Diagnostic studies can confirm, rule out, stage, or diagnose various disease states, including cancer. Time should be allotted after diagnosis with the patient in addition to offering information resources.
- Preparation for many studies include a clear-liquid or low-residue diet, fasting, ingestion of a liquid bowel preparation, the use of laxatives or enemas, and ingestion or injection of a contrast agent or radiopaque dye. In older patients or those with comorbidities, this may lead to fluid and electrolyte imbalance.
- General nursing interventions for GI diagnostic evaluation: establish the need for information, provide education to patients and families on the diagnostic test, pre- and post-procedure restrictions and care, helping the patient cope with discomfort and alleviate anxiety, inform the primary provider of known medical conditions or abnormal laboratory values that may affect the procedure, and assess for adequate hydration before, during, and immediately after the procedure (also provide education about the maintenance of hydration).
Blood Tests
- Complete blood count (CBC): GI bleeding may result in acute or chronic anemia.
- Prothrombin Time (PT): Liver damage will prolong an individual’s PT due to its role in the production of coagulation factors.
- Serum Electrolytes: GI malabsorption, excessive vomiting, and excessive diarrhea may all result in electrolyte imbalance.
- Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT): these are liver function tests. AST and ALT levels are raised in chronic alcoholics and patients with viral hepatitis.
- Serum Amylase & Lipase: the best indicator of acute pancreatitis if elevated within 1 to 5 days.
- Bilirubin Levels: evaluation of liver and biliary tract functioning.
- Serum Ammonia: evaluation of hepatic function. Ammonia is used to rebuild amino acids or is converted to urea and excreted.
Urine Tests
- Urine Amylase: increased in acute pancreatitis. This may remain high even after serum levels return to normal.
- Urobilinogen: indicative of hepatic and biliary obstruction.
Stool Tests
- Fecal Occult Blood Test: test for GI bleeding.
- Parasitic Infection
- Fecal Fats (steatorrhea): malabsorption.
Plain Abdominal X-Ray
- Also referred to as a KUB (Kidney, Ureter, Bladder) X-Ray or a Scout Film; a Flat Plate of the Abdomen. Used for detection of masses, tumors, structures, or obstructions. There are no special preparations required for this test.
Upright Abdominal X-Ray
- The standing position will allow the radiologist to see if there are any blockages or perforations in your digestive tract.
- Erect abdominal X-rays are used to look for fluid levels in obstruction or ileus. Air may be seen under the diaphragm in an erect film if the bowel has been perforated, although a CXR is more usual to look for that sign.
Barium Swallow Test
- A special type of imaging test that uses barium and X-rays to create accurate images of the upper gastrointestinal tract (back of mouth, pharynx, esophagus). Barium coats the walls of the alimentary organs and allows for better visualization of their size and shape, as well as how the patient performs deglutition. Barium is only used for GIT imaging. It does not cause any harm.
- This may be part of the upper GI series, which visualizes the esophagus, stomach, and duodenum. Fluoroscopy is often used during a barium swallow test.
- Used for heartburn, gastric reflux, and problems with eating, drinking, or swallowing. It may show ulcers, abnormal growths, blockages, and narrowing.
Procedure
- NPO a few hours before the test. Even medication may be withheld prior to the test. Some hospitals also recommend not chewing gum, eating mints, or smoking cigarettes the midnight before the test.
- Takes ~60 minutes at the x-ray department of the hospital. Changing into a gown is required.
- The patient then drinks the barium liquid. It is often chalky but may have added flavoring.
- The patient then lies on a tilting table, but may stand up on some other parts of the exam to facilitate barium flow and imaging. An injection may be used to relax the stomach.
- This injection may be skipped if the patient has glaucoma or heart problems.
- This is performed on an outpatient basis, and results are usually available within 1 to 2 weeks.
Upper GI Series and Small Bowel Series
- X-ray of the Upper GI structures from the oral pharynx to the duodenojejunal junction. Used for the detection of esophageal (with a barium swallow), gastric, or duodenal disorders and function.
- Up to the ileocecal junction with a small bowel follow-through (SBFT)
- The barium preparation is traced by fluoroscopy through the esophagus and stomach.
Client Preparation
- 8 hours NPO before the procedure. Withhold opioid analgesics and anticholinergics 24 hours before the test, as these decrease motility.
