Diagnosis of digestion and liver problems

Albumin level
A sample of blood is obtained from your child's vein. Below-normal levels of albumin — a protein made by the liver and found in the bloodstream — are associated with many chronic liver disorders.

Bilirubin level
A sample of blood is taken from your child's vein. Bilirubin is produced by the liver and is excreted in the bile. Elevated levels of bilirubin may indicate an obstruction of bile flow or a defect in the processing of bile by the liver.

Complete blood count (CBC)
A sample of blood is taken from your child's finger or vein, and the different types of cells in the bloodstream are examined.

• White blood cells multiply when infection is present.
• Red blood cells will be present in smaller amounts than normal if blood has been lost, if the diet has been inadequate or if certain diseases are present.

Electrolyte tests
A sample of blood is taken from your child's vein, and the amounts of minerals known as electrolytes are measured.

Electrolytes are minerals that are important for the body to function properly. Children who have lost large amounts of fluid due to vomiting or diarrhea often lose large amounts of the various electrolytes as well.

Your child's physician uses electrolyte tests to help determine when your child might need extra fluids given intravenously or other medications to help with dehydration and mineral loss.

Fecal fat test
With this test, you child is asked to eat a high fat diet for several days. You collect small samples of stool in sealed containers for three days. Your child's physician will send them to a laboratory.

The amount of fat contained in your child's stool is measured. If the digestive tract is working properly, only small amounts of fat will be present in the stool; the rest of the fat that was in the diet will have been digested and reabsorbed by the body.

If your child has a condition known as malabsorption, then the intestinal tract cannot digest fats as well as it should, and elevated amounts of fat will pass through into the stool.

Fecal occult blood test
A fecal occult blood test checks for hidden (occult) blood in the stool. It involves placing a very small amount of stool on a special card, which is then tested in the physician's office or sent to a laboratory.

Blood in your child’s stool can be indicative of a number of problems.

Hydrogen breath test
Your child will fast overnight, and then breathe into a balloon periodically. He or she will be given samples of a carbohydrate to drink. The amount of hydrogen produced in the breath will be measured at the start of the test, and at intervals after carbohydrates are given.

This test helps diagnose several digestive problems, including the following:

• Carbohydrate intolerance
• Bacterial overgrowth of the small intestine
• Rapid transit of food through the small intestine.

If the amount of hydrogen in the breath is elevated, it’s likely that bacteria in the intestines are digesting carbohydrates. Proper digestion is performed by the normal digestive enzymes.

Liver enzymes
A sample of blood is taken from your child's vein, and the amounts of enzymes that the liver normally makes are measured.

Elevated levels of liver enzymes can alert physicians to liver damage or injury, since the enzymes leak from the liver into the bloodstream under these circumstances.

Prothrombin time (PT) test
This test measures the time it takes for blood to clot. Blood clotting requires vitamin K and a protein made by the liver. Liver cell damage and bile flow obstruction can both interfere with proper blood clotting.

Stool culture
A small sample of stool is collected from your child and sent to a laboratory by your physician's office. A stool culture checks for the presence of abnormal bacteria in the digestive tract that may cause diarrhea and other problems.

Urea breath test
 Your child swallows a capsule containing urea. Your child breathes into a balloon, and the amount of carbon in the breath is measured.

• A positive test, meaning carbon is present, indicates the presence of Helicobacter pylori (H.pylori).
• A negative test, meaning no carbon is detected, indicates no H.pylori is present.

Computerized tomography scan (CT or CAT scan)
A diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called “slices”), both horizontally and vertically, of your child’s body.

A CTscan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general x-rays.

Your child will lie on a bed that moves into a doughnut shaped machine that takes many pictures of different areas of the body. Because the machine is noisy, and because your child may need to lie still for a while with his arms over his head, a sedative might be given to help your child rest during the procedure.

Lower GI (gastrointestinal) series (also called barium enema)
A procedure that examines the rectum, the large intestine and the lower part of the small intestine.

A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is delivered into the rectum as an enema. An x-ray of the abdomen shows narrowed areas, obstructions and other problems.

Magnetic resonance imaging (MRI)
A diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within your child’s body.

