Exam 2: Chapter 43 - Assessment of Digestive and Gastrointestinal Function Flashcards
Journey of the GI Tract
Mouth -> Esophagus -> Stomach -> Small and Large Intestines -> Rectum -> Terminal Structure -> Anus
Functions of the Stomach
Stores Food During Eating, Secretes Digestive Fluids, Propels the Partially Digested Food (or Chyme), into the small intestine
Parts of the stomach?
Cardia (entrance), fundus, body, and pylorus (outlet)
Longest segment of the GI tract?
Small intestine, accounts for 2/3
Parts of the small intestine?
Duodenum (Proximal), Jejenum (Middle), and Ileum (Distal Secretion)
What is the Ileocecal Valve?
The valve controls the flow of material into the cecal portion of large intestine, and prevents reflux of bacteria into the small intestine
What is attached into the cecum?
Vermiform appendix, it has no function
What empties into the duodenum?
Common bile duct, which allows for the passage of both bile and pancreatic secretions
Parts of the large intestine?
Ascending -> Transverse -> Descending -> Sigmoid Colon -> Rectum -> Anus
What occurs in small intestine?
Absorbs nutrients and small amount of H20. Also secretes mucous.
Blood flow to the GI tract?
20% of total cardiac output and increases significantly after eating
How does food look in ascending?
Chocolate shake
How does food look in Transverse?
Chocolate Frosty
How does food look like Descending?
Blizzard because it has small chunks inside of it
How does food look like in Sigmoid?
A brownie
Functions of the GI Tract?
- Breakdown of food particles into the molecular form for digestion
- Absorption into the bloodstream of small nutrient molecules produced by digestion
- Elimination of undigested unabsorbed foodstuffs and other waste products
How much salvia secreted daily?
1.5 L
What begins the digestion of starches?
Amylase
What happens as a bolus of food is swallowed?
Epiglottis moves to cover the tracheal opening and prevent aspiration of food into the lungs
Functions of the gastric secretions?
- To break down food into more absorbance components
2. To aid in the destruction of most ingested bacteria.
What is Pepsin?
An important enzyme for protein digestion, is the end product of the conversion of pepsinogen from the chief cells
What is Intrinsic Factor?
Secreted by the gastric mucosa, and combines with dietary vitamin B12 so that it can be absorbed in the ileum
What happens without Intrinsic Factor?
Vitamin B12 cannot be absorbed, and pernicious anemia results
Where do duodenal secretions come from and include?
accessory digestive organs: pancreas, liver, and gallbladder- and the glands in the wall of the intestine itself
These include amylase, lipase, and bile
What digestive enzymes secreted by the Pancreas included?
Amylase (Helps with digestion of starch)
, Lipase (Helps with digestion of fats),
and Trypsin (Helps with digestion of proteins)
Where do digestive enzymes secrete to?
Drain into pancreatic duct, which empties into CBD
What does bile do and what controls it?
Secreted by liver and stored in the gallbladder, aids in emulsifying ingested fats, making them easier to digest and absorb
Controlled by Sphincter of Oddi
What two contractions occur regularly in the small intestine?
Segmentation Contractions and Intestinal Peristalsis
What is Segmentation Contractions?
Produces mixing waves that move the intestinal contents back and forth in a churning motion
What is Intestinal Peristalsis
Propels the contents of the small intestine toward the colon
Carbohydrates (glucose) are brokwn down into what?
Disaccharides and Monosaccharides
What is absorbed in the duodenum and smal intestine?
Nutrients
What is absorbed in jejenum?
Fats, Proteins, Carbohydrates, Sodium, and Chloride
What is absosrbed in ileium?
Vitamin B12 and bile salts
What is absorbed throughout the entire small intestine?
Magnesium, Phosphate, and POtassium
What two types of colonic secretions are added to the residual material?
Electrolyte Solution
Mucus
What is in the electrolyte solution that is added to the large intestine?
Chiefly a bicarbonate solution that acts to neutralize the end products formed by the colonic bacterial action
What is the mucus that is added to the large intestine?
Protects the colonic mucosa from the interluminal contents and provides adherence for the fecal mass
Major function of colon??
Reabsorption of water and electrolytes
What is fecal matter composted of?
75% fluid and 25% solid material.
