gastrointestinal assessment&diagnosis

1. assessment

1) how to measure abdominal girth: With the client supine, bring the tape measure around the client and take a measurement at the level of the umbilicus. Before removing the tape, mark the client’s abdomen along the sides of tape on the client’s flanks (sides) and midline to ensure that later measurements are taken at the same place

2) assessment

  • empty bladder
  • supine with knees slight flexed
  • inspection → auscultation → percussion → palpitation
  • RLQ → RUQ → LUQ → LLQ

3) Increased gastric motility interferes with the absorption of oral drugs.

 

2. diagnosis

1) liver study

  •  Liver enzyme levels (transaminase studies) are elevated with liver damage.
  •  Alkaline phosphatase is released with liver damage or biliary obstruction.
  •  The serum ammonia level assesses the ability of the liver to determine protein by-products.
  • An increase in bilirubin level indicates liver damage or biliary obstruction.
  • Prothrombin time is prolonged with liver damage.

2) pancreas study

  • Increased values for amylase and lipase levels indicate pancreatitis.
  • An increase in cholesterol level indicates pancreatitis or biliary obstruction.

3) urea breath test

  • The urea breath test detects the presence of Helicobacter pylori. H. Pylori can also be detected by assessing serum antibody levels.
  • The client consumes a capsule of carbon-labeled urea and provides a breath sample 10 to 20 minutes later.

4) gastric analysis

  • Gastric analysis requires the passage of a nasogastric tube into the stomach to aspirate gastric contents for the analysis of acidity (pH), appearance, and volume.
  • The entire gastric contents are aspirated, and then specimens are collected every 15 minutes for 1 hour.

5) ★ stool specimens

  • Testing of stool specimens includes inspecting the specimen for consistency and color and testing for occult blood. Tests for fecal urobilinogen, fat, nitrogen, parasites, pathogens, food substances, and other substances may be performed. Cf.) occult blood: screen for colorectal ca., 50세 이후 매년
  • Random specimens are sent promptly to the laboratory. Quantitative 24 to 72 hours collections must be kept refrigerated until they are taken to the laboratory.
  • 소변이 섞이지 않도록. 변에서 dip하는 것이 가장 정확. menstruation 후 3일 지나서.
  • 3일 전부터 영향을 주는 음식 중지 : red meat & iron (false positive), vitamin C & raw turnip & radish & broccoli & horseradish (false negative), aspirin, NSAID, laxative

6) abdomen CT

  • NPO 4 ∼ 6 hr. Check allergy to the iodine dye.
  • Lie still. May hold breath short period. It takes 30 ∼ 60 minutes.

7) upper GI tract study (barium swallow)

  • Examination of the upper gastrointestinal tract under fluoroscopy after the client drinks barium sulfate. (x-ray 나 CT보다 뒤에 시행해야 함.  Iodine 계열은 아니지만 조영제 사용.)
  • NPO after midnight the day of the test.
  • 30분 정도 소요. Change position as direction.
  • Monitor stool for the passage of barium because barium can cause a bowel obstruction. Stools will appear chalky white. Instruct the client to increase oral fluid intake to help pass the barium. A laxative may be prescribed.

8) ★ upper GI endoscopy (EGD, EsophagoGastroDuodenoscopy)

  • Following sedation, an endoscope is passed down the esophagus to view the gastric wall, sphincters, and duodenum. Tissue specimens can be obtained.
  • Obtain informed consent. The client must be NPO for 6 to 12 hours before the test. Bowel preparation is not needed. Establish intravenous access. A local anesthetic (spray or gargle) is administered along with medication that provides conscious sedation and relieves anxiety, such as IV midazolam, just before the scope is inserted. Medication may be administered to reduce secretions, and medication may be administered to relax smooth muscle.  Obtain vital signs. Airway patency is monitored during the test and pulse oximetry is used to monitor oxygen saturation. Emergency equipment should be readily available. The client is positioned on the left side to facilitate saliva drainage and to provide easy access to the endoscope.
  • Maintain bed rest for the sedated client until alert. Monitor for signs of perforation (pain, bleeding, unusual difficulty in swallowing, elevated temperature). (단, bloating은 expected symptom) The client must be NPO until the gag reflex returns (1 to 2 hours). Lozenges, saline gargles, or oral analgesics can relieve a minor sore throat, which is an expected sign, not given to the client until the gag reflex returns. 전신마취 후 EGD 했으면 24hr 이내에 운전하지 않도록.
  • the complication of EGD: aspiration,  bleeding, perforation