Your child lies on a bed that moves into the cylindrical MRI scanner. The machine takes a series of pictures of the inside of the body using a magnetic field and radiowaves. The test is painless, and does not involve exposure to radiation.

Because the CT scanner is like a tunnel, some children prone to claustrophobia may be unable to hold still during the test. Medication to help them relax or sleep is available, but calming distraction techniques are always the first resort.

Ultrasound
A diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues and organs. Ultrasounds are used to view internal organs as they function and to assess blood flow through various vessels.

Gel is applied to the area of your child’s body being studied — such as the abdomen — and a wand called a transducer is placed on the skin. The transducer sends sound waves into the body that bounce off organs and return to the ultrasound machine, producing an image on the monitor.

A picture or video of the test is also made so it can be reviewed in the future.

Upper GI (gastrointestinal) series
A diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine).

A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an x-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.

Colonoscopy
Colonoscopy is a procedure that allows the physician to view the entire length of your child’s large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers and bleeding.

It involves inserting a colonoscope, a long, flexible lighted tube, in through the rectum up into the colon. Your child is sedated during this procedure. The colonoscope allows the physician to see the lining of the colon, remove tissue for further examination and possibly treat some problems that are discovered.

Endoscopic retrograde cholangiopancreatography (ERCP)
ERCP is a procedure that allows the physician to diagnose and treat problems in your child’s liver, gallbladder, bile ducts and pancreas.

The procedure combines x-ray and the use of an endoscope — a long, flexible, lighted tube. The scope is gently guided through your child’s mouth and throat, then through the esophagus, stomach, and duodenum. Your child is sedated during this procedure.

The physician can examine the inside of these organs and detect any abnormalities. A tube is then passed through the scope, and a dye is injected which will allow the internal organs to appear on x-ray.

Esophagogastroduodenoscopy (EGD) (also called upper endoscopy)
EGD (upper endoscopy) is a procedure that allows the physician to look at the inside of your child’s esophagus, stomach and duodenum.

A thin, flexible, lighted tube called an endoscope is gently guided into the mouth and throat, then into the esophagus, stomach and duodenum. Your child is sedated during this procedure. The endoscope allows the physician to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).

Anorectal manometry
This test helps determine the strength of the muscles in your child’s rectum and anus — it’s very helpful in evaluating anorectal malformations and Hirschsprung's disease.

A small tube is placed into the rectum, and the pressures inside the anus and rectum are measured. These muscles normally tighten to hold in a bowel movement and relax when a bowel movement is passed.

Esophageal manometry
This test helps determine the strength of the muscles in the esophagus — it’s useful in evaluating gastroesophageal reflux and swallowing abnormalities.

A small tube is guided into the nostril, then passed into the throat and finally into the esophagus. The pressure the esophageal muscles produce at rest is then measured.

Esophageal pH monitoring
An esophageal pH monitor measures the acidity inside of your child’s esophagus — it’s helpful in evaluating gastroesophageal reflux disease (GERD).

• A thin plastic tube is placed into one of your child’s nostrils, guided down the throat and then into the esophagus.
  • At the end of the tube inside the esophagus is a sensor that measures pH, or acidity.
• The other end of the tube outside the body is connected to a monitor that records the pH levels for a 12 to 24 hour period.

Doctors will encourage your child to engage in normal activity, and a diary is kept of symptoms experienced or activity that might be indicative of reflux, such as gagging or coughing. The pH readings are compared to what your child was doing for that time period.

Liver biopsy
A small sample of liver tissue is obtained with a special biopsy needle and examined for abnormalities. A liver biopsy helps diagnose liver diseases.

A small area of skin over your child’s liver is numbed with a local anesthetic. The anesthetic is then injected deeper under the skin to numb the area that the biopsy needle will pass through and reduce the discomfort of the test.

The biopsy needle is quickly inserted through the skin and into the liver, and then withdrawn. Sometimes, an ultrasound of the liver is done at the same time to help the physician know exactly where to obtain the tissue samples.

After a liver biopsy, a healthcare professional will observe your child for bleeding problems for a few hours. Pain medications will be given, if needed. Your child may also be given medication to minimize their anxiety during the procedure.