Gerontologic Considerations
Difficulty chewing and swallowing
REflux and Heartburn
food intolerances
Decreased motility and trasnit time
Gerontologic Considerations :Enema
This occurs because of a decrease in albumin and proteins
Gerontologic Considerations : Parietal Cell
Will then be decreased due to decrease HCl acid production. This will result in less IF, which leads to not producing any B12
Most common presentation in the ambulatory setting for pain with GI disease?
Abdominal Pain
What is Dyspepsia?
Upper abdominal discomfort associated with eating; is the most common symptom of patients with GI dysfunction
What foods cause the most discomfort?
Fatty foods because they remain in the stomach for digestion longer than proteins or carbohydrates.
Accumulation of gas in the GI tract may result in
belching or flatulence (expulsion of gas from the rectum).
Could be an indication of food intolerance or gallbladder disease
Causes of Nausea and Vomiting?
- Visceral Afferent Stimulation
- CNS Disorders
- Irritation of the chemoreceptor trigger zone from radiation therapy, systemic disorders, and endogenous and exogenous toxins.
Common cause of nausea?
Distention of the duodenum or upper intestinal tract.
Changes in Bowel Habits: When does Diarrhea occur?
An abnormal increase in the frequency and liquidity of the stool or in daily stool weight or volume, and commonly occurs when the contents move so rapidly through the intestine and colon so there is inadequate time for GI secretions.
Physiologic function of diarrhea?
Typically associated with abdominal pain or cramping and nausea or vomiting
What can constipation be associated with?
A decrease in the frequency of stool, or stools that are hard, dry, and of smaller volume and may be associated with anal discomfort and rectal bleeding
What happens to stool of blood is shed into the upper GI tract?
Tarry-black color (melena)
What happens to stool of blood that is shed into the lower gi?
appear bright or dark red
Stool Color: Meat Protein
Dark Brown
Stool Color: Spinach
Green
Stool Color: Carrots, Beets, and Red Gelatin
Red
Stool Color: Cocoa
Dark red or brown
Stool Color: Senna
Yellow
Stool Color: Bismurth, Iron, Licorice, Charcoal
Black
Stool Color: Barium
Milky White
How is current nutritional status assessed?
Via history, laboratory tests (complete metabolic panel including liver function studies, triglyceride, iron studies, and CBC)
Physical examinations includes assessment of
mouth, abdomen, rectum, and requires good source of light, full exposure of abdomen, warm hands, and empty bladder
Physical Examination: Lips
Look for moisture, hydration, color, texture, symmetry, and presence of ulcerations or fissures
Physical Examination: Gums
Inspected for inflammation, bleeding, retraction, and discoloration. Odor of the breath also.
Physical Examination: Tongue
Back of tongue inspected for texture, color, and leisons
How can the abdomen be divided?
Four quadrants or nine regions
Physical Examination: What is performed first on Abdominal?
Inspection performed first, noting skin changes, nodules, lesions, scarring, discolorations, inflammation, bruising, or striae
Importance of Lesions on Abdomen?
GI diseases often produce skin changes.
Physical Examination: What is performed second on Abdominal?
Auscultation. Used to determine character, location, and frequency of bowel sounds
Frequency of normal bowel sounds?
sounds every 5-20 seconds
hypoactive bowel sounds?
one or two sounds in 2 minutes
hyperactive bowel sounds?
5-6 sounds heard in less than 30 seconds
Physical Examination: What is performed third on Abdominal?
Percussion: Used to assess the size and density of the abdominal organs and to detect the presence of air-filled. masses
Physical Examination: What is performed final on Abdominal?
Rectal Inspection and Palpation
The discovery of tenderness, inflammation, on the rectum should indicate what?
Pilondial Cyst
Perianal Abscess
Anorectal Fistula or Fissure
Purpose of GI diagnostic studies?
confirm, rule out, stage, or diagnose various disease states, including cancer
Preparations for many of these studies include
clear liquid 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
Initial Diagnostic tests begin with
Serum Laboratory Studies
Whats included in Serum Laboratory Studies?
CBC, Metabolic Panel, prothrombin time, triglycerides, Liver Function Tests,
Specific tests include: Carcinembryonic Antigen (CEA). Cancer Antigen (CA), and Alpha-Fetoprotein.
Why is CEA important ?
A protein that is normally not detected in the blood of a healthy person; therefore when detected indicates that cancer is present
CEA results can most likely determine what?
