Diagnostic Studies

To complete the assessment of a critically ill patient with GI dysfunction, the patient’s
diagnostic tests are reviewed. Although many procedures exist for diagnosing GI
disease, their application in a critically ill patient is limited. Only procedures that are
currently used in the critical care setting are presented here. The nursing management
of a patient undergoing a diagnostic procedure involves a variety of interventions.
Nursing actions include preparing the patient psychologically and physically for the
procedure, monitoring the patient’s responses to the procedure, and assessing the
patient after the procedure. Preparing the patient includes teaching the patient about the
procedure, answering any questions, and transporting and positioning the patient for the
procedure. Monitoring the patient’s responses to the procedure includes observing the
patient for signs of pain, anxiety, or hemorrhage and monitoring vital signs. Assessing
the patient after the procedure includes observing for complications of the procedure
and medicating the patient for any post-procedural discomfort. Any evidence of GI
bleeding should be immediately reported to the physician, and emergency measures to
maintain circulation must be initiated. Table 1 summarizes diagnostic studies used for
evaluating the gastrointestinal tract

Table 1.

Test and Purpose Method of Testing Nursing Implications

NON-INVASIVE

Abdominal film
 Used to evaluate organ  X-rays visualize a  No special

size, position, single flat plane. preparation

intactness, and gas needed

patterns in the stomach,

small intestine, and
colon.

Upper gastrointestinal (GI)

series (barium swallow)
 Used to visualize the  Fluoroscopy is used  The patient must
esophagus, stomach, to evaluate the be NPO for 6
and duodenum; aids in movement of hours prior to
diagnosis of hiatal barium through the study
hernia, ulcers, tumors, upper
foreign bodies, bowel gastrointestinal
obstruction tract; double-
contrast study
administers barium
first followed by a
radiolucent
substance (eg, air)
to help coat
mucosa for better
visualization of any
type of lesion.

Upper GI series with small

bowel follow-through
 The patient must
 Used to visualize the
 Fluoroscopy is used be NPO for 6
jejunum, ileum, and
to evaluate the hours prior to
cecum; aids in the
movement of study
diagnosis of tumors,
barium through the
Crohn’s disease,
small bowel.
Meckel’s diverticulum.

Barium enema  Bowel cleansing is

 Used to visualize the necessary prior to
 Barium is
colon; aids in diagnosis the procedure
administered via
of polyps, tumors,
enema to make the
fistulas, obstruction,
colon visible on x-
 diverticula, and stenosis ray.

Ultrasonography
 Aids in diagnosis of  High-frequency  The patient must

masses, dilated bile sound waves are be NPO for 6

ducts, gallstones, and passed over an hours prior to

ascites abdominal organ to study

obtain an image of
the structure

Hepatobiliary scan
 Used to visualize the  Images are  The patient must

biliary system, obtained as an be NPO for 6

gallbladder, and intravenously hours prior to

duodenum (size, injected study

function, vascularity, radioisotope is

and blood flow) taken up by the
liver and then
secreted into the
bile
Tagged red blood cell scan
(technetium-labeled red blood
cell scintigraphy)
 No special
 Aids in the diagnosis of  Red blood cells are
preparation
GI bleeding labeled with
needed
technetium and
injected
intravenously;
images are
obtained with a
gamma camera that
can identify areas
 of increased
radioactivity as a
site of slow or
intermittent GI
hemorrhage

Computed tomography (CT)

 Used to visualize the  No special
 Narrow x-ray
abdomen, preparation
beams produce
retroperitoneal required
cross-sectional
structures, tumors,
images of organs
cysts, fluid collections,
and tissues; can be
air in a cavity, bleeding
performed with or
without contrast
media

Magnetic resonance imaging

(MRI)
 The patient must
 Used for evaluating
 A magnetic field is be able to lie flat,
abdominal soft tissue
used to obtain hold his breath for
and blood vessels,
images periods of time,
abscesses, fistulas,
and tolerate
tumors, and sources of
confinement in the
bleeding
scanner
 Metal in the body
is a

