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Diagnostic Procedures of the Gastrointestinal System | NCLEX Review


Welcome to this video tutorial on diagnostic
procedures of the gastrointestinal system. Numerous tests may be used in the evaluation
of the GI system. We’re going to take a look at lab tests, imaging
tests, and endoscopic procedures. A blood test to evaluate stomach problems
is the gastrin test. This test measures gastric acid secretion
or Helicobacter pylori, which is an infection found in peptic ulcer disease. Blood tests for amylase, lipase, and calcium
evaluate the pancreas function. Total bilirubin and alkaline phosphatase evaluate
the biliary system. The function of the intestine can be evaluated
with total protein, D-Xylose absorption test, and lactose intolerance test. Urine tests to evaluate GI function include
urine bilirubin, urobilinogen, and urine amylase. Stool can be collected and examined for occult
(hidden) blood, bacteria, fat content, and ova & parasites. The stool culture checks for abnormal bacteria
in the digestive tract that may cause diarrhea or other problems. The fecal occult blood test checks for occult
blood in the stool that is useful in identifying bleeding in the GI tract. A guaiac smear test is used, which involves
placing a small amount of stool on a card of guaiac paper and applying hydrogen peroxide,
which turns the paper blue if it is positive for blood. There are several imaging tests that can be
done to evaluate the GI system. The GI tract may be visualized by doing a
barium swallow or barium enema. Barium is a radiopaque substance that outlines
the passageways of the GI tract for viewing by x-ray or fluoroscopy. The barium swallow is also called an upper
GI series, as it examines the upper part of the digestive system the esophagus, stomach,
and duodenum. It allows for examination of the structure,
position, peristaltic activity, and motility of the organs. It helps to detect ulcers, hiatal hernias,
tumors, abnormal anatomy, malposition, or inflammation. The upper GI series involves swallowing barium
(the contrast medium), in a milkshake form; however, it tastes unpleasant and may cause
vomiting. The test takes about 45 minutes, in which
x-rays are taken at various intervals. The nurse needs to ensure the patient is NPO
for at least 6 hours before the test. Then, following the test, the patient is given
a laxative to quicken the elimination of the barium. A lower GI series, or barium enema, is done
to examine the rectum, large intestine, and the lower part of the small intestine. It is used to detect colon polyps, tumors,
and chronic inflammatory bowel disease. Prior to the procedure, the patient must cleanse
the bowel with laxatives and/or enemas. They may also need to follow a liquid diet
for 24 hours before the test, and then remain NPO for 8 hours prior to the test. The procedure requires about 30 minutes, while
the patient is placed in various positions as a radiologist observes the barium flowing
through the colon on a monitor. Following the test, laxatives are given to
expedite the removal of the barium. Ultrasonography is another diagnostic imaging
technique in which high-frequency sound waves are transmitted into the abdomen, creating
echoes that vary with tissue density. The transducer wand placed on the skin sends
sound waves into the body that bounce off organs and are electronically converted into
computer images. Ultrasounds reveal organ size, shape, and
position and can assist in diagnosing cysts, tumors, and stones. The patient should remain NPO for 8 to 12
hours prior to the test, since gas in the bowel may interfere with results. It is often the preferred procedure, especially
for diagnosing gallbladder disease, since it does not expose the patient to radiation
and it is painless and safe. Computed Tomography (CT) is an imaging test
that uses multiple x-rays to make detailed images of the body. A computer then reconstructs the data into
two-dimensional images to show details of bones, muscles, fat, and organs. The CT scan can be used to assess patients
with gallbladder, biliary ductal system, or pancreatic problems. CT angiography combines a CT scan with the
injection of contrast media to emphasize differences in tissue density in the pancreas and better
visualize the biliary tract. The patient should be assessed for allergies
to iodine, seafood, or contrast medium and remain NPO for 8 to 12 hours before the test. There are no specific aftercare instructions. Magnetic resonance imaging (MRI) is a diagnostic
test that uses strong magnetic fields, radio frequencies, and a computer to generate detailed
