ADULT GASTROINTESTINAL DISORDER

ANATOMY AND PHYSIOLOGY (BASIC HMPK) INTESTINAL PHASE

 DIGESTIVE SYSTEM is the body’s food processing complex.  Omenta

o Two layered fold of peritoneum connecting the stomach
CEPHALIC PHASE to another viscus
o The LESSER OMENTUM attaches the lesser curvature
 Oral cavity (mouth)
of the stomach to the liver
o Glands secrete enzymes- ptyalin and salivary amylase (
o The GREATER OMENTUM connects the greater
carbohydrate digestion)
curvature of the stomach to the transvers colon
o Saliva helps keep the oral cavity moist and contains
enzymes that begin the process of chemical digestion.
 3 parts small intestines
GASTRIC PHASE o Main functions
 Chemical digestion
 GASTRIN- RELEASED  Absorption of nutrients (90%) from chyme
o (STOMACH WALL DISTENTION)
o Duodenum
 GASTRIN - STIMULATES  “Mixing bowl”; acid neutralization
o GASTRIC JUICE SECRETION o Jejunum
o Highly acidic – pH (0.9-1.5)  Bulk of chemical digestion and nutrient
o STOMACH MOTOR FUNCTION absorption occurs here
o Ileum
 Stomach wall  Vit b12 absorption
o Mucosal barrier with a thick coat of bicarbonate-rich
alkaline mucus  Superior mesenteric artery and its branches
o branches off the abdominal aorta and supplies
 Mucoid secretions
o coat stomach wall and prevent autodigestion oxygenated blood to the pancreas and the lower parts
of the intestine.
 Pepsinogen
o This includes the lower duodenum, as well as
o Aids in protein digestion
transverse colon.
 Hydrochloric acid
o released in response to gastrin Functions in protein
 Inferior mesenteric artery and its branches
digestion,
o It supplies arterial blood to the organs of the hindgut –
 Intrinsic factor
the distal 1/3 of the transverse colon, splenic flexure,
o Promotes absorption of vitamin B12
descending colon, sigmoid colon and rectum.
 Stomach
o can hold 1 – 1.5L of food and fluid.  Liver (lover boy)
o Removes potentially toxic byproducts of certain
 Chyme is either delivered in small amounts to the duodenum or medication
forced backward to the stomach for further mixing. o Prevents shortages of nutrients by storing vitamins,
 Depending on the type of food the stomach empties 2-6 hours mineral and sugar
after meals. Fluid pass through rapidly, fats progress slowly o Metabolizes or break down nutrients from food to
 Enterogastric reflex – prevents overloading of the duodenum, for produce energy when needed
digestion and absorption o Produces most proteins need by the body
o Helps your body fight infection by removing bacteria
from the blood
o Produces most of the substances that regulate blood
clotting
o Produces bile, a compound needed to digest fat and to
absorb vitamin ADEK

 Gallbladder
o BILE - Neutralizes gastric acid, emusifies fats,
facilitates fat and cholesterol absorption
 Pancreas
 Large intestine
o Decreased motility causes greater absorption
o Hard feces in the transverse colon causes constipation
o Increased motility causes less absorption and diarrhea
or loose feces
o Bacteria in the large intestine aids in the synthesis of
Vit.K and some of vitamin B groups

 Anus
o internal sphincter
 involuntary relaxes and opens (stool is
present in the rectum)
o external sphincter
 voluntary relaxes to allow stool to be expelled
from the body
o ↑ pressure to expel feces –

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 ADULT GASTROINTESTINAL DISORDER

 Valsalva manueuver (straining while  Heart burn / pyrosis

maintaining a closed airway)  Pain – referred pain

ASSESSMENT

MOUTH CONSTIPATION (BOWEL HABITS)

