CH # 28: Speciality Examinations & Procedures Flashcards
A black tar-like color to the stool caused by oxidation of the iron in the blood by intestional and bacterial enzymes
Melena
Non-visible blood in the stools
Occult blood
A chemical test used 2 screen 4 fecal occult blood
Fecal specimens r taken 3 times on separate days in order 2 provide 4 the detection of blood from GI lesions because they cause intermittent blood loss. Patient must prepare all 3 slides and turn in 2 the office 4 testing
+ results occur when blood loss is greater than 5 mL/day. Medical conditions that can cause a + result r: hemorrhoids, anal fissures, colorectal polyps, diverticulitis, peptic ulcers, ulcerative colitis, GERD(acid reflux), Crohn’s Disease
After a + FOBT test, additional procedures must be done 2 figure out the cause of the bleeding
FOBT guaiac slide test
A type of patient education
Patient is placed on a high fiber and meat free diet 3 days b4 taking the 1st specimen and must b continued until all 3 slides r made. High fiber is done 2 encourage bleeding from lesions. Meat can cause a false + test result
Patient must avoid all aspirin containing drugs. Iron supplements can cause a false + result
FOBT guaiac slide test patient preparation
- test does not contain any blue color on the entire slide
+ test contains blue anywhere on the slide
Interpreting FOBT guaiac slide test
The visual examination of the mucosa of the rectum using a flexible fiber optic device that is lubricated and inserted in2 the anus
Purpose is 2 detect where blood is coming from due 2 a + FOBT test
Air can b blown into the tube 2 distend the lumen of the colon 4 better visualization aka:insufflated
Suction equipment can b used 2 clear any substances out of the way 4 better viewing
A long thin instrument can be inserted in the tube 2 collect a specimen 4 biopsy
Test only reaches the lower 1/3 of the colon: rectum and sigmoid colon only
Patient is put on their side in the sims position
Sigmoidoscopy
A type of patient preparation
The lower 1/3 of the colon must b flushed out b4 this test and is known as a partial bowel prep. This is done because feces can make it hard 2 detect abnormalities
Test will b rescheduled if the patient did not flush bowels
- find out if patient properly prepared 4 the procedure
- ask if patient needs 2 void b4 test starts
- position and drape in the sims position
- reassure patient and help them 2 relax
- lube up physicians gloved index finger 4 digital examination
- lube distal end of tube b4 physician inserts in2 patient
- assist w/suction equipment
- have and hold specimen container if needed
- assist patient after examination
- prepare specimen 2 b sent 2 the lab
- clean examination room
- sanitize and disinfect the device
Sigmoidoscopy patient preparation
A flexible fiberoptic insertion tube w/a light attached. Tube is 1/2” in diameter and 24 inches long. Composed of extremely thin fibers of bendable glass that transmits light and images that r 10x’s the actual size. Lens is located in the handle. Sometimes has a video camera attached.
Only views the lower 1/3 of the colon: rectum and sigmoid colon
Sigmoidoscope
The visual examination of the mucosa of the rectum and the entire length of the colon
Test is done 2 locate the bleeding after a + FOBT
Considered the “gold standard” 4 assessing colon abnormalities
Conditions it can detect:
- lesions of the colon or rectum
- colorectal polyps
- hemorrhoids
- fissures
- infection and inflammation
Colonoscopy
A type of patient preparation
- performed in a hospital on an outpatient basis
- full bowel prep (entire colon must b flushed out)
- reschedule if patient fails to properly prep colon
5 days b4: discontinue iron supplements and aspirin drugs
2 days b4: discontinue all NSAID’s
1 day b4: do not consume solid foods or milk products
Consume only gelatin or popsicles EXCEPT purple or red
Drink only clear liquids ex.water, soda, juice NO alcohol
Coffee or tea is ok but no milk or cream
After 12am on day: no food or drink including water. Only take medications physician allows u 2 take w/a small sip of water
Arrange 4 some1 to pick u up after procedure due 2 sedation and no public transportation
Afterwards patient may experience bloating, abdominal cramping and gas farts. Also may have traces of blood in stools if a biopsy is taken. Contact if significant rectal bleeding, faintness, dizziness, shortness of breath or heart palpitations
Colonoscopy patient preparation
-take laxative on the afternoon, 2pm-4pm, b4 procedure
-drink one 8 ounce glass of liquid laxative solution every
10-15 minutes until 2 quarts(8 8oz glasses)*easier 2 drink quickly
-may cause bloating or nausea feeling temporarily, stop drinking
for 30 min then continue drinking solution every 15 min
-1st bowel movement should occur 1 hour after u begin drinking
and continued bowel movements 10-15 times.
-if stool is clear 2 pale yellow after drinking 2 quarts-u can stop
drinking. If not continue drinking until it is.
Colonoscopy patient bowel preparation
Purpose is 4 early detection of cancer. Number among Caucasian men has more than doubled in the last 40 years and can happen at any age. Most common in males 15-34 and most cases r detected by males. High cure rate though.
Increased risk factors:
- history of cryptorchidism (undescended testes)
- family history of this cancer
- cancer of the other 1
- 5x’s more common in Caucasians than African American men
Testicular cancer
- should b performed monthly starting at 15 years
- best 2 perform after a shower or warm bath (easier 2 palpitate)
- most common sign is a pea size lump that is hard and painless
Steps:
1)take warm bath or shower
2)stand in front of mirror and look 4 any swelling
3)grasp by thumb on top and middle fingers on bottom
4)apply small amount of pressure and gently roll between thumb
and fingers, feeling 4 lumps, swelling, or any change of size,
shape or consistency(should feel smooth, egg-shaped and firm if
normal and 1 can b larger than the other)
5)find epididymis-not 2 confuse w/lump(tenderness is normal)
6)repeat on other 1
7)report if: any unusual lump, a feeling of heaviness, dull ache in
lower abdomen or groin, any enlargements, tenderness or pain,
any change in the feel
Testicular self-examination
TSE
1 of the most common forms of cancer in individuals over 50
Lesions, both benign and malignant tumors, of the colon and rectum bleed a small amount on an intermittent basis and is usually in the form of occult blood
Colonoscopy is performed if cancer is present
Earlier detection and treatment increases patient survival rate
Symptoms of advanced stage: visible bleeding from the rectum, a change in bowel habits, abdominal pain
Colorectal cancer
