On this page we have tried to put together as many medical examinations as possible that are connected
with the gastrointestinal tract and the urinary tracts. Can’t find what you are looking for? Let us know!

In the case of many illnesses, the urine contains material which should not be there. In some cases, such as chronic kidney insufficiency, less urine may be produced. On the other hand, diabetics can produce large quantities of urine. Even the recording of the obvious characteristics of the urine can help to diagnose illnesses. Infected urine or urine which contains blood can, for example, lose its normal clarity and become murky. Urine can also be tested for infections of the urinary tract by looking for white blood cells and bacteria under a microscope and checking whether micro-organisms develop if they are cultured for 48 to 72 hours.

Faeces can be tested for various illnesses and infections. The presence of fat in the excrement (steatorrhoea) indicates a problem with the liver, the gall bladder or the pancreas. The presence of a small quantity of blood (occult blood, hemocult = a test to detect a microscopic amount of blood in the faeces) can sometimes indicate the early stages of intestinal cancer. If small eggs or cysts are seen under the microscope this confirms there is a worm infection. By means of a culture showing the presence of bacterial organisms dysentery and other bacterial infections of the intestine can be revealed.

Picture source: Dymo

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X-rays

The X-ray is an extremely common examination. When x-ray images are made, rays are passed through the patient’s body and projected onto a photographic plate or television screen. Bones prevent the passage of the rays and thus create shadows. In order to make the intestines or bladder visible, a means of contrast is often used. Just like the bones, this material prevents the rays totally, or at least partially, from penetrating the photographic plate or television screen, The contrast fluid leaves the body via the faeces or urine.

There are various kinds of x-ray examination. First of all there is an overview of the abdomen. This is an x-ray image of the entire abdomen without the use of contrast fluid. If, for example, there is severe constipation, then the pile up of large quantities of faeces is visible on the x-ray..

One examination which uses an overview of the abdomen is the Pellet passage test. You have to swallow granules or little rings which are visible on an x-ray so that the passage of food through the intestinal canal can be followed. X-rays are then taken several days in succession in order to see where the rings are in the intestinal canal. If, for example, the rings are still visible after 4 days then there is evidence of constipation.

There are also x-rays where a specific part of the body is photographed. For example, an image of the small intestine; the latter must be empty and this can be achieved by following a special diet together with a laxative. You are given contrast fluid through a tube in your nose or mouth into your stomach and then you lie under the x-ray machine in a number of different positions. There is also an image of the large intestine which, just as in the case of the previous examination, must be empty. First contrast fluid and then air is injected into the anus so that the intestine unfolds and is thus easier to see.

Enteroclysis. This is a special technique for taking x-rays of the small intestine where the contrast fluid is injected instead of being ingested via a tube in the mouth or nostril. The small intestine is filled with a thin barium meal by means of a duodenal catheter (a sort of abdominal catheter placed in the small intestine). Without the catheter the barium meal would have to be drunk (circa 1 litre)and first come into the stomach. It would take 3 to 6 hours before the last of it reached the small intestine. Via the catheter the meal goes directly to the small intestine, bypassing the stomach. A pump attached to the catheter ensures that the meal flows into the small intestine at a certain speed. While the meal runs in a number of photos are taken. In order to take a better look at some parts of the small intestine, photos are taken when careful pressure is applied to the abdomen.

Picture source: LUMC

An x-ray which examines the kidneys, ureters and bladder is known as an Intra Veneus Pyelogram (IVP). The intestines must be clean for this examination since otherwise, there is the possibility that part of the kidneys and/or ureters will not be visible. A contrast fluid containing iodine is inserted by means of an injection into a blood vessel in the arm and then photos are taken.

A complementary test that you get along with an IVP is a cystogram (cyst = bladder, gram =image). Here a catheter (a tube that is inserted via the urethra into the bladder) fills the bladder with a fluid that can be seen on an x-ray. This can make larger tumours visible. At the same time, after the bladder is emptied, it is also possible to see to what extent the bladder empties.