 Check for  Note number of stools/day or week

o Dental carries  Changes in size or color of stool
o Bleeding gums  Alterations in food/fluid intake
o Dryness/ increase salivation  Painful defecation
o Odors  Associated symptoms (abdominal pain, cramps)
o Difficulty of chewing  Causes:
o Mechanical obstruction or surgery
INGESTION o Psychological factors resulting to use of restricted
toilet facilities
 Changes in appetite: Anorexia
o Drugs- atropine and codeine
o Note food preferences/dislikes
o Old age
 Food intolerances:
o Allergies, fluid, fatty foods.
 Leaning forward specifically promotes fecal elimination
 Weight gain/loss:
because it raises intra-abdominal pressure
 Dysphagia
 Nausea and Vomiting  Check Bristol tool at last page
 Regurgitation
o foods eaten, positioning DIARRHEA (BOWEL HABITS)

NATURE OF VOMITUS  No. of stools/day, Consistency

 COLOR/TASTE/CONSISTENCY/POSSIBLE SOURCE HEPATIC / BILIARY PROBLEMS

o Yellowish or greenish
 May contain bile  Jaundice
 Pruritus
o Bright red (arterial)  Urine changes
 Hemorrhage, peptic ulcer  Clay colored stools
 Increased bleeding
o Dark red (venous)
 Hemorrhage, esophageal or gastric LIFESTYLE
varices
 Eating behaviors (rapid ingestion, skipping meals, snacking)
o “Coffee grounds”  Cultural/religious values - vegetarian, kosher diet ( no pork
 Digested blood from slowly bleeding products[bacon, sausages], Poultry can be eaten ONLY -
gastric or duodenal ulcer goose, chicken, duck and turkey.
 Ingestion of alcohol
o Undigested food  Smoking
 Gastric tumor? Ulcer obstruction?
USE OF MEDICATIONS (note use of)

o “Bitter” taste  Antacids

 Bile  Antiemetics
 Antiflatulents
o “Sour” or “Acid”  Vitamin supplements -
 Gastric contents  Aspirin and anti-inflammatory agents4

o Fecal components  Planning nutritional interventions for a healthy old

 Intestinal Obstruction man/woman ( senior citizen) - MOST likely to affect his
nutritional status is Living alone on a fixed income
DIGESTION / ABSORPTION

 Dyspepsia (indigestion)
PAST MEDICAL HISTORY
o Is a sensation of discomfort in the upper part of the
stomach or the abdomen which usually starts  Childhood
immediately after having a meal  Adult
o There may be a feeling of burning or pain between  Psychiatric illness (anorexia nervosa)
novel and the lower part of breastbone  Surgery
o Cause
 Bleeding disorders
 Non-ulcer dyspepsia
 Menstrual history
 Gastic ulcer
 Exposure to infectious agents
 Gastritis
 Allergies
 Reflux
 Hiatal hernia
 Medications
 H.Pylori infection PHYSICAL ASSESSMENT

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 ADULT GASTROINTESTINAL DISORDER

