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GIHEP Medicine - PUD (ii) Investigations (H Pylori detection (CLOtest…
GIHEP Medicine - PUD (ii) Investigations
FBC
normal or Fe-deficient anaemia due to blood loss
Barium meal x-ray
historical now (a/w radiation unlike endoscopy)
barium gathers in ulcer
ulcer appears round/oval + may be surrounded by a smooth mound of oedema
Upper endoscopy (OGD)
essential - direct visualisation of ulcer
benign gastric + duodenal ulcers have smooth regular rounded edges with a flat smooth base often filled with exudate
most accurate Dx test for PUD
sensitivity approx 90%, but varies based on ulcer location + experience of endoscopist
endoscopic features that suggest an ulcer may be malignant
an ulcerated mass protruding into the lumen
folds surrounding the ulcer crater are nodular, clubbed, fused or stop short of ulcer margin
overhanging, irregular, thickened ulcer margins
all ulcers with malignant features should be bxed
H Pylori detection
CLOtest
contains a combo of urea substrate + pH sensitive indicator
gastric bx placed in kit, colour change if organism present (orange to red, as ammonia changes pH)
quickest (10 mins)
Urea breath test
inhaled radio labelled 13C-urea, if +ve patient breathes out 13CO2
serology - blood - stays +ve for life
histology (bx) - expensive
culture
faecal antigen testing
all these tests are highly sensitive + specific