- Fluoroscopic examination – stomach – lumen fills – barium – stomach motility, thickness

– gastric wall, mucosal pattern, patency – pyloric valve, anatomy – duodenum.

- Obstructions, ileitis, diverticula – detected
- Enteroclysis – detailed study – entire small intestine
- Nursing interventions – advices – against – smoking, chewing gum, using mints
- Follow – up care – eliminate – ingested barium.

Lower Gastrointestinal Tract Study

- Barium enema – detect – presence – polyps, tumours, other lesions – of large intestine
- Procedure – 15 to 30 minutes
- Double contrast studies & water – soluble contrast study – visualizing – colon.
- Nursing Interventions – emptying & cleansing – lower bowel – low – residue diet – 1 to
2 days before – test
- Postprocedural – increasing fluid intake – evaluating bowel movements – noting
increased number – bowel movements.

Computed Tomography

- Cross – sectional images – abdominal organs & structures.

- Multiple x – ray images
- Detecting & localizing – many inflammatory conditions – colon – appendicitis,
diverticulitis, regional enteritis, ulcerative colitis, diseases – liver, spleen, kidney,
pancreas, pelvic organs, structural abnormalities – abdominal wall.
- Three – dimensional CT – detailed pictures – GI organs.
- Nursing Interventions – allergies - contrast agents – iodine, shellfish, patient’s current
serum creatinine level – urine human chorionic gonadotropin - must be determined –
before administration – contrast agent
- Allergic – contrast agent – IV prednisone 24 hours, 12 hours, & 1 hour – before scan.
- Renal protective measures – administration – IV sodium bicarbonate 1 hour before & 6
hours after IV contrast & oral acetylcysteine before or after – study.

Magnetic Resonance Imaging

- Gastroenterology - supplement – ultrasonography & CT

- Uses – magnetic fields & radio waves – produce images – area – being studied
- Use – oral contrast agents – application – diagnosis – GI diseases.
- Useful – evaluating – abdominal soft tissues, blood vessels, abscesses, fistulas,
neoplasms, other sources – bleeding.
- Not totally safe – all people – attracted – magnet – cause injury.
- Contraindicated – patients – permanent pacemakers, artificial heart valves and
defibrillators, implanted insulin pumps, implanted transcutaneous electrical nerve
stimulation devices, internal metal devices, intraocular metallic fragments, cochlear
implants.
 - Nursing Interventions - removal – all jewelry – other metals.
- Deep breaths – intervals.

Endoscopic Procedures

- Fibroscopy/ esophagogastroduodenoscopy (EGD) – small bowel enteroscopy,

colonoscopy, sigmoidoscopy, proctoscopy, anoscopy, endoscopy through ostomy.

Upper Gastrointestinal Fibroscopy/ Esophagogastroduodenoscopy

- Direct visualization – esophageal, gastric, & duodenal mucosa through – lighted

endoscope
- Collect secretions – tissue specimens – further analysis
- PillCam ESO2 – pill sized instrument – two cameras – seven photographs per second –
transmits – wirelessly – nearby storage device
- Side – viewing flexible scopes – visualize – common bile duct & pancreatic & hepatic
ducts – through – ampulla of Vater – in duodenum.
- Evaluating jaundice, pancreatitis, pancreatic tumours, common bile duct stones, & biliary
tract disease.
- Therapeutic endoscopy – remove common bile duct stones, dilate strictures, treat gastric
bleeding & esophageal varices.
- Nursing Interventions – local anesthetic gargle or spray – Midazolam, sedative –
administered. Atropine – reduce secretions, Glucagon – relax smooth muscle. Patient –
left lateral position – clearance of pulmonary secretions.

Fibreoptic Colonoscopy

- Computer – simulated endoluminal – air – filled distended colon – using conventional

spiral or helical CT scanning.
- Direct visual inspection – large intestine – flexible fibreoptic colonoscope.
- Cancer screening – previous colon cancer or polyps.
- Other uses: evaluation – diarrhea of unknown cause, occult bleeding, or anemia,
abnormalities – detected – barium enema, other bowel disease.
- Therapeutically – remove – visible polyps
- Colonoscopic polypectomy – early detection – prevention – colorectal cancer.
- Biopsy forceps or a cytology brush – through – scope – obtain specimens – histology &
cytology examinations.
- Nursing Interventions – polyethylene glycol electrolyte lavage solutions – intestinal
lavages – effective cleansing – bowel.
- Clear liquid diet – ingests – lavage solution – orally – intervals – 3 to 4 hours.
- Monitoring elderly patients – nurse’s knowledge – daily medication – instructs –
maintain adequate fluid, electrolyte & caloric intake
- Cannot be performed – suspected or documented colon perforation, acute severe
diverticulitis, or fulminant colitis.
 - Informed consent – before – patient is sedated
- After – test – signs & symptoms – of bowel perforation.