In addition to x-rays there is another imaging technique: The CT-scan (Computer tomography) and the MRI (Magnetic Resonance Imaging). On a CT-scan the bone structure is just as visible as on an x-ray but the surrounding soft tissue is also visible to some extent. An x-ray is a sort of portrait in which a person is portrayed as if they had been photographed, while a CT-scan is actually a section of the body drawn by the computer. This has to do with the way in which a CT-scan is carried out. You have to lie without moving on a sort of mattress while the part of the body being examined lies in the opening of the scanner. The CT-scanner is a sort of ring where the parts of the body which are to be scanned are pushed through “slice by slice” so that a cross section of the body can be obtained.

The spiral CT-scan is a new development. This new technique is faster and more can be seen than with an ordinary CT-scan. In a spiral CT-scan a so-called volume scan is made in a continuous spiral–shaped movement of the x-ray source. In a very short time very thin cross sections can be made from which three-dimensional images can be reconstructed.

Picture source: Kennislink

In an MRI scan, also known as a magnetic scan, sections are also made in three dimensions. You lie in a long cylinder which has a strong magnet which magnetises water in the tissues. As a result, the atoms of water in the tissues act as miniature magnets. Radio waves are also emitted from the tunnel with a wave length that makes the water magnets vibrate (resonate) taking up energy from the radio waves. When the radio wave is stopped, the energy which has previously been taken up is sent out as a signal. From these signals the computer in the apparatus can calculate the composition of the various tissues and draw them in the form of a section (the MRI-scan) Areas where there is no water, air or bone, for example, give off no signal and are black on the scan.

Picture source: Bupa hospitals UK

There is yet another x-ray examination: defaecography is an x-ray examination of the faeces (excrement). In this case the rectum is filled with thick barium meal (barium sulphate suspension) via a tube in the anus. As far as volume is concerned, the barium meal resembles a normal bowel movement. Then you have to try to evacuate the barium meal into a so-called defaecographic chair. This is similar to a normal lavatory pot and stands on top of an x-ray table. X-rays are taken of the whole process. Thus the movements of the pelvic floor, the rectum and the anus can be examined while at rest, squeezing and pressing. Any variations in the movements of the pelvic floor and the anus, protrusion or prolapse of the anus into the vagina can then be revealed.

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Endoscopic examinations

Endoscopy: ‘endo’ means ‘from the inside’ and ‘scope’ means ‘see/look’. This means looking at inner organs with the help of an endoscope which is inserted in natural bodily orifices. An endoscope is a flexible tube and has a small camera and a lamp at the end so that the examination can be followed on a television screen. The doctor can pass instruments through the flexible tube, so that, for example a small ‘bite’ can be taken from the mucous membrane. The biopsy can then be further examined for anomalies. This sort of biopsy does not hurt since most of the inner organs do not have any nerve endings. Depending on the organ being examined there are various names for these endoscopic examinations but here we are only concerned with investigations of the gastrointestinal and the urinary tracts.

Picture source: Ultrason medical

Colo(no)scopy: this looks into the large intestine or ‘colon’ and sometimes the last part of the small intestine or ‘ileum’. In order to carry out a proper examination, the large intestine must be completely empty. There are different ways to do this, depending on the hospital. If you wish, you can have an anaesthetic administered via a drip in your hand (also known as sedation). The colonoscope is carefully inserted into the rectum via the anus. Then it is slowly and gradually pushed further into the large intestine. Air is also introduced through the endoscope so that the intestine walls open up. During this examination some problems can already be treated, for example the opening up of constrictions and the removal of polyps. It is not such a pleasant examination and this is largely due to the air which can cause cramp.

There is also a sigmoïdoscopy where only the last part of the large intestine (approximately 50 cm) is examined. A rectoscopy/proctoscopy is where only the inner side of the rectum and anus are examined. In these latter 2 cases you have far fewer cramps since less air is introduced.