images of organs, soft tissues, bone, and all other structures within the body. The test is painless and does not involve
x-rays; however, due to the requirement to lie still in the tunnel-like machine, patients
that are claustrophobic or unable to hold still may need a sedative to help them relax. It is important that all metal objects, such
as jewelry and wheelchairs be removed from the MRI room. Patients with pacemakers, metal clips, or
rods in the body cannot have an MRI done. In GI nuclear scanning, a small amount of
radioactive material is introduced into the body and a special camera is used to detect
the radioactivity, producing images of the GI tract that can’t be seen as well with standard
x-rays. There are five types of GI nuclear scans. The radioactive material is injected into
a vein for the GI bleeding scan, liver-spleen scan, and gallbladder nuclear scan. Radioactive material is ingested orally for
the gastroesophageal reflux scan and gastric emptying scan. These tests are valuable for detecting gallbladder
disease, tumors, GI bleeding, liver function and abnormalities, and other digestive disorders. Cholangiography involves the x-ray examination
of the bile ducts using a contrast medium to locate and identify stones, strictures,
or tumors. The radiopaque dye may be administered by
IV or injected directly into the common bile duct. The patient remains NPO for 8 hours before
the test, and typically rests in bed about 6 hours after the test. Endoscopy procedures allow for direct visualization
of portions of the GI tract by using a long, flexible, fiberoptic scope. Endoscopy means looking inside, in which an
endoscope is inserted directly into the organ and images from the camera tip are seen on
a video screen. It may be used for inspection, biopsy, removal
of polyps and stones, and to control GI bleeding with laser, photocoagulation, or sclerosing
agents. Most endoscopic procedures are performed on
an outpatient basis. An upper GI endoscopy may look at just the
esophagus (an esophagoscopy), the stomach (gastroscopy), or the duodenum (duodenoscopy). If it involves the entire region, it is called
an esophago-gastro-duodenoscopy (more easily referred to as an EGD). This test is useful for identifying the source
of upper GI bleeding and for determining whether there is a gastric malignancy or benign ulcer. It can also differentiate between gastric
ulcers and duodenal ulcers. An EGD can visualize esophageal strictures,
varices, tumors, hiatal hernias, and achalasia, as well as surgically remove gastric polyps. To prepare for an EGD, the nurse instructs
the patient to remain NPO for 8 hours prior to the test. The test usually lasts 15-30 minutes and involves
introducing air into the stomach to improve visibility, causing the patient to feel pressure
or fullness. Following the procedure, the nurse monitors
the patient’s vital signs every 30 minutes for 3 to 4 hours, while also monitoring for
signs of pain, bleeding, dyspnea (difficulty breathing), or acute dysphagia (difficulty
swallowing). Another test involving the oral insertion
of an endoscope is the endoscopic retrograde cholangio-pancreatography (ERCP). This test is used to identify stones, tumors,
or narrowing in the biliary and pancreatic ducts. Once the endoscope is properly placed, contrast
agent can be injected through the ducts, which is visible on x-rays. If needed, a biopsy can be taken, a gallstone
can be removed, or a stent can be placed in a narrowed bile duct. An ERCP is an outpatient procedure that usually
takes about 30 to 60 minutes, then the patient goes to recovery for 1 to 2 hours. The risks of ERCP include pancreatitis, intestinal
perforation, and bleeding. Another technique used to look at the gallbladder,
biliary ducts and pancreatic duct, is the magnetic resonance cholangio-pancreatography
(MRCP). However, it is a non-invasive procedure that
uses magnetic resonance imaging to see if gallstones are lodged in any ducts surrounding
the gallbladder. A colonoscopy is an endoscopic procedure that
allows for the examination of the entire colon. It is used to help identify malignant growths,
take biopsy specimens, remove polyps, and locate bleeding. Preparation for the test involves a 1-day
thorough bowel cleansing with an oral osmotic solution, in which 8 ounces are taken every
15 minutes to induce profuse diarrhea that lasts about 4 hours. Patients are sedated before the colonoscopy. As the colonoscope is inserted through the
rectum up into the colon, air is introduced to allow for better visualization. The procedure lasts 20 to 60 minutes and the
nurse should monitor the patient for full recovery from the sedation. Any changes in vital signs or the development
