Which of the following tests should be ordered next for this patient? A 42-year-old woman with type 1 diabetes mellitus, hypertension, and chronic kidney disease presents to your clinic with complaints of abdominal bloating and nausea for 3 to 4 months and a 5.4 kg (12 lb) weight loss. She states that she feels full all the time and consequently has been eating less. She denies any symptoms of heartburn or dyspepsia. On physical examination, she has mild tenderness to palpation in the epigastrium and her liver span is normal. Her stool is hemoccult negative. A laboratory examination, including a complete blood count and liver function tests, is normal, aside from her known elevated creatinine (2.1 mg/dL). Given her weight loss, you refer her for an esophagogastroduodenoscopy, which reveals retained food but no ulcers.
A. Urease breath test B. Gastric emptying scintigraphy C. Barium swallow D. Abdominal ultrasonography
Gastric emptying scintigraphy -key concept/objective: to recognize that long-standing diabetes is a risk factor for gastroparesis and that transit tests can provide a diagnosis gastroparesis is a well-recognized complication of diabetes mellitus. classically, diabetic gastroparesis occurs in patients with long-standing type 1 diabetes mellitus who have other associated complications of diabetes, such as retinopathy, nephropathy, and peripheral neuropathy. gastroparesis may also occur in patients with type 2 diabetes.a motility disorder should be suspected whenever undigested solid food or large volumes of liquids are observed during an esophagogastroduodenoscopy that has been performed after an overnight fast. transit tests, which can be performed relatively simply and inexpensively, enable good discrimination between healthy and disease states. gastric emptying scintigraphy of a solid-phase meal is considered the gold standard for the diagnosis of gastroparesis. barium studies rarely identify the etiology of the motor disorder except in small bowel systemic sclerosis.