GI Assessment And Diagnostics Flashcards
Assessment
- General Nutritional Status Interview
- Health History
- Physical Assessment
- Should begin with questions regarding client’s dietary habits
- Questions should elicit information about average daily intake of food and liquids, types and quantities consumed, where and when food is eaten, and any conditions or diseases that affect intake of absorption
Questions: - Food intake history, time, food/ drink, amount, method of preparation
. General Nutritional Status Interview
- Elicit a description of present illness and chief complaint or symptoms through COLDSPA (Characteristics, Onset, Location, Duration, Precipitating Factors, and Alleviating Factors)
- Family history, prenatal history, medications, use of tobacco and alcohol
- Complete nutritional history including 24-hour dietary intake
Health History
- Elicit description of present illness and chief complaint
o Onset, course, duration, location, and precipitating and
alleviating factors
o Cardinal signs and symptoms indicated altered hepatic,
biliary, and pancreatic function include:
▪ Jaundice, pruritus
▪ Changes in urine and stool color
▪ Vague to severe abdominal pain especially after eating
fatty foods
▪ Abdominal tenderness and distention
▪ Easy bruising and bleeding - Alcohol consumption
- Diet high in fat
- Infectious agents (transmitted through nonsterile needle
puncture, unprotected sexual activity, ingestion of potentially
contaminated food, etc.) - Recent blood transfusion
- Medications and herbal remedies
o Some sample drugs with high potential for hepatotoxicity
▪ NSAIDS (ibuprofen, acetaminophen, etc.)
▪ Antiseizure medications (phenytoin, valproic acid)
▪ TB drugs (isoniazid, pyrazinamide)
Health HIstory
On altered Hepato-Biliary and Pancreatic Disorders
- The general physical assessment is IPPA (inspection, palpation,
percussion, auscultation). - But for abdominal physical assessment, have it in this order:
Inspection, auscultation, percussion, palpation
Physical Assessment
Skin, mucosa & sclerae:
* Jaundice (yellow skin and sclera)
* Petechiae or ecchymotic area
* Spider angiomas
* Palmar erythema
Extremities:
* Muscle atrophy
* Edema
* Skin excoriation due to scratching
Abdomen:
* Contour
* Girth
* Pigmentation
* Color
* Scars
* Striae
* Visible masses
* Peristalsis
* Pulsations
Cognitive and neurologic status
Inspection
.Auscultation
- Auscultate bowel sounds before percussion and palpation (5-30
clicks/ min using diaphragm of stethoscope for 5 min) - Normal bowel sounds occur 5-30 times a min or every 5-15
seconds - Auscultate in all abdominal quadrants
- Auscultate for vascular sounds (bruits, hepatic friction rub)
Percussion
- Percuss all 4 quadrants noting tympany and dullness
Palpation
- Palpate deeply over all 4 quadrants for any masses and note
location, size and shape, pulsation - Palpate liver, spleen, kidneys, aorta for enlargement
- Always palpate tender areas last, because if you start there, you
may aggravate the pain and make the patient uncomfortable.
Diagnostic Assessment
NON-INVASIVE
1. GUAIAC TEST
2. HEPATOBILIARY SCAN/ LIVER SCAN
3. RADIONUCLIDE IMAGING/ CHOLESCINTOGRAPHY
4. BARIUM SWALLOW
5. BARIUM ENEMA
INVASIVE
1. COMPLETE BLOOD GLUCOSE (CBG) MONITORING
2. ESOPHAGOGASTRODUODENOSCOPY (EGD)
3. ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY
4. PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY (PTC)
5. LIVER BIOPSY
6. LIVER FUNCTION TESTS
- Looks for hidden (occult/ old) blood in a stool sample
- Detect GI bleeding (GI cancer)
- Increase fiber diet (48-72 hours)
- No red meats, poultry, fish, turnips, horse radish, melons,
salmon, sardines
o Avoid red/ colorful food that may alter stool color for
examination) - Withhold 48 hours: iron, steroids, indomethacin, colchicine,
vitamin C
o These will cause stool discoloration and may cause false
positive results - Three stool specimens (3 successive days)
- Hydrogen peroxide will be placed.
o Positive bleeding: BLUE color
GUAIAC TEST
- Non-invasive nuclear medicine study using radioactive materials
to show size and shape of liver tissue and visualize replacement
of liver tissue with scars, cysts, and tumors - Radioactive agent is injected IV which is taken up by the liver/
hepatocytes and excreted rapidly through the biliary tract - Patient is placed on NPO and NO opioids given 4H before
procedure
HEPATOBILIARY SCAN/ LIVER SCAN
- Procedure is more or less the same with liver scan but this time,
images of the gallbladder and biliary tract are obtained after IV
administration of radioactive agent.
RADIONUCLIDE IMAGING/ CHOLESCINTOGRAPHY
- An examination of the upper GIT under fluoroscopy after the
client drinks a contrast medium: barium sulfate (BaSO4) - To visualize the esophagus, stomach, duodenum, and jejunum
PRE-OP
* NPO PM (post-midnight)
before the day of test
* Withhold opioids 24H
before test
POST-OP
* Laxative
* Encourage oral fluids
* Monitor for passage of
barium (chalky white
stools for 24-72 hours)
BARIUM SWALLOW
- An examination of the lower GIT
- A fluoroscopic and radiographic examination of large intestine is
performed after rectal instillation of BaSO4 - Indicated for detecting bowel obstruction and cause of diarrhea
and constipation - Contraindication
o Patients with color perforation or fistula
PRE-OP
* Low residue diet 1-2 days
* Clear liquid diet and a laxative the evening before test
* NPO PM before the day of test
* Suppository/ cleansing enema on the morning of test
POST-OP
* EOF (early oral feeding)
* Administer mild laxative as
prescribed
* Monitor passage of
barium and notify
physician if bowel does
not occur 2 days after
BARIUM ENEMA
- Convenient way of monitoring blood glucose patterns and can be useful aid in guiding treatment changes in patients with Type 1 and Type 2 diabetes, especially during periods of illness or frequent hypoglycemia
- Let patient fast prior to extraction 2-3 hours prior to getting CBG.
Collect before lunch. - rotate sites
- discard first drop of blood because it is considered as “dirty blood”
COMPLETE BLOOD GLUCOSE (CBG) MONITORING
- An upper GI fibroscopy
- Done with fiberscopes
- After sedation, an endoscope is passed down the esophagus to view the gastric wall, sphincters, and duodenum
- Tissue specimens can be obtained for direct visualization of esophagus, stomach, and duodenum
- Esophagus → stomach → duodenum
PRE-OP
* Obtain written consent
* NPO 6-8H or 12H before test
* Sedatives, narcotics, tranquilizers as prescribed
(diazepam, meperidine hydrochloride)
* Atropine sulfate (SO4) to reduce salivation and glucagon as ordered
* Remove dentures or prevent airway obstruction
* Airway patency is monitored during the test
* Apply mouthguard
POST-OP
* Patient is positioned on left side (to allow secretions to flow and avoid asphyxia)
* NPO until gag reflex returns
* Monitor for signs of perforation
* Maintain bedrest for the sedated patient until alert
and advise to avoid driving 12H if sedative was used
* Lozenges, saline, gargle, or oral analgesics can relieve
minor sore throat, after the gag reflex returns
ESOPHAGOGASTRODUODENOSCOPY (EGD)
