DIAGNOSTIC STUDIES OF THE

GASTROINTESTINAL SYSTEM

PRESENTED BY
ASWATHY CHANDRAN
PBDSN,CRITICAL CARE NURSING
GOVT.COLLEGE OF NURSING TVM
 Diagnostic studies provide important
information in monitoring the patient’s condition
and planning appropriate interventions. For most
diagnostic studies, nurses should make sure a
signed consent form for the procedure that has
been completed and is in the medical record. It is
the responsibility of the health care provider
doing the procedure to explain the procedure and
obtain the written consent. When preparing the
patient it is important to ask about any known
allergies to drugs or contrast media.
 GENERAL NURSING INTRVENTIONS
Providing general information about a healthy
diet and the nutritional factors that can cause GI
disturbances after a diagnosis has been confirmed,
information about specific nutrients that should be
included in the diet.
Providing information about the test and the
activities required of the patient.
Providing instructions about post procedure care
and activity restrictions.
 Alleviating anxiety
 Helping the patient cope with discomfort.
 Encouraging family members or others to
offer emotional support to the patient
during the diagnostic testing.
 Assessing for adequate hydration before,
during , immediately after the procedure,
and providing education about maintenance
of hydration
 STOOL TESTS
Basic examination of the stool
includes inspecting the specimen for
consistency and color and testing for
occult(not visible) blood. Special
tests, include test for fecal
urobilinogen, fat, nitrogen, parasites,
pathogens, food residues, and other
substances.
Random specimens should be sent
promptly to the laboratory for
analysis. The quantitative 24-72 hr
collections must be kept
refrigerated until they are taken to
the laboratory.
 • FECAL OCCULT BLOOD TESTING
It is the one of the most commonly
performed stool tests. It can be useful
in initial screening for several
disorders. It is most frequently used in
cancer screening programs. The most
widely used occult blood test is the
Hematest. It is inexpensive and non-
invasive.
 BREATH TESTS
•HYDROGEN BREATH TEST
It was developed to evaluate carbonated
absorption. It is used in the diagnosis of
bacterial overgrowth in the intestine. This test
determines the amount of hydrogen expelled in
the breath after it has been produced in the
colon and absorbed into the blood.
 • UREA BREATH TESTS
It can detect the presence of Helicobacter
pylori, the bacteria that can live in the mucosal
lining of the stomach and cause peptic ulcer
disease. The patient takes a capsule of carbon
labeled urea and then provides a breath sample
10 to20 minutes later. Because H. pylorus
metabolizes urea rapidly, the labeled carbon is
absorbed quickly, it can then be measured as
carbon dioxide in the expired breath to
determine whether H. pylori is present.
 NURSES RESPONSIBILITIES
 Avoid antibiotics or loperamide for
1month before the test
 Avoid Sucralfate and omeprazole for
1week before the test.
 Avoid cimetidine, famotidine, rantidine
and nizatidine for 24 hrs before urea
breath test.
 RADIOLOGICAL STUDIES
 ABDOMINAL ULTRASONOGRAPHY
Ultrasonography is a non-invasive
diagnostic technique in which high
frequency sound waves are passed into
internal body structures and images are
recorded .This procedure is generally used to
indicate the size and configuration of
abdominal structures. It is particularly
useful in the detection of cholelithiasis ,
cholecystitis,appendicitis and acute colonic
diverticulitis.
 ENDOSCOPIC ULTRASONOGRAPHY(EUS)

It is a specialised enteroscopic
procedure that aids in the diagnosis of GI
disorders by providing direct imaging of a
target area. A small high frequency
ultrasonic transducer is mounted at the tip
of the fibroptic scope so that a
transintestinal study can be completed.It
helps in staging of a tumor ,including
size,spread, and whether the tumor is
operable. It is useful in evaluating
transmural changes in the bowel wall that
occur in ulcerative collitis.
 NURSES RESPONSIBILITIES
•Keep patient NPO for 8 hrs.
•If gallbladder studies are being performed , the
patients should eat a fat free in the evening before the
test.
•Make sure consent is on chart.
•Give preoperative medications if ordered.
•Explain to patient that local anesthesia may be sprayed
on throat before insertion of scope and that patient will
be sedated during the procedure.
 RADIONUCLIDE IMAGING
It involves intravenous injections of a
radiopharmaceutical imaging agent and the use
of computerized direction camera to gather
images . Although the choice of a
radiopharmaceutical agent depends on the
specific organ or function being studied, the
most commonly used agent is technetium . It is
used to visualize the liver , spleen , bile ducts,
gall bladder etc.
  FIBROSCAN
Fibroscan uses an ultrasound
transducer to determine liver
stiffness . It is noninvasive and
is used in patients with
chronic hepatitis c and
cirrhosis
  UPPER GASTROINTESTINAL STUDY(BARIUM
SWALLOW)

