GI Diagnostic Tests

• Gastrointestinal Nursing includes abdominal confirmatory tests and diagnostics

Non-Invasive Procedures

• Abdominal Ultrasonography uses high-frequency sound waves

• Sound waves are passed into body structures and recorded as they are reflected

• Conductive or lubricant gel is applied to skin

• The transducer is placed on the area

• Ultrasonography is helpful in detecting an enlarged gallbladder or pancreas, and the presence of gallstones

• Ultrasonography can also be used to detect an enlarged ovary, ectopic pregnancy or appendicitis

• UTz can detect masses, cysts, or tumors

• Patients should be NPO for 8-12 hours before UTz to improve image quality

• Air or gas in the abdomen can reduce the quality of images

• Abdominal Computed Tomography or CT Provides cross-sectional images of abdominal organs and structures

• CT can detect appendicitis, diverticulitis, regional enteritis, and ulcerative colitis

• CT can also detect diseases of the liver, spleen, kidney, pancreas, and pelvic organs

• CT scans are contraindicated for cachectic or very thin patients

• Nurses should assess for allergies to contrast agents, iodine, and shellfish if contrast medium is used

• Serum creatinine level and urine human chorionic gonadotropin should be checked before contrast administration

• Patients allergic to contrast agents may be premedicated with IV prednisone 24 hours, 12 hours, and 1 hour before the scan

• Renal protective measures include administration of IV sodium bicarbonate 1 hour before and 6 hours after IV contrast

• Oral acetylcysteine, also known as Mucomyst, can be given before or after study

• Both sodium bicarbonate and Mucomyst are free radical scavengers, and help to sequester contrast byproducts

• Abdominal Magnetic Resonance Imaging or MRI uses magnetic fields and radiofrequency waves to produce an image of the area being studied.

• MRI is useful in evaluating abdominal soft tissues, as well as blood vessels, abscesses, fistulas, and neoplasms.

• MRI can also be used to evaluate sources of bleeding

• Ferromagnetic objects, such as metals containing iron, are contraindicated for MRI

• Examples of contraindicated items: jewelries, pacemakers, dental implants, paperclips, pens, keys, IV poles, and clips

• Contraindicated items also include items on a patient's gowns, oxygen tanks, artificial heart valves and defibrillators

• Implanted insulin pumps, transcutaneous electrical nerve stimulation devices, aneurysm clips, and intraocular metallic fragments are contraindicated

• Patients should be NPO 6-8 hours before MRI

• Patients should have all jewelry and other metals removed

• Patients should lie still for 60-90 minutes during the procedure

• Patients with claustrophobia should be assessed

• Patients should expect a knocking sound during the procedure

• Foil-backed skin patches, like nitroglycerine, scopolamine, or clonidine, should be removed before an MRI because of the risk of burns

• A physician must be consulted before removing the patch

Fecal Occult Blood / Guaiac Stool Exam

• Fecal Occult Blood/Guaiac Stool Exam is a microscopic analysis using chemical tests for hemoglobin in stool
• Stool normally contains a small amount of blood between 2-2.5ml/day
• It is used to detect GI bleeding and early signs of colorectal cancer

Patient Preparation

• 48-72 hours before the test, a high-fiber diet is emphasized
• Avoid eating red meats, turnips, and horseradish prior to test and throughout the collection period
• Three stool specimens are randomly collected
• The lab and practitioner should be notified of drugs the patient is taking that may affect results
• Specimens should be obtained from two different areas of each stool

Hemoccult Slide Test:

• Apply a thin smear of of the stool specimen on guaiac-impregnated filter paper using wooden applicator
• If done with a digital examination, smear the gloved finger on the filter paper
• Apply a 2nd smear from another part of the specimen to the filter paper exposed in box B
• Dry the specimen for 3-5 minutes, then add 2 drops of Hemoccult developing solution on the paper over each smear
• A positive result, with blue color will show after 30 - 60 seconds

Hematest Reagent Tablet Test

• Smear a bit of stool specimen on a filter paper using a wooden applicator
• If done with a digital examination, smear the gloved finger on the filter paper
• Place the smeared filter paper on a glass plate, then place the reagent tablet at the center of the stool specimen
• Add a drop of water to soak for 5-10 seconds, then add a 2nd drop on the tablet and let it run from the specimen
• A positive result with the filter paper turning blue indicated a positive result after 2 minutes

Instant-View Fecal Occult Blood Test

• Add a stool sample to the collection tube, shake to mix the sample with the extraction buffer, then dispense 4 drops into the sample well of the cassette
• Results will appear in 5-10 minutes, it will show the level of Hgb if ≥0.05mcg/ml of stool