- The client must drink ~16 ounces of barium preparation.
Post-procedure Considerations
- Plenty of fluids should be given to eliminate ingested barium.
- Mild laxatives or stool softeners can be given.
- Advise clients that stool may be chalky white for 1 to 2 days as barium is excreted.
Lower GI Series (Barium Enema)
- Radiographic visualization of the large intestine with a barium enema. It often complements lower gastrointestinal endoscopy. Two forms may be used: single contrast (only uses barium) and double contrast (uses barium and air). Double contrast barium enemas are often more successful and common.
- This detects bowel obstructions due to the twisting of the colon upon itself (volvulus), lower GI bleeding, altered bowel habits or abdominal pain, and screens for polyps, or colorectal cancer.
- Contraindication: suspected colon perforation or fistula. This may cause cardiac arrest if barium enters venous circulation, acute colitis/diverticulosis, recent polypectomy or colonic biopsy, old age (>70 y.o.), and pregnancy.
Client Preparation
- All preparations are related to reducing fecal content of the colon for the procedure.
- Clear liquid diet 12 to 24 hours before the procedure to reduce fecal matter in the bowel.
- NPO the night before the procedure.
- Potent laxatives or a cleansing enema is performed the evening before the test.
Procedure
- The patient is cannulated. IV antispasmodics (e.g. hyoscine butytbromide) may be used for comfort.
- Positioning: left lateral position on an x-ray table.
- Perform a digital rectal examination, followed by the insertion of a (lubricated) rectal catheter. The catheter should have two connectors, one for passing barium, and one for insufflating air.
- Positioning: prone
- Pass the barium slowly through a giving set into the catheter. Fast passing may cause discomfort and stimulate defecation. X-ray screening begins once the barium is being passed.
- Stopped once the rectum has been filled, and barium moves along the colon. Positioning of the patient may be changed by the radiologist to aid in filling.
- Once the barium reaches splenic fixture, they return to the prone position and air is insufflated. As air enters, the colon inflates and the mucosa becomes clearer in imaging.
- Screening continues until the cecum (via imaging of the appendix or the small intestines) is identified. Final photos are taken in various positions to obtain complete views.
- Empty the rectum and remove the catheter. The patient may still pass barium for several hours after the procedure.
Post-procedure Considerations
- Complications:
- Major: colonic perforation, hemorrhaging, oversedation, cardiac arrhythmias
- Minor: constipation, abdominal discomfort, rectal bleeding, and flatus.
- Advise the client to drink plenty of water (to eliminate barium)
- Mild laxatives or stool softeners can be given.
- Chalky white stool may persist for 1 to 3 days until all barium is expelled.
Percutaneous Transhepatic Cholangiography (PTC)
- Iodinated dye (contrast medium) is instilled via a percutaneous needle through the liver into the intrahepatic ducts with x-ray guidance. This is now an uncommon diagnostic procedure. The needle is inserted into the left hepatic ducts, so the patient is placed on the right side.
- Observe for bleeding, hematoma, ecchymosis, or bile leakage.
Computed Tomography (CT) Scan
- A non-invasive cross-sectional x-ray visualization detecting tissue densities and abnormalities in the abdomen and the structures in it. It can be performed with or without a contrast medium. As usual, check for seafood or iodine allergies.
- No particular follow-up care is required unless sedatives were used. Monitor VS until the client is fully awake.
Endoscopy
- Direct visualization of the GIT by means of a flexible fiberoptic endoscope. This is often used to evaluate bleeding, ulceration, inflammation, masses, tumors, and cancerous lesions.
Esophagogastroduodenoscopy (EGD)
- Upper endoscopy; a visual examination of the upper GI tract: the esophagus, stomach, and duodenum. This may also include a biopsy.
Client Preparation
- Medications used: Midazolam HCl (sedative), Meperedine (Demerol) (sedative), Fentanyl, Atropine (reduces secretions and vagal responses), Local Anesthetics (inactivates gag reflex and facilitates passage of tube).
Procedure
- The test lasts from approximately 30 to 60 minutes.
- Monitoring for breathing, heart rate, blood pressure, and oxygen levels are set up.
- IV medication for relaxation is given. Analgesia and induced amnesia should occur for the procedure.