of fever, rectal bleeding, or severe abdominal pain should be reported to the physician immediately. A sigmoidoscopy is similar to a colonoscopy,
but it only allows for the visualization of the anus, rectum, and distal sigmoid colon. It is helpful in identifying the causes of
abdominal pain, constipation, diarrhea, bleeding, and abnormal growths. The cost is considerably less than a colonoscopy,
but sedation is not usually used and it is uncomfortable for the patient. Most doctors recommend a colonoscopy as the
best test for colon cancer screening. It should be done every 10 years, starting
at the age of 50. A lot of the digestive tract can be seen using
upper endoscopy or colonoscopy, but it is harder to see the small intestine. Capsule endoscopy is one way to visualize
the small intestine, in which the patient swallows a capsule containing a light source
and tiny camera. The capsule travels through the stomach and
small intestines, which usually takes about 8 hours, taking thousands of pictures as it
travels. The pictures are sent to a device worn around
the patient’s waist, and can then be downloaded to a computer for the doctor to view as a
video. The capsule passes out of the body during
a normal bowel movement. This method can be used to find the source
of pain, bleeding, or other symptoms in the small intestine; however, it is not useful
for looking closely at the colon and it is expensive. Virtual colonoscopy is a fairly new procedure
that is really not an endoscopy procedure, but an imaging test. It uses a CT scan to create a 3-D picture
that looks at the inside surfaces of the colon. The images can even be used to create a moving
‘fly-through’ view on the screen, much like an actual colonoscopy. The advantage to this type of test is that
no drugs are needed and it is totally noninvasive. It shows good detail; however, it doesn’t
show the fine surface detail seen in a standard colonoscopy. If something abnormal is found, the patient
may still need a standard colonoscopy to get better pictures, take biopsy samples, or remove
growths. There are several other diagnostic tests that
may be used to evaluate abnormal function of the esophagus. While endoscopy can look at the lining of
the esophagus, it does not usually provide information about the cause of the problem. Three major symptoms to evaluate include difficulty
swallowing (dysphagia), heartburn, and chest pain. There are three basic tests used to assess
esophageal function manometry, esophageal pH monitoring, and x-ray studies. We discussed x-ray studies earlier, with the
barium swallow and radionuclide scanning. Manometry is a test that measures the pressure
changes in the lower esophageal sphincter and records the sequence and duration of peristaltic
movements within the esophagus, with the patient at rest and during swallowing. The patient swallows a small tube that senses
changes in pressures in the esophagus. This test is useful for investigating dysphagia
and identifying diseases that produce disturbances of motility or contractions of the esophagus. To evaluate recurrent heartburn or GERD, esophageal
pH monitoring tests for the esophagus’ exposure to acid reflux from the stomach over a 24-hour
period. A thin tube with a pH monitor is swallowed
and stays in the esophagus to record changes in acidity, while the patient also documents
their symptoms during specific activities. In conjunction with manometry and pH monitoring,
the doctor may also perform an acid clearing test and a Bernstein test (acid perfusion
test). In the acid clearing test, hydrochloric acid
is directed into the esophagus and if the patient has to swallow more than 10 times
to move the acid down, there is a problem with esophageal motility. In the Bernstein test, a small amount of hydrochloric
acid is also directed into the esophagus, and if the patient feels pain from the acid,
the test is positive for reflux esophagitis. No pain means another explanation must be
sought for the patient’s heartburn symptoms. Gastric function tests, such as gastric analysis,
examine the gastric acid in the stomach when fasting and when stimulated. Abnormal secretion of acid may be related
to a gastric disease, such as ulcers, pernicious anemia, malignancy, or Zollinger-Ellison syndrome. This concludes our tutorial on GI diagnostic
procedures. I hope this overview of lab tests, imaging,
and endoscopic procedures will help you in your study for the NCLEX! Be sure to check out our other videos.

6 thoughts on “Diagnostic Procedures of the Gastrointestinal System | NCLEX Review

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