Invasive Procedures

• These involve endoscopic procedures
• Endoscopy refers to the direct visualization of a body structure through a lighted fiber-optic instrument

Colonoscopy

• Colonoscopy is used to directly visualize the entire colon up to the ileocecal valve, using flexible fiberoptic scopes
• Colonoscopies are used for cancer screening, allowing for biopsy and surveillance in patients with previous colon cancer and polyps
• Colonoscopies can diagnose inflammatory bowel disease, detecting tumors, diagnosing diverticulitis, and dilate strictures
• During the test the patient will lie on the left side with the legs drawn up toward the chest
• Patient position may be changed during the test to facilitate advancement of the scope
• Colonoscopies can not be performed if there is suspected colon perforation
• Commonly ordered nursing responsibilities prior to procedure include placing the patient in a clear liquid diet 24 hours prior to procedure
• 1 gallon of Polyethylene Glycol, an electrolyte lavage solution, is given to the patient the evening before the procedure
• Patients will take an 8 oz glass every 10 minutes
• Polyethylene Glycol includes Go-LYTELY, CoLyte, Nu-Lytely
• Drinking the preparation as cold as possible can make it more palatable
• The stool will become watery, clear and free of any solid material
• Side effects may include nausea, bloating, cramps, abdominal fullness, fluid and electrolyte imbalance, and hypothermia
• Fleet's Phospho-Soda, a laxative, is administered as a prep
• The 1st dose, 1.5 oz, is taken in the afternoon before the procedure, followed by 10 oz of clear liquid and then 3-5 additional glasses of clear liquid
• The 2nd 1.5 oz dose is taken before bedtime, followed by 10 oz of CL and then 3-5 additional glasses of clear liquid
• A Sodium Phosphate Monobasic Monohydrate (Visicol) is an alternative laxative used for bowel preparation
• Patients will take 20 pills over a 1-hour period the afternoon before the procedure, then at bedtime, 8 more tablets with 8 oz of water
• Bisacodyl or Dulcolax tablet, a laxative, may be added to complete the regimen
• Patient should be NPO 6 hours prior to the actual procedure, informed consent is obtained
• During the test, Midazolam, also known as Versed, is an opioid, analgesic, or sedative, administered to provide moderate sedation
• Glucagon may be administered to relax the colonic musculature and to reduce spasm
• After the test abdominal cramp is normal due to increased peristalsis, monitor for complications.
• Monitor for bowel perforation which is the likely complication
• Monitor for rectal bleeding, abdominal pain or distension, and fever
• Cardiac dysrhythmias, respiratory depression, vasovagal reactions, circulatory overload or hypotension

Esophagogastroduodenoscopy (EGD)

• EGD Directly visualizes the mucosal lining of the esophagus, stomach, and duodenum with a flexible, fiberoptic scope.
• It is indicated to test and detect inflammations, ulcerations, tumors, varices, or Mallory-Weiss tear and neoplasms
• Test can take place in the esophagus, stomach, and duodenum, biopsies may also be taken
• Nursing responsibilities involve keeping the patient NPO for 8 hours.
• Make sure a signed consent is on the chart.
• Local anesthetic may be sprayed on the throat before insertion of scope.
• Midazolam (Versed) is administered to provide moderate sedation and relieves anxiety
• Atropine may be administered to reduce secretions
• Glucagon may be administered to relax smooth muscles
• The patient should be placed in the left lateral position
• After the test, assess for the return of gag reflex, level of consciousness, vital signs, oxygen saturation, and pain level
• Monitor for signs of perforation, pain, bleeding, unusual difficulty swallowing, and rapidly elevated temperature

Capsule Endoscopy

• Capsule Endoscopy, also known as PillCam ESO, is a pill-sized instrument equipped with cameras that is swallowed by the patient
• Capsule Endoscopy provides 57,000 images of the GI tract
• The capsule relays images to a data recorder that the patient wears on a belt
• Indicated for diagnosing Crohn's disease, celiac disease, malabsorption syndrome, identify sources of possible GI bleeding
• Contraindications include patients with a previously anastomosed section of the bowel
• Bowel preparation is similar to colonoscopy, but patients should be NPO for 4-6 hours after swallowing the capsule

