GASTROINTESTINAL DIAGNOSTIC PROCEDURES ENDOSCOPY Lower GI endoscopy Also called colonoscopy or proctosigmoidoscopy Helps diagnose inflammatory and ulcerative

ve bowel disease, pinpoints lower GI bleeding, and detects lower GI abnormalities such as tumors, polyps, hemorrhoids, and abscesses.

Nursing considerations Tell the patient that he must maintain a clear liquid diet for up to 48 hours before the test and, as ordered, fast the morning of the test Explain that he should continue any oral drug regimen as ordered (except for anticoagulants, aspirin, and NSAIDs.

Upper GI endoscopy also called esophagogastroduodenoscopy it identifies abnormalities of the esophagus, stomach, and small intestine, such as esophagitis, IBD, Mallory-Weiss syndrome, lesions, tumors, gastritis, and polyps.

Nursing considerations Tell the patient that he must restrict food and fluids for at least 6 hours before the test. If the test is an emergency procedure, inform the patient that hell have his stomach contents suctioned to permit better visualization. Explain that hell be given IV sedation to help keep him comfortable.

LABORATORY TESTS 24 HOUR Ph TESTING The lower esophageal sphincter (LES) normally prevents gastric reflux. However, if this sphincter is incompetent, the recurrent backflow of acidic juices (and of bile salts, if the pyloric sphincter is also incompetent) into the esophagus inflames the esophageal mucosa. The inflammation (esophagitis) causes burning epigastric or retrosternal pain that radiates to the back of the arms. To distinguish such pain from angina pectoris, patients who also complain of chest pain would have received cardiac testing to eliminate that possibility

Nursing considerations

Document medications the patient takes for reflux, including the date and time of the last dose. Tell the patient not to use any antacids, chewing gum, lozenges, or hard candy during the study. Encourage him to follow his usual routine so that the study can accurately demonstrate the correlations between activities and reflux disease. To help relieve throat discomfort, tell the patient to suck ice chips or use dyclonine hydrochloride (Cepacol) spray. To help prevent reflux, tell the patient to avoid large meals, caffeine, alcohol, and lying in a supine position after meals.

FECAL STUDIES Normal stool- appears brown and formed but soft Narrow, ribbon-like stool- signals spastic or irritable bowel or partial bowel or rectal obstruction Spastic bowel or viral infection- indication of diarrhea Soft stool mixed with blood and mucus- signal bacterial infection Soft stool mixed with blood and pus- colitis Yellow or green stool -suggests severe, prolonged diarrhea Black stool suggests GI bleeding or intake of iron supplements or raw-to-rare meat Tan or white stool-shows hepatic-duct or gallbladder-duck blockage, hepatitis, or cancer Red stool- signal colon or rectal bleeding (but some drugs and foods can also cause this coloration. Most stool contains 10% to 20% fat. However, higher fat content can turn stool pasty or greasy a possible sign of intestinal malabsorption or pancreatic disease.

Nursing considerations Collect the stool specimen in a clean, dry container. Dont use stool that has been in contact with toilet-bowl water or urine. Send the specimen to the laboratory immediately for accurate results. Keep in mind that serial stool specimens are ussualy collected once per day with the first morning stool. Instruct the patient being tested for fecal occult blood to avoid eating red meat, poultry, fish, turnips, or horseradish or taking iron preparations, ascorbic acid (Vit C), or antiinlammatory agents for 48-72 hours before the specimens are collected. Use commercial Hemoccult slides as a simple method of testing for blood in stool. Follow the package directions.

PERCUTANEOUS LIVER BIOPSY Involves the needle aspiration of a core of liver tissue for histologic analysis. Its done under local or general anesthesia. This biopsy can detect hepatic disorders and cancer after ultrasonography, CT scans, and radionuclide studies have failed.

Nursing considerations Tell the patient to restrict food and fluids for at least 4 hours before the test. Explain the testing procedure to the patient : -He will be awake during the test and, although the test is uncomfortable, medication is available to help him relax. -The doctor will drape and clean an area on his abdomen. Then hell receive a local anesthetic, which may sting and cause brief discomfort. -Hell be instructed how and when to hold his breath and to lie still as the doctor inserts the biopsy needle into the liver. -The needle may cause a sensation of pressure and some discomfort in the right upper back but will remain in his liver for only a few seconds After the procedure: The patient must remain in bed on his right side for at least 2 hours and maintain bed rest for 24 hours. The patient may experience discomfort for several hours for several hours and may take ibuprofen (Motrin) but not aspirin. Let the patient know that he may resume his normal diet. Watch for bleeding and symptoms of bile peritonitis- tenderness and rigidity around the biopsy site. Be alert for signs and symptoms of a pneumothorax, such as rising respiratory rate, depressed breath sounds, dyspnea, persistent shoulder pain, and pleuritic chest pain. Report these complications promptly. Apply a gauze dressing to the puncture site. Check the dressing frequently, whenever you check vital signs. Reinforce or apply a pressure dressing if needed. Maintain the patient in a right side-lying position for at least 2 hours because the pressure will enhance coagulation at the site. Monitor urine output for at least 24 hours and watch for hematuria, which may indicate bladder trauma.

PERITONEAL FLUID ANALYSIS The peritoneal fluid analysis series includes examination of gross appearance, erythrocyte and leukocyte counts, cytologic studies, microbiological studies for bacteria and fungi, and determinations of protein, glucose, amylase, ammonia, and alkaline phosphatase levels. A sample of peritoneal fluid is obtained by paracentesis, which involves inserting a trocar and cannula through the abdominal wall while the patient is under a local anesthetic. If the sample of fluid is being removed for therapeutic purposes, the cannula can be connected to a drainage system.

Nursing considerations Before the procedure, have the patient empty his bladder Observe the patient for dizziness, pallor, perspiration, and increased anxiety Check the site for peritoneal fluid leakage. Watch for signs of hemorrhage, shock, and increasing pain and abdominal tenderness

URINE TESTS Urinalysis provides valuable information about hepatic and biliary function Urinary bilirubin and urobilinogen tests are commonly used to evaluate liver function

Nursing considerations Collect a freshly voided random urine specimen in the container provided You can analyze bilirubin at the patients bedside using dip strips. Wait 20 seconds before interpreting the color change on the dip strip. Bilirubin must be tested within 30 minutes, before it dis-integrates. If its to be tested in the laboratory, send it immediately and record the collection time on the patients chart. For urobilinogen, obtain a random specimen and send it to the lab immediately; it, too, must be tested within 30 minutes, before the sample deteriorates.