X-rays are used to examine the entire GI tract

after the introduction of a contrast agent . A
radiopaque liquid (barium sulphate) is
commonly used . The patient ingests this
tasteless,orderless,non granular,and
completely insoluble powder in the form of a
thick or thin aqueous suspension for the
purpose of studying the upper GI tract.Used
to diagnose structural abnormalities of
esophagus , stomach , and duodenum.
 Nurses Responsibilities
 Explain the procedure to patient,including
the need to drink contrast medium and
assess various positions on X-ray table.
 Keep patient NPO for 8-12 hr before
procedure.
 Tell patient to avoid smoking after midnight
before study.
 Tell patient that stool may be white up to 72
hrs after tests.
  LOWER GASTROINTESTINAL
STUDY(BARIUM ENEMA)

A barium enema is instilled rectally to

visualized the lower GI tract. The purpose
of a barium enema is to detect the
presence of polyps ,tumors, and other
lesions of the large intestine and to
demonstrate any abnormal anatomy or
malfunction of the bowel.The procedure
usually takes about 15 to 30 mts during
this time X-ray images are taken.
 Nurses Responsibility
Patient preparation include,
 Emptying and cleansing the lower bowel.
 Instruct to take low residue diet for 1-2 days
before test.
 Clear liquid diet and a laxative the evening
before.
 Keep the patient NPO after midnight.
 Give cleansing enema on morning the day of
procedure.
 Contraindication
• Patient has active inflammatory disease of
colon.
• Patient with signs of perforation or
obstruction.
• Active GI bleeding.
COMPUTERIZED TOMOGRAPHY
CT Provides cross sectional images of
abdominal organs and structures . Indications
for abdominal CT scanning are disease of the
liver , spleen , kidney , pancreas and pelvic
organ. It is a valuable tool for detecting and
localizing many inflammatory conditions in the
colon, such as appendicitis ,
diverticulitis ,regional enteritis , and ulcerative
colitis.
 Nurses Responsibility

• NPO for 6 to 8 hrs.

• Explain procedure.
• Determine sensitivity to contrast
media if used.
 MAGNETIC RESONANCE
IMAGING
It is a non –invasive technique
that uses magnetic fields and radio
waves to produce an image of the
area being studied.It is useful in
evaluating abdominal soft tissues as
well as blood
vessels,abcesses,fistula,neoplasms
and other sources of bleeding.
 Nurses Resposibilities
• Explain procedure .
• NPO for 6-8 hrs before procedure.
• Remove all jeweleray and other metals.
• Contraindicated in patient with metal
implant (eg:Pacemaker) or one who is
pregnant.
 PERCUTANEOUS TRANSHEPATIC
CHOLANGIOGRAPHY
PTC is a radiological technique
used to visualize the anatomy of the biliary
tract. A contrast medium is injected into bile
duct in the liver,after which x-rays are taken.
Complication
 Bile leakage
 Biliary peritonitis
 Bleeding
 ENDOSCOPIC PROCEDURES
ESOPHAGOGASTRODUODENOSCOPY
Directly visualizes mucosal lining of
esophagus , stomach, and duodenum
with flexible endoscope . Test may use
video imaging to visualize stomach
motility , inflammation , ulcerations ,
tumors may be detected .Biopsy may
taken.
 Nurses Responsibilities
• Before
 Obtain signed consent
 Give preoperative medication if orderd.
 Keep NPO for 8 hrs
 Expalin to patient that local anesthesia may
be sprayed on the throat before insertion of
scope and that patientn will be sedated
during the procedure.
• After
Keep patient NPO until gag reflex
returns.
Use warm saline gargles for relief of
sore throat.
Check temperature every 15-30 mts
for1-2 hrs.
 COLONOSCOPY

lt is used to directly visualized the entire

colon up to ileocecal valve with flexible
fiberoptic scope . Patient’s position is changed
frequently during procedure to assist with
advancement of scope to cecum . It is used to
diagnose inflammatory bowel disease, detect
tumors , diagnose diverticulosis, and dilate
strictures. It also allows for biopsy and removal
of polyps without laparotomy.
 Nurses Responsibilities
BEFORE
•Informed consent.
• Bowel preparation to be done
•Patient may kept on clear liquid 1-2 days before
procedure.
•Enema may be given the night before.
•Explain to patient sedation will be given.
•Explain to patient that flexible scope will be
inserted while patient is inside-lying position.
 SIGMOIDOSCOPY