Magnetic resonance contraindication

cholangiopancreatography
(MRCP)
 The patient must
  Aids in the diagnosis of  A magnetic field is be able to lie flat,
disorders affecting the used to obtain hold his breath for
pancreatic ducts and images periods of time,
biliary tree and tolerate
confinement in the
scanner
 Metal in the body
is a
contraindication

Positron emission tomography

(PET)
 No special
 Useful for precisely  Radioactive
preparation
locating a tumor substances are
needed
used to examine
the metabolic
activity of body
structures

INVASIVE

Esophagogastroduodenoscop
y (EGD)  The patient must
 Used to evaluate the  An endoscope is
be NPO for 6
upper GI tract passed through the
hours prior to
mouth and
study
advanced to
visualize the
esophagus,
stomach, and
duodenum

Colonoscopy  Bowel cleansing is

 Used to evaluate the  A flexible fiber-optic necessary prior to

 large intestine endoscope is the procedure
passed through the
rectum and
advanced to
visualize the large
intestine

Endoscopic retrograde
cholangiopancreatography
(ERCP)  The patient must

 Used to visualize the be NPO 6 hours

 A flexible fiber-optic
common bile duct, prior to procedure
endoscope is
hepatic bile ducts, and inserted into the
pancreatic ducts esophagus, passed
through the
stomach, and into
the duodenum; the
common bile duct
and the pancreatic
duct are cannulated
and contrast
medium is injected
into the ducts to
permit visualization
and radiographic
evaluation
 The patient must
Endoscopic ultrasonography
be NPO for 6
 Used to evaluate and
hours prior to
stage tumors of the GI  An ultrasonic
study
tract transducer built into
the distal end of the
endoscope allows
 for high quality
images of the walls
of the GI tract  The patient must
Enteroclysis be NPO for 6
 Used to visualize entire  A duodenal tube is hours prior to
small intestine; aids in used to study
diagnosis of partial continuously infuse
bowel obstruction or air in a barium
diverticula sulfate suspension
along with
methylcellulose to
fill the intestinal
loops; transit of
contrast filmed at
intervals to evaluate
progress through
the jejunum and  No special
ileum preparation
Gastric lavage needed
 Aids in diagnosis of
 A large gastric tube
upper GI bleeding, also
is used to aspirate
used to arrest
or wash out
hemorrhage and
stomach contents  No special
prepare for further tests
preparation

Paracentesis needed

 Used to obtain samples

 A long, thin needle
of peritoneal fluid for
is inserted into the
laboratory or cytologic
abdomen
studies, and as a
comfort measure (to
 No special
 alleviate accumulations preparation
of ascetic fluid) needed
Peritoneal lavage
 Used to evaluate blunt  The peritoneal

or penetrating trauma to cavity is irrigated,

the abdomen and then the

irrigating fluid is  The patient must
examined for blood be NPO for 6
hours prior to
Biopsy study
 Aids in diagnosis of
malignancy

 A needle is placed
 Percutaneous
through the skin to
obtain tissue
specimen for
pathology
evaluation
 Fine-needle aspiration  A thin needle is
(FNA) used to obtain cells
or minute tissue
fragments from a
suspect area for
examination by light
microscopy; usually
guided by
fluoroscopy,
ultrasound, CT, or
 The patient must
MRI
be NPO 6 hours
 prior to study
Percutaneous transhepatic
cholangiography (PTC)
 Helps to distinguish
obstructive jaundice  The intrahepatic

caused by liver disease and extrahepatic

from jaundice caused biliary ducts are

by biliary obstruction; examined

during procedure, a fluoroscopically;

percutaneous following
 The patient must
transhepatic biliary percutaneous
be NPO 6 hours
drain may be placed to needle injection of
prior to study.
relieve obstruction contrast medium
into the biliary tree

Angiography
 Used to visualize
 Radiographic
defects in the walls of
contrast is injected
arteries or veins and to
into the vessel
evaluate blood flow
under fluoroscopic
through the vessels
guidance and x-ray
images are
obtained

References:

Perrin, K., & MacLeod, C. E. (2017). Understanding the essentials of critical care
nursing (3rd ed.). Pearson.