Colorectal Cancer
What is CA 19-9
A protein that exists on the surface of certain cells and is shed by tumor cells, making it useful as a tumor marker to follow the course of cancer. Elevated in those with pancreatic cancers.
What test is CA 19-9 associated with?
Serum Laboratory Tests
What does basic examination of the stool include?
Inspecting the specimen for consistency, color, and occult blood
Usually collected on random basis and sent promptly to laboratory.
Stool Tests: What requires laboratory evaluation?
Fecal Urobilinogen Fecal Fat Nitrogen C. Diff Fecal Leukocytes Parasites Food Reidues
Most common performed stool test?
Fecal Occult Blood Testing (FOBT)
Why is FOBT useful?
Useful in initial screening for several disorders, most frequently used in early cancer detection programs
What can cause a false-positive in a FOBT test?
Avoid ingesting red meats, aspirin, nonsteroidal anti-inflammatory drugs , turnips, and horseradish for 72 hours
What can cause a false-negative in a FOBT test?
Vitamic C supplements from food
Stool Tests: What is the FIT
FEcal Immunologic Tests: Use monoclonal or polyclonal antibodies to detect the globin protein in human hemoglobin
Is there a restriction on a Fecal Immunologic Test?
No
Why was the hydrogen breath test developed?
To evaluate carbohydrate absorption, in addition to aiding in the diagnosis of bacterial overgrowth in the intestine and short bowel syndrome
What does the hydrogen breath test determine?
The amount of hydrogen expelled in the breath after it has been produced in the colon and absorbed in the blood
What does the urea breath test detect?
Presence of H.Pylori, which lives in stomach and cause peptic ulcer disease
How is a urea breath test performed?
Patient ingests a capsule of carbon-labeled Urea, breath sample obtained 10-20 minutes later. H Pylori metabolizes Urea rapidly and carbon is absorbed quikcly
How is Ultrasonography performed?
Noninvasive diagnostic technique in which high-frequency sound waves are passed into internal body structures, and the ultrasonic echoes are recorded on an oscilloscope as they strike tissues.
How is Ultrasonography useful?
Noninvasive. Useful in the detection of an enlarged gallbladder or pancreas, the presence of gallstones, an enlarged ovary, ectopic pregnancy, or appendicitis.
Advantrages of abdominal ultrasonography ?
Absence of ionizing radiation, no noticeable side effects, relatively low cost, and almost immedite results
Ultrasonography cannot be used to..
examine structures that lie behind bony tissue.
Gas and fluid in the abdomen or air in the lungs also prevent transmission of ultrasound.
What is Endoscopic Ultrasonography (EUS)?
Specialized enteroscopic procedure that aids in diagnosis of GI disorders by providing direct imaging of a target area
What is Endoscopic Ultrasonography (EUS) used for?
May be used to evaluate submucosal lesions, specifically their locaiton and depth of penetration.
May aid in evaluation of Barrett Esophagus, portal hypertension, chronic pancreatitis, suspected pancreatic neoplasm, biliary tract disease and changes in bowel wlal due to ulcerative colitis
How long should patients fast before ultrasound testing?
8-12 hours, to decrease the amount of gas in the bowel
If gallbladder ultrasound studies are being performed, patient should eat
fat-free meal the evening before the test.
If barium studies are performed, they should be scheduled after
ultrasonography.
What happens if barium studies performed before ultrasonography?
The barium could interfere with the transmission of the sound waves.
An upper GI fluroscopy delineates the entire GI tract after
the introduction of a contrast agent, radiopaque liquid (barium sulfate) is commonly used
Variations of the upper GI study include
double-contrast studies and enteroclysis
What are double-contrast method?
Involves administration of a thick barium suspension to outline the stomach and esophageal wall. Tablets release CO2 in presence of water given. Shows esophagus and stomach in finer detail
What is Enteroclysis?
Very detailed-double contrast study of entire small intestine that involves the continuous infusion (through duodenal tube) of a thin barium sulfate suspension. Methycellulose then infused. They mix and are observed as they travel through the jejenum and ileum.
This can take 6 hours.
Aids in diagnosis of partial small bowel obstructions or diverticula. After complete, patient undergoes CT scan to check for lesions or adhesions
Dietary Changes prior to Upper GI Tract Study
Clear liquid diet, with NPO from midnight to night before. No smoking or chewing gum .