1. INSPECTION
2. AUSCULTATION
3. PERCUSSION
4. PALPATION

LABORATORY AND DIAGNOSTIC TESTS

SERUM GASTROINTESTINAL STUDIES

6. BILIRUBIN
1. ALBUMIN  Bilirubin is produced by the liver, spleen and bone marrow
 Main plasma protein in blood and is also a by-product of Hgb breakdown.
o (Normal value: 3.5 – 5.5 g/dl)
o Maintains oncotic pressure  Total bilirubin levels can be broken down into
o Direct bilirubin, which is excreted primarily via the
 Collect 5-7 ml venous blood in red top bottle intestinal tract
 No fasting required o Indirect bilirubin, which circulates primarily in the
bloodstream
 Increased in conditions
o Dehydration  Total bilirubin levels increase with any type of jaundice;
o Diarrhea direct and indirect bilirubin levels - jaundice.
o Metastatic carcinoma
 Normal values:
o Total: 0.1 – 1.2 mg/dL
 Decreased in conditions
o Bilirubin, direct (conjugated): 0.1 - 0.3 mg/dL
o Acute infection
o Bilirubin, indirect (unconjugated): 0.2 to 0.8 mg/dL
o Ascites
o Alcoholism.
 Nursing considerations:
o Presence of detectable albumin, or protein in the
o Fast for 8 hours before the blood is drawn.
urine is indicative of abnormal renal function
o Note that results will be elevated with the ingestion
2. ALKALINE PHOSPATASE of alcohol
 It is the enzyme normally found in bone, liver, intestine and
placenta. ALANINE AMINOTRANSFERASE (ALT)
o Normal level in adults: 35-150 U/L
 No fasting required  An enzyme used to detect liver disease. Injury of liver cells
causes release of this enzyme.
 Increased levels  Normal value:1 – 45 IU/L
o liver disease and bile duct obstruction  No fasting is required
 Low levels
o Malnutrition / Anemia
o Hypothyroidism ASPARTATE AMINOTRANSFERASE (AST)
o Scurvy
 An enzyme found in the heart, liver and muscle tissue
o Magnesium and zinc deficiency
 Normal range:1 – 36 units/L
 Helps detect acute hepatitis or biliary obstruction
3. AMMONIA
 It is a by-product of protein catabolism.
o (Normal values- 10 – 80 mg/Dl) PROTHROMBIN TIME (PT)
 Metabolized by the liver and excreted by the kidneys as
urea.  An enzyme found in the heart, liver and muscle tissue
o Normal range: 12.0 – 14.0 sec.
 Elevated levels o Reduced in patients with liver disease, causing a
o liver cirrhosis may lead to encephalopathy. prolonged clotting time
 No fasting is required
 No fasting is required.
 No smoking (8-10 hours) before the test
PARTIAL THROMBOPLASTIN TIME (PTT)
4. AMYLASE
 Helps detect deficiencies in clotting mechanism
 enzyme, produce by the pancreas and salivary glands, aids
o Prolonged in liver disease
in the digestion of complex carbohydrates and is excreted by
the kidneys. o Normal range: 60 – 70 sec.
 In acute pancreatitis- level is greatly increased  Helps detect acute hepatitis or biliary obstruction

 (Normal value- 25 to 151 units/L)

ACTIVATES PARTIAL THROMBOPLASTIN TIME (APPT)
5. LIPASE  Decreased in liver failure
 This pancreatic enzyme converts fats and triglycerides into  Normal range: 20 – 35 sec.
fatty acids and glycerol.
 If patient is receiving heparin injections, draw specimen 30-
 Elevated levels- pancreatic disorders 60 min before next dose

 (Normal value: 10 to 140 units/L)

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 ADULT GASTROINTESTINAL DISORDER

FECAL ANALYSIS
Limitation and interfering substances
 The stool is examined for its amount, consistency, and color (Normal - light
to dark brown)  May cause false positive results:
o RED MEAT
 Various foods affect stool color  Eliminate from the diet 48 hours prior to and during
o Meat protein - dark brown the sampling phase.
o Spinach - green
o Beets – red o HIGH DOSES OF ASCORBIC ACID (Vitamin C, 250 mg/day or
o Cocoa – dark red or brown more)

 Various medication affects stool color o FRUITS AND VEGETABLES HIGH IN PEROXIDASE
o Aluminum Hydroxide – gray-white  Turnips
o Barrium – white  Broccoli
o Hematinics (iron salts ) – black  Horseradish
o Pyrivinium pamoate (Povan) - red orange  Cauliflower
 cantaloupe
 Hemoglobin and bleeding affect the stool  NO Aspirin or other NSAID’s
o Upper G.I. Bleeding o 72 hours prior to and during the test period.
 tarry black (melena)
 NO Heavy alcohol consumption
o Lower G.I. bleeding o (GI irritation or bleeding)
 bright red blood o 48 hours prior to and during the sampling procedure.