Picture source: Sweetlove

If you have a stoma, an endoscope can be done through your stoma. Often this investigation as well as the preparation is a little less taxing than through the anus.

A relatively new variation is the double balloon endoscope or ‘push and pull endoscopy’, which is a big breakthrough for disorders of the small intestine. The double balloon endoscopy is worked with a two meter long, very flexible endoscope. This is, as apposed to other endoscopies, well able to navigate the many turns of the small intestine. At the tip of the scope are two small balloons. Each balloon can be manipulated from outside. The scope is first put inserted into the mouth, then following the gullet and stomach into the small intestine. The balloons adhere and release by alternately inserting or releasing a small amount of air. By using these balloons the small intestine can be viewed completely with the endoscope. A doctor can view the whole intestine in 10 – 15 steps. This form of endoscopy offers treatment options such as: polyp collection, injection therapy and cauterisation (coagulation treatment). This technique is also much less taxing and painful for the patient because the scope moves through the intestines with a forward pulling motion rather than a pushing motion, as is the case with other endoscopies. The investigation is however more expensive than the traditional endoscopy. This is because the medical material can only be used once and is more expensive to replace.

Picture source: Onis

The endomicroscope is also new, which won the prestigious award for ‘Best medical application in technology in 2007’ in France. By combining an endoscope and a microscope the picture of the intestinal wall can be enlarged 1000 times, meaning that in the future fewer tissue samples have to be taken and the doctor, together with the pathologist, can immediately make a diagnosis. Endomicroscopy is a joining of two words: endoscopy (internal viewing using a fibre optic cable) and microscopy (investigating tissue in the inside of cell structure). At this moment the gold standard is that at every suspect spot of the intestine a biopsy is taken and then the pathologist investigates this. This will change with the coming of the new endomicroscope. Using this doctors can during the investigation, use a contrast liquid and can see to a depth of 0.25 to 0.50mm if cells are healthy or malignant. Investigation with the endomicroscope is especially of importance for the early discovery of small deviations (polyps) and for patients with a chronic intestinal obstruction. This is the big hope for the apparatus: on the spot diagnosis. This would have the effect of not only taking less biopsies, but also more accurate – up to the cell – biopsies can be chosen and submitted to the pathologist. The endomicroscope will be used on patients with a high risk of colon cancer, such as people with many polyps and patients with hereditary colon tumours. The diseases of Crohn’s and Colitis Ulcerosa occur in approximately 1% of the population and cause a serious restriction in the daily life.

Gastroscopy: here the doctor looks at the inside of the stomach, the oesophagus and the first part of the duodenum. Your stomach must be empty for this examination. First, you are given a drink that prevents foam forming in the stomach. This reaction of the stomach to a foreign object is quite normal. You can be given a spray (xylocaine) to numb your throat in order to overcome nausea or you may even be sedated. A ring is placed in your mouth to protect your teeth and the gastroscope and then the gastroscope is pushed down through the oesophagus into the stomach. Once again some air is introduced During the examination instruments can be inserted through the endoscope in order to extract small pieces of tissue for further tests (biopsy), to staunch the flow of blood, to remove polyps or to widen constrictions.

There is also an oesophagoscopy to examine the inside of the oesophagus and a duodenoscopy to examine the inside of the duodenum.

Picture source: Sweetlove

With endo-echography it is possible to get a detailed picture of the oesophagus, the stomach, the pancreas, the duodenum and the rectum. In an endo-echography the pictures are much clearer than in a CT-scan, for example. An endoscope with a small echographic appliance is introduced into the rectum. This examination is used to detect damage to the sphincter, to localise fistulas around the anus and in rectal cancer. Sound waves are used which are reflected by the tissues in and around the stomach in a different way. A picture can be formed on a monitor of these reflected waves.