How is visualization occured in lower GI tract?
Obtained after rectal installation of barium.
Lower GI Tract Study: What can barium enema be used for?
Can be used to detect the presence of polyps, tumors, or other lesions of the large intestine and demonstrate any anatomic abnormalities or malfunctioning of the bowel. Takes 15-30 mins while x-ray images are obtained.
Lower GI Tract Study: Other means for visualizing the colon?
Include double-contrast studies and a water-soluble contrast study. Occasionally used because they are inexpensive and simple
Lower GI Tract Study: Double-Contrast or Air-Contrast Barium Enema involves
the instillation of a thicke barium solution. Followed by instillation of air. Pt may feel cramping or discomfort during this process.
Test provides contrast between air-filled lumen and barium-coated mucosa, allowing easier detection of smaller lesions.
Lower GI Tract Study: Preparation
Patient includes emptying and cleansing the lower bowel. Necessitates low-residue dieet 1-2 days before the test, a clear liquid diet and laxative the evening before, NPO after midnigh and cleansing enemas until returns are clear the following morning
Lower GI Tract Study: Postprocedural patient education includes
information about increasing fluid intake, evaluating bowel movements for evacuation of barium, and noting increased number of bowel movements
CT is a valueable tool for detecting
many inflammatory conditions in the colon, such as appendicitis, diverticulitis, regional enteritis, and ulcerative colitis
Also evaluate the abdomen for disease of the liver, spleen, pancreas, and pelvic organs and abdominal wall
Common risks from IV contrast agents?
allergic reactions and acute kidney injury, Allergies include iodine or shellfish
MRI used in
gastroenterology to supplement ultrasonography and CT
How does MRI work
Noninvasive technique uses magnetic fields and radio waves to produce images of the area being studied.
MRI useful in
evaluating abdominal soft tissues as well as blood vessels, abscesses, fistulas, neoplasms, and other sources of bleeding
Nursing Intervention before MRI?
Includes NPO status 6-8 hours before study and removal of all jewerly and other metals.
Positron Emission Tomography (PET) produce images by
detecting the radiation emitted from radioactive substances. Injected into the body IV and usally tagged with radioactive isotopes of oxygen, nitrogen, carbon, or fluorine.
Isotopes decay quickly and are eliminated in the urine or feces
Scintigraphy relies on the use of
radioactive isotopes to reveal displaced anatomic structres, changes in organ size, and presence of neoplasms or other focal lesions such as cysts or abscesses.
Scinigraphy also used to measure
uptake of tagged red blood cells and leukocytes
Performed to define areas of inflammation, abscess, blood loss, or neoplasm. Useful in determining sourcec of internal bleeding when all other studies have retrned negative result
GI Motility Studies: Radionuclide Testing used to
Assesss gastric emptying and colonic transit time. Foods are tagged and pt positioned under scintiscanner after eating to measure rate of passage of radioactive substances in stomach
What are some endoscopic procedures?
Fibroscopy/Esophagogastroduodenoscopy, Collonoscopy Anoscopy Proctoscopy Sigmoidscopy Small Bowel Enteroscopy
Fibroscopy of the upper GI tract allows direct visualization of the
Esophageal, gastric, and duodenal mucosa through a lighted endoscope.
How does a Esophagogastroduodenoscopy EGD work?
Gastroenterologist views GI tract through a viewing lens and can obtain images through the scope to document findings.
How does a PllCam ESO/Capsule Endoscopy work?
REquires that patient swallows a capsule that travels by peristalsis through the small intestines. This transmit it to a recorder on patients wrist. Takes around 24 hours.
Provides superior visualization of the small intestines and useful to detect occult areas of bleeding, inflammatory bowel disease and celiac disease
How does Endoscopic Retrograde Cholangiopancreatography (ERCP) work?
Uses the endoscope in combination with x-rays to view the bile ducts, pancreatic ducts, and gallbladder.
ERCP helpful in evaluating what?
Jaundice, pancreatitis, pancreatic tumors, common bile duct stones, and biliary tract disease.
Therapeutic endoscopy can be used to remove
comon bile duct stones, dilate strictures, and treat gastric bleeding and esophageal varices.