Urden, L. D., Stacy, K. M., & Lough, M. E. (2021). Critical care nursing - E-book:
Diagnosis and management (9th ed.). Elsevier Health Sciences.
Gastrointestinal bleeding - Diagnosis and treatment - Mayo Clinic. (2020, October 15).
Mayo Clinic - Mayo Clinic. Retrieved September 23, 2022 from
https://www.mayoclinic.org/diseases-conditions/gastrointestinal-bleeding/diagnosis-
treatment/drc-20372732

Gastrointestinal (GI) bleeding: Symptoms, diagnosis, treatment. (2019, June 2).

Cleveland Clinic. Retrieved September 23, 2022 from
https://my.clevelandclinic.org/health/diseases/23391-gastrointestinal-gi-bleeding

GI bleed | Gastrointestinal bleeding: MedlinePlus. (2020, March 15). MedlinePlus -

Health Information from the National Library of Medicine. Retrieved September 23, 2022
from https://medlineplus.gov/gastrointestinalbleeding.html

ASSESSMENT FINDINGS OF COMMON GASTROINTESTINAL DISORDERS

Condition History Physical Findings Diagnostic Studies

Appendicitis  Patient  Patient lying  CBC with differential,
reports still; ultrasonography, CT,
sudden involuntary laparoscopy
onset of guarding;
 colicky tenderness
pain that in RLQ;
progresses other tests
to constant for
pain; pain peritoneal
can begin irritation
in positive;
epigastriu rebound
m or tenderness;
periumbilic variation in
al area presentation
and then common,
later particularly
localizes in with infants,
RLQ; pain children,
worsens and older
with adults.
movement
or
coughing;
vomiting
after onset
of pain is
sometimes
present.
Peptic ulcer
perforation  Diagnosis confirmed
 Patient lying
 Sudden by upright or lateral
still;
onset of decubitus radiograph
epigastric
severe showing air under
tenderness;
intense, diaphragm or in
rebound
 steady tenderness; peritoneal cavity;
epigastric abdominal perforation is
pain that muscles surgical emergency
radiates to rigid; bowel
sides, sounds can
back, or be absent.
right
shoulder;
history of
burning,
gnawing
pain that
worsens
with empty
Peritonitis stomach.  Guarding;  CBC with differential,

rebound abdominal

 Occurs tenderness; radiographs

more often bowel

in older sounds
adults; decreased
sudden or absent.
onset of
severe
pain that is
diffuse and
worsens
with