o Lower rectal or anal bleeding  NO IRON causes blackish/greenish discoloration of stool

 blood streaking on surface of stool or on toilet paper  Menstrual blood or active bleeding due to hemorrhoids or polyps -
contamination will give a false positive test.
 Characteristics of stool
o STEATORRHEA STOOL CULTURE
 Bulky, greasy, foamy, foul in odor, gray in color with
silvery gloss  sterile test tube/cotton tipped applicator
 Should be collected using sterile technique so as not to introduce any
o biliary obstruction pathogens that would alter test results
 Light gray “clay colored” (due to absence of bile .
pigments)  Most common intestinal pathogens:
o Campylobacter species
o chronic ulcerative colitis o Salmonella species
 Mucus or pus visible o Shigella species

o constipation, obstruction, fecal obstruction FECAL FAT TEST

 Small, dry, rocky-hard masses
 Assess steatorrhea (excessive excretion of fecal fat)
Nursing management  Preparation:
 High fat diet for 3 days
 Save a sample of any fecal material if it is unusual in appearance, o Intake of 100 grams of fat each day for 3 days before
contains worms or blood, is blood streaked, has unusual color or taking the fecal fat test.
much mucus. o Ex - Two cups of whole milk, for example, contain 20
grams of fat, and 8 ounces of lean meat contain
Test for ova and parasites approximately 24 grams of fat.
 Used to detect parasites and eggs in the intestines
 No alcohol for 3 days
 For patients who exhibit symptoms of an intestinal infection, such as:
 No mineral oil, neomycin sulphate
o excessive diarrhea
o stools with mucus or blood
 Suggested foods to boost fat intake
o severe abdominal pain
o whole milk
o headache
o full-fat yogurt
o fever
o cheese
o nausea or vomiting
o beef
o eggs
Fecal occult blood test
o peanut butter
 Hemocult Guaic slide test - blood in the stool that is not visible to the o Nuts
naked eye. o baked goods.
 Uses: To detect G.I. Bleeding and early cancer
 3 stool specimen (3 successive days)  Client is given a plastic “hat” to place over the toilet bowl, or be
directed to loosely cover the bowl with plastic wrap. Urinate before
 Positive Result: BLUE COLOR presence of occult blood. you place the hat or plastic over the toilet bowl.
 Urine, water, and regular toilet paper can contaminate your sample
and render the test results

 After high-fat diet for three days

o patient returns to a normal diet and begin the stool
collection process.

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 ADULT GASTROINTESTINAL DISORDER

o Patient collects his stool each time he has a bowel

movement
o Normal range:
 2-7 grams - 24-hour period.
 21 grams. – 72 hours (3days)

 Crohn’s disease. This autoimmune inflammatory bowel disease

affects the entire digestive tract.
 Pancreatitis. This condition is an inflammation of the pancreas.
 Cancer. Tumors in the pancreas or biliary ducts can affect body’s
absorption of fat.

BREATHE TEST

HYDROGEN BREATH TEST

 LACTOSE INTOLERANCE
o most common sugar that is digested is lactose, the UREA BREATH TEST
sugar in milk. Testing also may be used to diagnose
problems with the digestion of other sugars such as  is a test for diagnosing the presence of a bacterium,
sucrose, fructose and sorbitol Helicobacter pylori (H. pylori) in the stomach.
 It causes inflammation, ulcers, and atrophy of the stomach
 SMALL INTESTINAL BACTERIAL OVERGROWTH (SIBO)
o a condition in which larger-than-normal numbers of  Preparation:
colonic bacteria are present in the small intestine o For 1 month before the test:
 no antibiotic or loperamide (Pepto
 Patients who present with bloating, gas, nausea, cramps, or Bismol)
diarrhea
o For 1 week before the test
 an oral dose of lactose is administered  no Sucralfate (Carafate) and
Omeprazole (Prilosec)
 the sole source of H2 is bacterial fermentation
 unabsorbed lactose makes its way to colonic bacteria, resulting in
o 24hrs before the test:
excess breath H2
 no Cimetidine (Tagamet), ranitidine
 increased exhaled H2 after lactose ingestion suggests lactose
(Zantac) Famotidine (Pepcid)
malabsorption
 The client takes a Carbon - urea capsule
 preparation
o Waits approximately 10-20 minutes, and blows up
o 2 weeks before the test
a balloon
 no antibiotics
 Air in the balloon is then transferred
 No pepto bismol
to a special vial for analysis
o 2 days before the test
 The Patient breathes normally and the device automatically
 low carbohydrate diet
samples her baseline.
o This step normally takes 2-3 minutes.
o Prior to arrival
o Breathes on nasal canula
 NPO after midnight
 12 hours empty stomach
 no gum or candy  The patient drinks a solution enriched with 13C-urea, and the
 no alcohol operator presses the OK button.
 no smoking  Total testing time is approximately 10 minutes