Sigmoidoscopy

- Endoscopic examination – anus, rectum sigmoid & descending colon – evaluate chronic
diarrhea, fecal incontinence, ischemic colitis, & lower GI hemorrhage – observe –
ulceration, fissures, abscesses, tumour, polyps, or other pathologic processes.
- Flexible fibreoptic sigmoidoscope – colon – examined – up to 40 to 50 cm – from anus –
with rigid sigmoidoscope.
- Biopsies & polypectomies – performed – during procedure.
- Nursing Interventions – limited bowel preparation – warm tap water or Fleet’s enema
- Monitor – vital signs, skin colour, temperature, pain tolerance, vagal response.
- After – procedure – rectal bleeding, intestinal perforation.

Laparoscopy (Peritoneoscopy)

- After – pneumoperitoneum – small incision – lateral – umbilicus – insertion – fibreoptic

laparoscope.
- Direct visualization – organs – structures – within – abdomen, any growths, anomalies,
inflammatory processes.
- Evaluate peritoneal disease, chronic abdominal pain, abdominal masses, gallbladder, &
liver disease.
- General anesthesia – gas – insufflated – peritoneal cavity – create – working space –
visualization

Hepatobiliary System

Ultrasonography

- Rapid and accurate – used – patients – liver dysfunction – jaundice

- Does not expose – ionizing radiation
- Can detect calculi – in gallbladder – or dilated common bile duct

Radionuclide Imaging or Cholescintigraphy

- Diagnosis – acute cholecystitis or blockage – of bile duct

- Radioactive agent – administered intravenously – taken up – hepatocytes – excreted –
through biliary tract
- Cannot detect gallstones.

Cholecystography

- Oral cholangiography – detect gallstones

- Healthy gallbladder – fills – radioplaque substance
- Gallstones – present – appear – shadows – x – ray film.
Endoscopic Retrograde Cholangiopancreatography (ERCP)

- Direct visualization – structures – could be seen – during laparotomy

- Flexible fibre optic endoscope – inserted – through – esophagus – to descending
duodenum
- Require – multiple position changes
- Fluoroscopy & multiple x – rays – used – ERCP – evaluate – presence of ductal stones
- Insertion – catheter – through – endoscope – into common bile duct – important step – in
sphincterotomy – gallstone extraction
- Nursing Implications – patient – explanation – procedure. Moderate sedation –
administer medications – glucagon or anticholinergics – to make – cannulation easier –
decreasing duodenal peristalsis.
- Observes – signs of respiratory & CNS depression, hypotension, oversedation, vomiting.
During ERCP – intravenous (IV) fluids, medications & positions.
- After procedure – observe – vital signs & signs – perforation or infection – side effects –
return of the gag – cough reflexes – after – use – anesthetics.

Percutaneous Transhepatic Cholangiography

- Injection – dye – directly – into biliary tract

- Entire length – common bile duct, cystic duct, gallbladder – outlined clearly
- Carried out – presence – liver dysfunction & jaundice
- Useful: distinguishing jaundice – caused by liver disease from – caused by biliary
obstruction
- Investing – GI symptoms – patient – gall – bladder – removed.
- Locating stones – within – bile ducts
- Diagnosing – cancer – involving – biliary system
- Procedure –moderate sedation – been fasting. Coagulation parameters – platelet count –
normal – minimize bleeding. Broad spectrum antibiotics – administered.
- Flexible needle – inserted – liver – right side – in midclavicular line – beneth – right
costal margin.
- Bile – aspirated – samples – sent – bacteriology & cytology.
- Water – soluble contrast agent – injected – fill – biliary system. Fluoroscopy – table –
tilted – repositioned – allow x – rays – taken – multiple projections.