Endoscopic Procedures: Laser-Compatible Scopes can be used to
provide laser therapy for upper GI neoplasm
Endoscopic Procedures: Sclerosing Solutions cna be injected through
the scope to control upper gi bleeding
Endoscopic Procedures: Nursing Interventions
Patient should be NPO for 8 hours prior to the examination.
PT given local anesthetic gargle or spray before introduction of endoscope. Midazolam provides moderate sedation with loss of gag reflex. Patient positioned on left lateral position.
Endoscopic Procedures: After Gastroscopy, assessment includes
level of consciousness, vital signs, oxygen saturation, painlevel, and monitoring for signs of perforation.
Someone should stay with pt until morning after procedure.
Fiberoptic Colonscopy used commonly as
a diagnostic aid and screening device. Most frequently used for cancer screening and for surveillance in patients with previous colon cancer or polyps.
Tissue Biopsies and polyps can be obtained.
Colonscopy is performed while the patient is
lying on the left side with the legs drawn up toward the chest.
Complications after a colonscopy can include
Cardiac dysrhythmias adn respiratory depression resulting from medications given, vasovagal reactions and circulatory overload or hypotension resulting from overhydration or underhydration
Capsule colonscopy is an alternative for those who cannot tolerate
a colonscopy. Must drink a lot of water to ensure the capsule transits through the colon
Colonscopy: Diet and medications before procedure
Patient maintains a clear liquid diet starting at noon the day before the procedure. Then ingests lavage solutions over 3-4 hour intervals.
Laxative for two nights before examination.
Colonscopy: Alternative to clean colon?
Sodium phosphate tablets. 20 tablets given teh evening prior, and 12 given the morning of the examination.
Colonscopy: What happens when you use a lavage?
Bowel cleansing fast. Side effects of electrolyte solutions include nausea, bloating, cramps, or abdominal fullness. Problematic for older adults.
Colonscopy cannot be performed if
there is colon perforation, acute severe diverticulitis, or fulminant colitis.
The flexible fiberoptic sigmoidscope permits the colon to be examined up to
16-20 inches from the anus, much more than 10 inches can be visualized with the rigid sigmoidscope
For flexible scope procedure, patients assumed what type of position?
Comfortable position on the left side with the right leg bent and placed anteriorly
Small Bowel Studies: Capsule Endoscopy allows the
noninvasive visualiziation of the mucuosa throughout the entire small intestine. Especially in evaluation of obscure GI bleeding
Small Bowel Studies: Capsule Endoscopy technique?
Patient swallows a capsule embedded with wireless minature camera. Passes teh rectum in 1 or 2 days. Limited because it is only diagnostic and cannot obtain specimens
Small Bowel Studies: Double-Balloon Enteroscopy has made it possible to
visualize the mucosa of the entire small bowel as well as carry out diagnostic and therapeutic interventions
Small Bowel Studies: How does a double-balloon enteroscopy work?
compromised of two balloons, one attached to distal end and other attached to the transparent overtube that slidese over the endoscope. It is advanced alternately inflating and deflating the balloons causing telescoping of the small intestine onto the overtube. Useful for visualizing a segment of small or large intestine Takes 1-3 hours
What does the Manometry test measure?
Measures changes in intraluminal pressures and the coordination of muscle activity in the GI tract with the pressures transmitted to a computer analyzer
Esophageal Manometry is used to detect
motility disorders of the esophagus and the upper and lower esophageal sphincter.
Esophagealmotility studies are helpful in the diagnosis of
achalasia (absence of peristalsis)
diffuse esophageal spasm
Scleroderma
Other esophageal motor disorders
Esophageal Manometry: Eating and Medications before test?
Refrain from eating or drinking for 8-12 hours before test
Medications should be withheld for 24-48 hours
How does a Esophageal Manometry work?
Pressure-sensitive catheter inserted through the nose and is connected to a transducer and a video recorder. Patient then swallows small amount of water while the resultant pressure changes are recorded
Gastroduodenal, small intestine, and colonic manometry procedures are used to
evaluate delayed gfastric emptying and gastric and intestinal motility disorders such as irritable bowel syndrome or atonic colon
Anorectal manometry measures the
resting tone of the internal anal sphincter and the contractibility of the external anal sphincter
Why is Anorectal Manometry helpful?
Helpful in evaluating patients with chronic constipation or fecal incontinence and is useful in biofeedback for the treatment of fecal incontinence
What is given before Anorectal Manometry and position?