9) ★ fiberoptic colonoscopy             

  • Colonoscopy is a fiberoptic endoscopy study in which the lining of the large intestine is visually examined. Biopsies and polypectomies can be performed.
  • Obtain informed consent. The client is NPO after midnight on the day of the test. A clear liquid diet is started on the day before the test. Adequate cleansing of the colon is necessary, as prescribed by the HCP. (하제 복용 : nausea를 억제하기 위해 차갑게 먹음. 스포츠 음료와 먹음. The day before the test.) Medication may be administered to relax smooth muscle. Prophylactic antibiotics may be administered. A mild sedative is administered intravenously. Colonoscopy is performed with the client lying on the left side with the knees drawn up to the chest. Position may be changed during the test to facilitate the passing of the scope.
  • Provide bed rest until alert. Monitor for signs of perforation.

10) Laparoscopy is performed with a fiberoptic laparoscope that allows direct visualization of organs and structures within the abdomen.

11) Endoscopic ultrasonography provides images of the GI wall and digestive organs. 제모 필요 없음. 수용성 젤. 15∼20분 소요.

12) ★ ERCP (Endoscopic RetroGrade CholangioPancreatography)

  • Examination of the hepatobiliary system is performed via a flexible endoscope inserted into the esophagus to the descending duodenum. (similar to EGD)
  • Obtain informed consent. The client is NPO for at least 4 hours before the procedure. Sedation is administered before the procedure. Multiple positions are required during the procedure to pass the endoscope.
  • Monitor for the return of the gag reflex. Monitor for signs of perforation, peritonitis, and pancreatitis (most common).

13) percutaneous transhepatic cholangiography

  • The examination involves the injection of dye directly into the biliary tree. The hepatic ducts within the liver, the entire length of the common bile duct, the cystic duct, and the gallbladder are outlined clearly.
  • Obtain informed consent. The client is NPO, usually from midnight before the procedure. Sedation is administered.
  • Monitor for signs of perforation.

14) ★ paracentesis

  • Transabdominal removal of fluid from the peritoneal cavity for analysis
  • Obtain informed consent. Obtain vital signs, including weight. Measure abdominal girth. Have the client void before the start of the procedure to empty the bladder and to move the bladder out of the way of the paracentesis needle.
  • Note that the client is positioned upright on the edge of the bed, with the back supported and the feet resting on a stool (or in Fowler’s position). The rapid removal of fluid from the abdominal cavity during paracentesis leads to decreased abdominal pressure, which can cause vasodilation and resultant shock. Assist the HCP and provide comfort and support during the procedure. Apply a dry sterile dressing to the site of puncture.
  • Monitor vital signs. Measure abdominal girth and weight. Monitor site for bleeding. Maintain the client on bed rest. Measure the fluid collected, describe, and record. Label fluid samples and send them to the laboratory for analysis. Monitor for hypovolemia, electrolyte loss, mental status changes, or encephalopathy. Monitor for hematuria caused by bladder trauma. Instruct the client to notify the HCP if the urine becomes bloody, pink, or red.

15) ★ liver biopsy

  • A needle is inserted through the abdominal wall to the liver to obtain a tissue sample for biopsy and microscopic examination.
  • Obtain informed consent. Assess the results of coagulation tests (prothrombin time, partial thromboplastin time, platelet count). Administer a sedative as prescribed. MN NPO. Hold aspirin and NSAIDs.
  • Note that the client is placed in the supine or left lateral position during the procedure to expose the right side of the upper abdomen. With right arm over the head. Exhale and hold 5 ∼10 sec. Sedation or local anesthesia.
  • Assess vital signs. Assess biopsy site for bleeding. Maintain bed rest for several hours as prescribed. (Observation for 4 hours 하며 bed rest 후 특이사항 없을 시 귀가.) Place the client on the right side with a pillow or other agency-approved pressure item such as a sandbag under the costal margin to decrease the risk of hemorrhage and instruct the client to avoid coughing and straining. Instruct the client to avoid heavy lifting and strenuous exercise for 1 week. Monitor for peritonitis. Sedation 한 검사는 24시간 동안 운전 금지.
  • complication of liver biopsy: bleeding, pneumothorax, peritonitis