L1 Assessment of Digestive & Gastrointestinal Functions Flashcards
What history do we need to ask our patients?
Previous and current relating disorders, treatment/surgeries/diagnostic studies, medication or supplements taken, nutritional status(daily food intake, appetite.BW, bowel)
Any special history that we need to ask?
Spiritual:Religious food restrictions
What do we call “err氣” and “fart”?
Belching(burping) & flatulence
Which 3 aspects should we assessed for nausea and vomiting?
1.visceral afferent stimulation:infections, obstruction, heptaobiliary disorders
2.CNS disorders:increase ICP, migraine, psychogenic
3.irritation of the chemotherapy
What kinds of food alter these stool colors respectively? 1.Dark brown 2.Light yellow/Green 3.Black
4.Milky white
1.Cocoa 2.Senna 3.Bismuth,Iron,Licorice,
Charcoal 4.Barium
What problem leads to pencil-like stool?
Rectal area contraction, stenosis from malignancy
What is the correct sequence of physical assessment of the abdomen?
Inspection–>Auscultation–>Percussion–>Palpation
What could be the sign of abdominal aortic aneurysm(AAA)? And what should we do?
Bulging and pulsating mass. DO NOT touch and report immediately
What could peristaltic movements mean?
1.Normal since the patient is thin and has increased peristalsis 2.intestinal obstruction
What position is chosen for rectal physical exams?
knee-chest, left lateral with hips and knees flexed
What are the purpose of diagnostic tests?
1.Assess nutritional status and function of GI and accessory organs
2.Provide info to identify/modify appropriate medication or therapy used
3.Moniter response to treatment and nursing interventions
What lab assessment need to be done before carrying out the diagnostic test?
BLOOD:
1.CBC(Hb↓&WBC↑)
2.Clotting Profile(Prothrombin Time↑&INR)
3.Renal function(Electrolyte)
LIVER:
1.↑AST(Aspartate transaminase)&↑ALT(Alanine aminotransferase)
2.↓Albumin
3.↑Ammonia
4.↑Bilirubin
OTHER:
1.Amylase&Lipase
2.Cholesterol
3:Oncofetal antigens
3a:CA19-9(tumor marker of GI)
3b:CEA(tumor marker for staging)
For Barium used diagnostic test, Barium swallow and enema, what should be ensured for the post-test?
Eliminate the barium promptly(asap) by laxatives +/- encourage fluid intake; inform patient that the stools may be light-coloured (milky white)for few days
What is the difference of the purpose of the two Barium-used diagnostic test?
Swallow: Check any varices, inflammation, ulcerations, hernia, foreign bodies, mass, polyps of oesophagus, stomach and duodenum
Enema: Identify structural abnormalities of colon and rectum, e.g. melena, obstruction, masses
How does the Barium-used tests are done?
Contrast medium (Barium) is administered(swallow/per rectal) to provide a contrast view. For swallow, the view is during swallowing and peristalsis from pharynx to the duodenojejunal
What is the difference of the pretest of the two Barium-used tests?
Both need fasting for 8-12hrs before the test
Swallow: withhold narcotics/anticholinergic medications for 24hrs
Enema: Low-residue diet 1-2 days before→Clear liquid diet for 24hours→keep fasting 8 hours+Klean-Prep
What is Klean-Prep?
By ingesting laxative solution orally Q3/4H to empty all feces the evening before the test
How does Oesophageal Acidity Test & Manometry be done?
Place a multi-lumen catheter transnasally to lower oesophageal sphincter which measure the sphincter pressure and peristaltic contractions
What are oesophageal acidity test and manometry done for?
To diagnose problem of lower oesophageal sphincter/achalasia 食道底下肌肉無法有效contract, 所以推唔到啲食物去胃度 and chronic reflux esophagitis 因為胃酸倒流刺激到食道所以發炎
What should we do before the Oesophageal Acidity Test and Manometry
Keep fasting 8-12hrs before, Avoid drugs that alter the pH(antacids, H2 inhibitors); weaken (anticholinergics, adrenergic blockers) or strengthen (cholinergics) smooth muscle ;Alcohol & corticosteroids that worsen the gastroesophageal reflux
What kinds of patient are not suitable to have the Magnetic Resonance Imaging? [Contraindications]
Patients with metal implant or other metal fragments
What can MRI do?
Identify the sources of bleeding, identify lesions and staging of cancers/tumors, evaluate the organs
What should we do if contrast media is needed for MRI?
1.Ensure fasting for 6-8hrs
2.IV assess
What should always ensure for MRI?
1.Remove all metallic objects and dental appliances
2.Make sure the patient is able to communicate–>so the patient can talk with the technician even suffer from claustrophobic 幽閉恐懼症
What is MRCP
Magnetic resonance cholangiopancreatography 磁共振胰膽管成像
What is OGD?
Oesophagogastroduodenoscopy上消化道內視鏡
What can OGD do?
Direct visualise the mucous membrane lining and detect any inflammation, ulcerations, tumor, bleeding, varices and gastric motility. Also, it can collect the biopsy and secretion specimen
What anaesthesia is needed for OGD?
Local anaesthetic throat spray; IF too anxious, narcotics like Midazolam or Fentanyl
What should be done during the test of OGD?
Suctioning to remove saliva, may use atropine to reduce the motility of intestinal tract, so to dry secretion. All for better visualisation
What are the post-test for OGD?