Dibasic sodium or a saline cleansing enema 1 hour before test and positioning is prone or lateral
Rectal sensory function studies used to evaluate
rectal sensory function and neuropathy
How is a rectal sensory function performed?
Catheter and balloon are passed into the rectum, with increasing balloon inflation until the patient feels distention. Then the tone and pressure of the rectum and anal sphincter are measured.
Results helpful in evaluation of patients with chronic constipation, diarrhea, or incontinence
Electrogastrography performed to
assess gastric motility disturbances and can be useful in detecting motor or nerve dysfunction i the stomach. Electrodes placed over abdomen and gastric electrical activity recorded for up to 24 hours.
Defecography measures
anorectal function and is performed with very thick barium paste instilled into the rectum
Fluroscopy is used to assess
the function of the rectum and anal sphincter while the patient attempts to expel the barium. Test requires no preparation
Gastric Acid Stimulation Test: Before the test eating and medications
Patient NPO 8-12 hours before the procedure
Medications withheld 24-48 hours. Smoking not allowed morning of.
Gastric Analysis: HCl and Pernicious Anemia
Patients with this disease secrete no acid under basal conditions or after stimulation
Gastric Analysis: HCl: Severe Chronic Atrophic Gastritis or Gastric Cancer
Patients with these diseases secrete little or no acid
Gastric Analysis: HCl: Gastric Ulcer
Patients with this disease secrete some acid
Gastric Analysis: HCl: Duodenal Ulcers
Patients with this disease usually secrete an excess amount of acid
Esophageal Reflux of Gastric Acid: Food and Medication Limit and how does it work?
Having patient NPO 6 hours before test. Meds witheld 24-36 hours before teh test.
Probe that measures pH inserted through nose into lower esophageal sphincter.
External recording device worn for 24 hours
Bravo pH monitoring system offers
the advantage of pH monitoring of the esophagus without the transnasal catheter
How does Bravo pH system work?
Capsule attached to the patients esophageal wall.
Data transmitted to receiver that patient wears. Data colelcted for 48 hours.
Capsule detaches in 7-10 days.
This method is moth accurate because patient can eat normall and continue typical activities.
What is a pneumoperitoneum
injecting carbon dioxide into the peritoneal cavity to separate the intestines from the pelvic organs
Steps of Laparoscopy
After Pneumoperitoneum, small incision is made lateral to the umbilicus allowing for the insertion of the fiberoptic labaroscope
Why is Laparoscopy useful?
Permits direct visualization of the organs and structures within the abdomen, permitting visualization and identifcation of any growths, anomalies, and infmallatory processes
Biopsy samples can also be taken
What can Laparoscopy be used to evaluate?
peritoneal disease, chronic abdominal pain, abdominal masses, and gallbladder and liver disease
Esophagus location?
Mediastinum, anterior to the spine and posterior to the trachea and heart
Proteins are a source of energy after they are broken down into
amino acids and peptides
Brown color of feces results from
breakdown of bile by the intestinal bacteria
Elimination of stool begins with
distention of the rectum, which initiates reflex contractions of the rectal musculature and relaxes the normally closed internal anal sphincter
Ingestion refers to
a host of upper abdominal or epigastric symptoms such as pain, discomfort, fullness, bloating, belching, or regurgitation
What type of response is vomiting?
Physiologic protective response that limits the effects of noxious agents by emptying the stomach contents and sections of the small intestine
What are light-gray or clay-colored stools caused by
decrease or absence of conjugated bilirubin
What is the Hemoccult II?
It is the most widely used in-office or at home occult blood test. It is inexpensive, noninvasive, and carries minimal risk to patient.
Should not be used when hemorrhoidal bleeding present
Urea breath test restrictions?
Avoid antibiotics or bismuth subsalicylate for 1 month.
Sucralfate and Omeprazole for 1 week
Cimetidine, Famotidine, and Ranitidine for 24 hours.
How does Endoscopic Ultrasonography work?
Small high-frequency ultrasonic transdcuer is mounted at the tip of the fiberoptic scope, which displays images that are of higher quality resolution and definition than regular ultrasound imaging
Endoscopic Ultrasonography: What must be done?