It helps to directly visualize

rectum and sigmoid colon with lighted
flexible endoscope. Sometimes special
table is used to tilt patient into knee-
chest position. Test may detect
tumors , polyps , inflammatory and
infectious diseases , fissures , and
hemorrhoids.
 Nurses Responsibilities
•Take deep breath during insertion of scope .
•Encourage patient to relax and let abdomen go
limp.
•Patients may have clear liquids day before or
no dietary restrictions may be necessary.
•Observe for rectal bleeding after
polypectomy/biopsy.
•Explain to assume knee-chest position.
•Administer enemas evening before and
morning of procedure.
ANOSCOPY AND PROCTOSCOPY

The anoscope is a rigid

scope that is used to examine
the anus and lower rectum.
Proctoscope is a rigid scope
that is used to inspect the
rectum and the sigmoid colon.
 ENDOSCOPIC ULTRASOUND
Combined use of endoscopy
and ultrasound using an ultrasound
transducer attached to an
endoscope . It enables visualization
of the esophagus, stomach ,
intestine,liver,pancreas,and
gallstones.
 LAPROSCOPY(PERITONEOSCOPY)

Peritoneal cavity and contents are

visualized with help of a laproscope. Biopsy
specimen may also be taken. It is usually
done under general anesthesia in operating
room. Double-puncuture peritoneoscopy
permits better visualization of abdominal
cavity especially liver.
 Nurses Responsibilities
• Informed consent.
• NPO for before 8 hrs.
• Administer preoperative sedative medication.
• Ensure that bladder and bowel are emptied.
• Instruct patient that local anesthetic is used
before scope insertion.
• Observe for possible complications of bleeding
and bowel perforation after the procedure.
 VIRTUAL COLONOSCOPY
Virtual colonoscopy combines
computed tomography (CT) scanning or
magnentic resonance imaging with computer
software to produce images of the colon and
the rectum.The test is less invasive than a
conventional colonoscopy but does require
radiation and prior cleansing of the colon.
 CAPSULE ENDOSCOPY
It is a noninvasive approach to
visualize the GI tract. Its sensitivity
in detecting the source of GI
bleeding, small lesions, esophageal
varices, colonic polyps, and
colorectal cancer is under
investigation.
 ENDOSCOPIC RETROGRADE
CHOLANGIOPANCREATOGRAPHY(ERCP)

Fibroptic endoscope is orally

inserted in to descending
duodenum, then common bile and
pancreatic ducts are cannulated.
Contrast medium is injected in to
ducts and allows for direct
visualization of structures.
 Nurses Responsibilities
 Before
 Expalin procedure to the patient.
 Keep NPO before 8 hr.
 Obtain informed consent.
 Administer sedation before and during
procedure.
 After
 Check vitals
 Check signs of infection.
 Check for retrun of gag reflex.
 VIDEO CAPSULE ENDOSCOPY
Patient swallow a capsule with
camera which provides endoscopic
visualization of GI tract. Most commonly
used to visualize small intestine ,
diagnose disease such s Crohn’s
disease , small bowel tumor , celiac
disease , malabsorption syndrome.
 GASTRIC ANALYSIS

The test is used to analyze gastric

contents for acidity and volume. A
NG tube is inserted , and gastric
contents are aspirated. Contents are
then analyzed mainly for HCL acid ,
but pepsin , and electrolytes may also
be determined.
 Nurses Responsibilities
• Keep patient NPO for 8-12 hr.
• Explain procedure.
• Withhold drugs affecting gastric
secretions 24-48 before test.
• Ensure no smoking on the morning
of test.
 BLOOD STUDIES
• Amylase
Measures secretion of amylase
by pancreas.It is important in
diagnosing acute pancreatitis.
Level of amylase peaks in 24 hr and
then drops to normal in 48-72 hr.
• Lipase
Measures secretion of lipase
by pancreas . Level stays
elevated longer than serum
amylase in acute pancreatitis.
References Interval : 31-186U/L
 • Gastrin
It is a hormone secreted
by cells of the stomach, the
duodenum and the pancreatic
islets of langerhans.
Referance Interval : 25-100 pg/ml