1.Resume diet only until resume gag reflex
2.Inform the patient that mild bloating, belching or flatulence may happen as air was pumped in to expand the upper GI
3.Monitor any abnormalities, especially for black tarry stools.
What are the purposes of Abdominal Ultrasound?
1.Detect abdominal masses or lesions, ascites, and disorders of appendix
2.For directing biopsy collection, drainage&collection of ascites/abscesses
What should be ensured for special ultrasound test?
1.If it is for gallbladder studies, eat a fat-free meal the evening before because the release of bile will obstruct the image
2.If barium studies is scheduled, it should be done after the USG
What kinds of patient is contraindicated to carry out Barium enema?
Patients with active inflammatory disease of the colon
For colonoscopy and sigmoidoscopy, what are their purposes?
Detect polyps and tumor+dilate the strictures for removing the polyps/ take biopsy. Sigmoidoscopy focus on the lower colon more.
What are the differences between the pretest preparation of colonoscopy and sigmoidoscopy?
sigmoidoscopy may not need bowel preparation (e.g. Klean Prep) and aim only to empty the fecal matter in lower colon.
So what should be done for the pretest preparation of colonoscopy?
Same bowel and diet preparation like the Barium test. But laxative will be changed into Fleet enema until the return is clear in the morning of the test.
IV access is needed for sedation.
Assess the risk of bleeding
Why fleet enema is used but not laxatives in Colonoscopy/sigmoidoscopy?
Because patients with internal obstruction/bowel inflammatory disease is contraindicated to laxatives.
Can patient with colon perforation or acute severe infection be carried out the colonoscopy?
NO!
Why Diabetic patients need special precautions for the diagnostic tests?
Since fasting is commonly required, medication adjustment might be done by doc to prevent hyper or hypoglycaemia.
Why patient that is old or implanted defibrillators & pacemakers need to be assessed carefully for colonoscopy/Sigmoidoscopy?
Elderly:Difficult to ingest lots of laxatives+easy to be dehydrated/suffer from electrolyte imbalance
Implant:If electrosurgical procedure like the polypectomy is performed during the endoscopy, those implanted devices easily become malfunctioning.
What are the post-test interventions for Colonoscopy and sigmoidoscopy?
1.Monitor vital every 30mins until patient is alert
2.Inform that fullness and mild abdominal cramping is expected for hours
3.Assess s/s: hypovolemic shock, bowel perforation
4.Outpatient must be accompanied to back home
What education should be given to patient removed polyps during colonoscopy/sigmoidoscopy?
Report sign of bleeding, avoid high-fibre food, no heavy lifting for a week
How many samples we need to take for the Guaiac fecal occult blood test
3 samples in 3 separate days
What are G-FOBT and Fecal Immunochemical Test FIT for?
Test feces for any occult blood as a screening test of colon cancer
What are the differences between the pretest preparation of G-FOBT and FIT?
G-FOBT need to withhold aspirin, NSAIDs, anticoagulant; red meats, fish, broccoli and other high fibre vegetables, mushrooms; and iron supplements that cause false-positive. vitamin C supplement that cause false negative.
FIT has no dietary restrictions and only need 1-2 separate samples
What is the purpose of percutaneous transhepatic cholangiogram?
With the guide of USG with contrast media, to visualise the biliary tract and locate its obstruction, remove the infected bile to treat obstructive jaundice by inserting a Percutaneous transhepatic biliary drainage.
Why we need to assess allergy for iodine/seafood/x-ray dye before carrying out Percutaneous transhepatic cholangiogram?
Because the patient might be allergic to the contrast media
Since the Percutaneous transhepatic cholangiogram is an invasive test, what else should be assessed except for allergy?
Clotting profile. To add on, prophylactics should be given 1 hr prior and continue during post-test period to prevent infection.
What are the post-test intervention for Percutaneous transhepatic cholangiogram?
1.Mon s/s of bile/blood leakage
2.Bed rest for 6hrs
3.Position patient right side with pillow support
What is the purpose of Computed tomography ?
Detect and localise the inflammatory conditions in colon and pathologic condition like any obstruction
What should we do for procedures that use contrast medium?
Pretest: 1. Consent,
2. allergy,
3.Since it might cause acute kidney injury:assess the renal function, withold Metformin(DM drug) which cannot be excreted for AKI case–>mon blood glucose
4.Prep IV access
5.Inform the patient that warm and flushed or having a metallic taste during injection
Posttest: encourage fluid intake and resume Metformin after 48hrs if normal RFT(renal function test)
What is ERCP?
Endoscopic retrograde cholangiopancreatography
What do ERCP do?
Check any biliary/pancreatic disorder, retrieve(remove) gallstones, dilate strictures by stent, take biopsy of tumors
Why allergy for iodine/seafood/x-ray dye needs to be checked before ERCP?
Cuz contrast medium is injected for higher accuracy.
What can be done during the ERCP?
Suctioning to remove saliva
What are the posttest interventions for ERCP? (Hints:Similar to Oesophagogastroduodenoscopy)
Make sure gag reflex is back to prevent aspiration of fluid/food by mouth. Might hv bloating/belching or flatulence. ALSO, s/s of perforation/bleeding(black tarry stool), inflammation, sepsis
What is the Two-Dose Regimen?
32mg of methy-prednisolone or 40 mg of prednisolone per oral for at least 12hrs and 2 hours prior the test for patient with allergic reactions of the contrast medium.