Moderate sedation is typically indicated
Upper GI studies enables the examiner to
detect or exclude anatomic or functional disorders of the upper GI organs or sphincters
Upper GI Studies aids in the diagnosis of
ulcers, varicies, tumors, regional enteritis, and malabsorption syndromes
Upper GI Fluroscopy: As the barium descends into the stomach, what occurs?
The position, patency, and caliber of the esophagus are visualized and enable the examiner to detect or exclude any anatomic or funcional derangement of that organ
Upper GI Fluroscopy: Examination of stomach includes
observation of stomach motility, thickness of the gastric wall, mucosal pattern, patency of pyloric valve, and anatomy of the duodenum
Lower GI Tract Study: If active inflammatory disease, fistulas, or perforation of colon suspected, what is done?
Water-soluble iodinated contrast agent can be used.
Lower GI Tract Study: How does a Water-Soluble Iodinated Contrast work?
Pt must be assessed for allergy. Occurs the same way as barium enema
Lower GI Tract Study: Nurse make sure that barium enemas are scheduled before any
Upper GI Studies
Lower GI Tract Study: Barium enemas are contraindicated if
The pt has active inflammatory disease of the colon. Also if there are signs of perforation or obstruction.
If so water-soluble contrast may be pefrformed
CT scan provides
cross-sectional images of abdominal organs and structures. Multiple x-ray images are taken from numerous angles/
What do Volume CT scanners do?
Provide more accurate reconstruction of patient data into alternate planes, require shorter scan times and have less artificat
GI Motility Studies: Radionuclide testing useful in diagnosing what?
Disorders of gastric motility, diabetic gastroparesis and dumping syndrome.
GI Motility Studies: What is Colonic Transit studed used for?
Evaluate colonic motility and obstructive defecation syndromes
GI Motility Studies: How are Colonic Transit studies performed?
20 radionuclide markers mixed with eggs. X-Rays aken every 24 hours until all markers have passed. Process takes 4-5 days. Patients with chronic diarrhea may be evaluated at 8-hour intervals
Time that it takes to move through colon indicates colonic motility
Esophagogastroduodenoscopy (EGD) valueable when
esophageal, gastric, or duodenal disorders or inflamatory neoplastric, or infectious processes are suspected
ERCP side-viewing felxible scopes used to visualize
the common bile duct and the pancreatic and hepatic ducts through the ampulla of vater in the duodenum
A downside to ERCP is that it is associated with
postprocedure pancreatitis
Endoscopic Procedure: How is the endoscope prepared after pt sedated and what occurs?
Endoscope lubricated with water-soluble lubricant and passed smoothly and slowly along the back of the mouth and down into the esophagus.
Gastroenterologist views gastric wall and sphincters and then advances endoscope into the duodenum for further exmination. Biopsy forceps obtain tisue specimen. Takes about 30 minutes
What are some other uses of Colonscopy?
Evaluation of patient with diarrhea of unknown cause
Occult Bleeding or Anemia
Inspecting inflammatory or other Bowel Disease
Colonscopy: Many colon cancers begin with
adenmatous polyps of the colon.
Colonscopy: One goal of colonscopic polypectomy is
early detection and prevention of colorectal cancer
Colonscopy: Colonscopic polypectomy also used to treat
areas of bleeding or stricture
Colonscopy: Postprocedure discomfort results from
instillation of air to expand the colon and insertion and movement of scope during procedure
Endoscopic examination of the anus, rectum, and sigmoid and descending colon is used to evaluate
chronic diarrhea, fecal incontinence, ischemic colitis and lower GI hemorrhage and to observe for ulceration, fissures, abscesses, tumors, polyps, or other pathologic processes
Restrictions for endoscopic examinations?
None. Warm tap water or enemas used until returns are clear
Analysis of the gastric juice yields information about
the secretory activity of the gastric mucosa and the presence or degree of gastric retention in patients thought to hav pyloric or duodenal obstructional
How does Gastric Analysis occur?
Small NG tube with a catheter tip marked at various points inserted in the nose. It should be within the stomach lying along greater curvature. Tube secured to pts cheek. Stomach conents aspirated by gentle suction into syringe and gastric samples collected every 15 minutes for the next hours
Important diagnostic information to be gained from gastric analysisincludes
the ability of mucosa to secrete HCL.
Why is a laproscopy not used as much anymore?
Because availability of less invasive tools such as CT and MRI.
Usually requires anesthesia and requires that stomach and bowel be decompressed.