Acute movement
or  CBC with differential,
pancreatitis
coughing. serum amylase and
lipase levels,
 triglyceride level,
 Patient calcium level, and
 History of
appears liver chemistries;
cholelithias
acutely ill; ultrasonography; CT
is or
abdominal
excessive
distention,
alcohol
decreased
use;
bowel
pain is
sounds,
steady and
diffuse
boring in
rebound
quality and
tenderness;
is
upper
unrelieved
abdomen
by change
can show
of position;
muscle
located in
rigidity; can
LUQ and
have limited
radiates to
diaphragmat
back;
Cholecystitis/ ic excursion
nausea,
 CBC with differential,
Cholelithiasis of lungs.
vomiting,
ultrasonography,
and
radiographs, serum
diaphoresi
amylase, and lipase
s.
levels
 Tender to
 Appears in
palpation or
females
percussion
more than
in RUQ;
males;
gallbladder
colicky
palpable in
pain with
 progressio about half
n to cases of
constant cholecystitis;
pain; pain positive
in RUQ Murphy
that can sign.
radiate to
right
scapular
area; pain
of
cholelithias
is is
constant,
progressiv
ely rising
to plateau
and falling
gradually;
nausea,
vomiting,
history of
dark urine
Obstruction and/or light  Diagnosis confirmed
stools; with CT, abdominal
may be radiographs
aggravate
d by
certain
foods.  Hyperactive,
high-pitched
  Sudden bowel
onset of sounds;
crampy fecal mass
pain, can be
usually in palpated;
umbilical abdominal
area of distention;
epigastriu empty
m; rectum on
vomiting digital
occurs examination.
early with
small
intestinal
Ileus
obstruction
 Gaseous distention
and late
of isolated segments
with large
of both small and
bowel
large intestines
obstruction
shown on
;
radiographs
obstipation
or
Incarcerated diarrhea.
 MRI, CT, ultrasound
hernia  Minimal or
absent
 Abdominal
peristalsis
distention,
on
vomiting,
auscultation.
obstipation
, and
cramps.
  More  Hernia or
common in mass that is
older non-
adults; reducible.
constant
severe
Irritable bowel
pain in
syndrome (IBS)
RLQ or
LLQ that  Proctosigmoidoscop
worsens y, colonoscopy if
with onset at middle
coughing age/older, stool
or positive for blood,
straining. family history of
colorectal cancer or
 Normal polyps, failure to
 Begins in examination; improve after 6-8
adolescen heme- weeks of therapy
ce or as negative
young stool.
adult;
hypogastri
c pain;
crampy,
variable
infrequent
duration;
associated
Crohn disease with bowel
function;
 associated
with gas,
bloating,
distention;
Diverticular
relief with
disease
passage of
flatus,
 CT, contrast enema,
feces
 Abdominal cystography,
tenderness; ultrasound,
weight loss. colonoscopy
 Abdominal
sometimes useful
Simple pain with
but not used during
constipation chronic
acute attack
bloody  Abdominal
diarrhea tenderness;
fever.
 .Localized
pain,
usually
LLQ; older
Esophagitis/ patient.
GERD  Fecal mass
palpable,  Endoscopy if
stool in symptoms are
 Colicky or
rectum. severe or do not
dull and
respond to therapy;
steady
manometry, pH
pain that
monitoring
does not
progress
and  Physical
examination
 worsen. negative; in
infants:
 Burning, weight loss,
gnawing in some
pain in cases
midepigast aspiration
rium that pneumonia.
worsens
with
recumbenc
y; water
brash; pain
occurs
after
Peptic ulcer eating and
can be
 H. pylori testing;
relieved
endoscopy if no
with
response to therapy
antacids;
in infant:
failure to
thrive,
irritability,
postprandi
 Can be
al spitting
epigastric
and
tenderness
vomiting.
on
palpation.
 Burning or
gnawing
pain;
 soreness,
empty
feeling, or
hunger;
occurs
most often
with empty
stomach,
stress, and
alcohol,
and
relieved by
Gastritis food
intake;
pain
 No diagnostic testing
steady,
necessary if patient
mild, or
responds to therapy
severe and
located in
epigastriu
m; can be
atypical in
children
and  Physical
minimal in examination
older negative.
adults.

 Constant
burning
Gastroenteritis pain in
epigastric
area that
can be  No diagnostic testing

accompani needed

ed by
nausea,
vomiting,
diarrhea,
or fever;
alcohol,
NSAIDs,  Hyperactive
and bowel
salicylates sounds will
make pain be heard on
worse. auscultation;
dehydration
if severe.
 Occurs at
any age
and
produces
diffuse
crampy
pain
accompani
ed by
nausea,
vomiting,
diarrhea,
and fever;
 can have
history of
recent
travel,
family
members
ill.

References:

Dains JE, Baumann LC, Scheidel P. Advanced health assessment & clinical diagnosis
in primary care. 6th ed. St. Louis: Elsevier; 2020.

Perrin, K., & MacLeod, C. E. (2017). Understanding the essentials of critical care
nursing (3rd ed.). Pearson.

Urden, L. D., Stacy, K. M., & Lough, M. E. (2021). Critical care nursing - E-book:
Diagnosis and management (9th ed.). Elsevier Health Sciences.

Gastrointestinal (GI) bleeding: Symptoms, diagnosis, treatment. (2019, June 2).

Cleveland Clinic. Retrieved September 23, 2022 from
https://my.clevelandclinic.org/health/diseases/23391-gastrointestinal-gi-bleeding