Laparoscopy or Peritoneoscopy

• Laparoscopy is a diagnostic procedure where the peritoneal cavity, pelvis, and abdomen are examined
• Gas, also known as carbon dioxide is insufflated into the peritoneal cavity to separate the intestines from the pelvic organs.
• It can detect cysts, adhesions, fibroids infections of the uterus, fallopian tubes, and ovaries
• Can used to look for ectopic pregnancies, liver lacerations, and cirrhosis
• Nursing responsibility:
  • Patients are instructed to fast for 8 hours before the surgery
  • Patient is catheterized to ensure the bladder is empty
  • Make sure signed consent is on the chart
  • The test is performed under local or general anesthetic agent
  • Observe for bleeding and bowel perforation after the procedure

Proctosigmoidoscopy

• it directly visualizes the rectum and sigmoid colon with a lighted flexible endoscope
• Used to detect internal hemorrhoids, polyps, fissures, and rectal and anal abscesses
• Nursing responsibility:
  • Secure consent
  • A clear liquid diet day before or no dietary restrictions
  • Administer an enema such as soap-suds, tap water, or Fleet enema, evening before and morning of procedure.
  • Explain to the patient, knee-chest position, need to take a deep breaths during insertion of the scope, and possible urge to defecate as scope is passed
  • Conscious sedation is often used
  • Monitor patient for rectal bleeding and intestinal perforation

Endoscopic Retrograde Cholangiopancreatography (ERCP)

• Fiberoptic endoscope is inserted through the oral cavity into the duodenum and common bile and pancreatic ducts are cannulated
• It retrieves gallstones from the distal common bile duct, dilate strictures, obtain a biopsy for tumor, and diagnose pseudocysts
• Nursing responsibilities include patients being NPO for 8 hours, and ensure consent form is signed before the procedure
• Monitor signs, check vital signs, signs of perforation or infection, and gag reflex after the procedure
• Be aware that pancreatitis is the most common complication

Paracentesis

• Paracentesis is the aspiration of fluid from the abdominal cavity
• It’s a diagnostic and therapeutic procedure for end-stage liver or renal disease when there is ascites
• Aspiration is therapeutic if diagnostic culture is obtained
• Nursing responsibilities include having the patient void to obtain body weight before procedure
  • Place the patient in a high-Fowler's position
  • The skin is prepared, before anesthetized and punctured with a trocar, a large bored abdominal paracentesis needle
  • Observe the patient for blood pressure changes that can result from rapid removal of fluid
  • Post procedure: apply a sterile dressing to the puncture site
  • Record the color, amount, consistency of drainage

Radiologic Procedures:

• Barium is a chalky white contrast medium and an oral preparation that allows roentgenographic visualization of the internal structures of the digestive tract in Barium swallow

Barium Swallow or Upper Gastrointestinal Study

• It’s also known as esophagography, is a fluoroscopic visualization of the esophagus following the ingestion of barium sulfate
• It diagnose structural abnormalities of the esophagus, stomach, and duodenum
• Nursing responsibilities before the procedure include telling the patient to avoid smoking 24 hours prior; explaining the need to drink contrast medium; Keep NPO for 8-12 hours
• After the procedure white stool is normal within 72 hours after the test, and force fluids / administer laxatives to prevent contrast medium impaction

Barium Enema

• It’s a Lower Gastrointestinal Study/ rectal infusion of barium sulfate the roentgenographic study lower intestinal tract colon
• Nursing responsibility includes a clear liquid diet the evening before, NPO 8 hours before, administer administer enema or laxative evening before
• Patients are to be told that cramping and the urge to defecate may occur during the administration of a barium enema, enforce fluids/ administer laxatives after the procedure to prevent intestinal obstruction

Acid Perfusion or Bernstein Test

• It helps to distinguish pain caused by esophagitis like heartburn from pain caused by angina pectoris or other disorders
• It requires infusion of saline and acidic solutions into the esophagus through a nasogastric tube
• Absence of pain or burning during infusion of solutions indicates a healthy esophageal mucosa
• Check for signed informed consent - No antacids 24 hours before the test, No food for 12 hours before the test
• No fluids or smoking for 8 hours before the test, an NGT will be inserted/ a 20ml syringe is attached to aspirate stomach contents
• Withdraw the NGT a few inches marking 12" into the esophagus, tell the client to to report immediately any discomfort or burning sensation during to infusion of liquid, record accurately for baseline data (PR, RR, BP)
• Hang labelled containers NSS Normal Saline Solution acidic solution of of .1 Na HCI, Connect to IV tubing, open line, infuse rate of 60-120, continue 5-10
• Ask the client about any discomfort record the response, close the NS line/ start infusion of
• Na HCI same infusion rate for 30 minutes client knowledge, check wclient for any discomfort// If client presence of pain close the line of the solutions to sensation and
• Precautions C/I- Bernstein esophogeal vericies heat failure Paraxysmal
• Assess for cyansis cough, assess V/S detect arrhthm