Picture source: Deventer ziekenhuis

A new kind of examination is virtual coloscopy where the tissue of the large intestine is examined 3-dimensionally on a computer screen. A virtual coloscopy can be carried out in 2 ways: via an MRI and a CT-coloscopy (or colography) An MRI is (still) rarely used. In a colography a CT-scanner and a computer equipped with special virtual reality software are used. Although the CT-scan makes horizontal section-images of the human body, the software can electronically recalculate these images, creating the impression that they show the inside of the large intestine. Thanks to this projection it is possible to look into the large intestine from the back or the side and you can see between the folds of the intestine to check for polyps or ulcers. With an ordinary endoscope it is not possible to see between the folds. With a virtual coloscopy, however, there is no possibility of further examination (taking sample tissue) or treatment (removal of polyps, staunching bleeding, opening constrictions) which can be done with a normal coloscopy. The advantage of virtual coloscopy is that no endoscope needs to be introduced into the intestines, a turn under the CT-scanner suffices.

You notice that there are many developments in this area. Investigators at the TU Delft are busy with a robot tube, which will glide itself through the colon. Some thing that is already in use is, is the camera pill. This pill is slightly larger than an antibiotic capsule (it weighs 4 grams and is 11 by 26 mm) and within the pill sits a tiny camera which can take 360 degree pictures (in the latest there are even 2). It also has a light source, 2 batteries and a transmitter. Beneath you can see how the camera pill looks; the yellow one is used for small colon investigations and the white one is specifically developed to view the inside of the gullet. The camera pill is a way of viewing the whole small intestine, which formerly required an investigative operation under anaesthesia. An endoscopic investigation can view the lower part (via the anus) or the top part (through the mouth) of the small intestine.

Picture source: Given Imaging (producer of the camera pill)

You have 3 sensors (stickers) stuck to your chest which are joined to a data recorder which you wear on a belt, this data recorder records the whole journey. When the tablet is swallowed it moves thanks to the natural contractions (peristalsis) through the intestines. The tablet makes 2 photographs a second, eventually 60,000 photos (the batteries last for approximately 8 hours). You do not feel the advancement of the camera and it leaves the body with the faeces. You must however view the camera pill as a complete investigation. For example you cannot have snacks during this investigation, the picture quality of the camera pill is poorer than with a gastro scope, the camera pill is very expensive (around 550 euros apiece) and for an investigation of the stomach the lighting of the pill is insufficient. The large intestine cannot be investigated, because the batteries are exhausted by the time the pill reaches there. This investigation is being used more frequently in various hospitals.

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Measurements

24-hour outpatient pressure measurement. This is a pressure measurement of your stomach and the first part of your small intestine (ambulant antroduodenal manometry). A thin tube (catheter) is inserted into the stomach via the nose. When the tip of the catheter is in the stomach it is introduced into the small intestine by means of x-rays. The catheter is then connected to a portable registration device which you wear round your neck. As the name suggests, the catheter remains in place for 24 hours and you need not remain in hospital. You may eat and drink while measurements are being taken and have to keep a sort of diary.

Anal manometry. This is a way to examine the workings of the sphincter and rectum, for example, to reveal or eliminate the possibility of Hirschprung’s disease. This examination is in two parts: first of all an examination of the sphincter muscles. This is done by inserting a narrow measuring tube with a small balloon approximately 10cm into the anus. Then you are asked to tighten your sphincter. The strength of the muscles is registered by the tube. Finally, the reaction of the sphincter is measured by filling the balloon with water or air.

In the second part the rectum is examined, in particular the sensitivity of the rectum and the tension of the rectal wall (is the wall simply very slack or very rigid?). Here again a tube with a measuring balloon is inserted and pushed up via the anus. The tube is connected to a computer which is capable of measuring all aspects of the rectal wall by inflating the balloon with air and then deflating it by suction.

For some of the topics on this page we have made use of the following websites: medicinfo and the Nederlandse vereniging van neurochirurgen.