- Local anesthetics may be used for the throat to prevent coughing or gagging.
- A mouth guard is used to protect the teeth and scope. Dentures are removed before the procedure begins.
- Positioning: left lateral position
- Insertion of the endoscope to the esophagus, stomach, and duodenum.
- Air is introduced through the scope in order to facilitate visual inspection.
- Biopsies may be performed.
- Treatments (therapeutic esophagogastroduodenoscopy) may be done such as stretching or widening a narrowed area of the esophagus.
- NPO until gag reflex returns.
Post-procedure Considerations
- Complications: colonic perforation, hemorrhaging, oversedation, cardiac arrythmias, abdominal discomfort, rectal bleeding, and flatus.
- Monitor VS q30m until sedation wears off. Put side rails up to prevent falls.
- NPO until gag reflex returns (often in 1 to 2 hours) to avoid aspiration.
- WOF: Signs of Perforation (Pain, Bleeding, Fever)
Endoscopic Retrograde Cholangiopancreatography (ERCP)
- Visual and radiographic examination of the liver, gallbladder, bile ducts, and pancreas to identify cause & location of obstruction. After the cannula is inserted into the common bile duct radio-opaque dye is inserted followed by x-ray examination.
- For removal of gallstones, a small incision (papillotomy) may be made at the ampulla of Vater (hepatopancreatic duct).
- The same preparations apply as for an EGD.
Colonoscopy
- Examination of the large bowel (colon). It is used to identify causes of chronic diarrhea, sources of bleeding, tissue biopsies, or to remove polyps.
Client Preparation
- Liquid diet for 12 to 24 hours before the procedure
- NPO for 6 to 8 hours before the procedure
- Laxatives, Suppositories, Cleansing Enemas to clean the bowel the night before the procedure.
- Sedation, preparation of Atropine Sulfate to prevent vasovagal responses from causing bradycardia.
Post-procedure Considerations
- Monitor VS q15m until the patient is stable. Keep the side rails up (prevent from falls) and observe for signs of perforation (bleeding, fever, pain).
Proctosigmoidoscopy
- Examination of the rectum and sigmoid colon. Either a rigid or a flexible scope may be used.
- Screens for colon cancer, GI bleeding, diagnosis or monitoring of inflammatory bowel disease.
Client Preparation
- Liquid diet for at least 24 hours before the procedure
- Laxatives the evening before, and cleansing enema the morning before the procedure.
- Positioning: left-side lying in the knee-chest position.
- No sedation is required because of the shallow depth.
Post-procedure Considerations
- Inform the client that mild gas pain and flatulence may be experienced because of air introduced by the procedure.
- If a biopsy was involved, slight bleeding may be observed. However, excessive bleeding should be immediately reported.
Gastroscopy
- A thin, flexible tube with a camera and light (endoscope) is used to look within the esophagus, stomach, and duodenum. This procedure is also referred to as an upper gastrointestinal endoscopy.
- Used to investigate dysphagia, persistent abdominal pain; to diagnose (diagnostic gastroscopy) stomach ulcers, GERD; or to treat (therapeutic gastroscopy) bleeding ulcers, esophageal obstruction, non-cancerous growths (polyps), or small cancerous tumors.
Procedure
- Therapeutic forms may last longer, but a gastroscopy generally takes ~15 minutes or less to perform in an outpatient setting.
- A local anesthetic spray (or sedative, if preferred) numbs the throat.
- The endoscope is inserted, with the patient being asked to swallow the first segment. It is then guided further down the esophagus and into the stomach.
- Pain should be minimal or absent, but discomfort and unpleasantness may still occur.
Complications
- Reaction to sedatives (affected breathing, heart rate, blood pressure)
- Internal bleeding
- Tearing of the lining of the esophagus, stomach, or duodenum.
Gastric Analysis
- Measures the hydrochloric acid and pepsin content of the stomach in order to determine aggressive gastric and duodenal disorders (e.g., Zollinger-Ellison)
Ultrasound
- Sound waves are passed through the body via a transducer, in which the “echoes” of the sound waves are recorded as images for analysis. It is commonly used to image soft tissue such as the liver, spleen, the pancreas, and gallbladder (biliary system).
- A full bladder is required for some forms of this procedure because a full bladder will move organs out of the way, as well as because the sound waves travel better through fluids than through air.