

The following tests and exams play a key role in finding a cause for hematuria:

Your doctor will begin by discussing your medical history and any symptoms you may have and perform a physical exam. During the physical exam, your doctor will check for any signs of injury such as bruising. If you are male, your doctor may perform a digital rectal exam to determine if your prostate may be causing the hematuria. You should also inform your doctor of any medications you may be taking, including vitamins or supplements.

Hematuria may be evaluated by one or more of the following imaging examinations:

X-ray: An abdominal x-ray may be used to look for some of the causes of hematuria, such as nephrolithiasis or cystoliths, especially if you have other symptoms such as nausea and vomiting. Most causes of hematuria will not be detected by an x-ray, and additional exams will likely be required.
MR/CT Urography: Your doctor may order a CT or MR urography exam. Both exams will help your doctor see your urinary tract, including the bladder, ureters and kidneys.

Abdominal ultrasound: Ultrasound may be useful for helping your doctor to see the kidneys and the bladder and identify abnormalities, such as the urinary tract obstruction or other potential causes of hematuria.
Intravenous pyelogram (IVP): IVP is an x-ray examination that will help to visualize the kidneys, bladder and ureters. It can help detect abnormalities within the urinary system and show how efficiently the urinary system eliminates waste. This exam requires the patient to receive an injection of contrast material into the vein. After several minutes, a series of x-rays will be taken revealing the kidneys, ureters and bladder.

MRI of the prostate: If the prostate gland is suspected to be the cause of hematuria, an MRI exam may be ordered to better visualize possible abnormalities of the prostate gland and seminal vesicles.