 during the test

o Rinse mouth with mouthwash to limit the effect of
bacteria in the mouth on the results.

o Blow in a instrument – to test breath every

 15 min – ADULTS,
 every 30 min – children – 2 to 3 hours

o bacterial fermentation of malabsorbed sugar produces

hydrogen (H2) and methane (CH4) gas
o these gases are absorbed into the bloodstream and
carried to the lungs
o concentration of exhaled breath H2 and CH4 are
measured in the test

o concentration of breath hydrogen and methane are

used to indicate if the test sugar is malabsorbed or if
proximal bacterial overgrowth is present
 Helicobacter pylori - DETECTED because it breaks 13C-Urea
to ammonia and carbon dioxide =Increase in CO2 in the
breath.

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 ADULT GASTROINTESTINAL DISORDER

 Gastric urease enzyme identified (balloon)

ABDOMINAL ULTRASOUND

Scanning technique

 image the interior of the abdomen (enlarged

gallbladder(gallstones) or pancreas, appendicitis)
 Sound waves into the abdominal area and images are recorded
on a computer.
 The black-and-white images show the internal structures of the
abdomen

Advantages:

 No radiation.
 Painless and safe (no noticeable side effects)
 Low cost & almost immediate results
 Disadvantages
 Cannot be used on structures behind bony tissues
 Gas and fluid in the abdomen prevents transmission of sound.

Nursing considerations

 Fast for 8-12 hours - to decrease the amount of gas in the bowel
 Gallbladder exam - Fat free meal the evening before the test
 Ultrasound exam before Barium studies will be done,
o Barium interferes with the transmission of sound waves.

ENDOSCOPING ULTRASOUND

 Endoscopy + ultrasound to obtain direct image

o submucosal lesions
o Barret’s esophagus
o portal hypertension
o biliary tract disease
o chronic pancreatitis

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 ADULT GASTROINTESTINAL DISORDER

 Types
o Single contrast
 Using HIGH density and BIG amount of
barium suspension alone to fill the
stomach and duodenum

o Double contrast
 Using with LOW density and Small
amount of barium suspension with air to
coat the wall of stomach and duodenum

o Bi-phasic contrast
 It combines both types in one procedure

 Patient preparation
o Fasting 6 hours after midnight
o Avoid smoking, chewing gum or medications
o Decrease fluid in stomach
o IV smooth muscle relaxants

BARIUM TESTS

 BARIUM SULFATE 3. barium follow through

o dry, white, chalky powder that is mixed with water to  test is similar to a barium meal but aims to look for problems
make a thick, milkshake-like drink. in the small intestine.
o odorless and insoluble in water.  Drink barium liquid
o X-ray absorber and appears white on X-ray film.  Wait 10-15 minutes before any X-rays are taken to allow
o X-rays do not pass through barium. time for the barium to reach the small intestine.
o Coats the inside walls of the upper parts of the gut and  X-ray every 30 minutes or so until the barium is seen to have
shows up clearly on X-ray pictures gone through all the small intestine and reached the large
intestine (colon)
1. Barium swallow
 This test aims to look for problems in the gullet  Post procedure:
(oesophagus). o LAXATIVE - elimination of barium and prevent
o narrowing (stricture) obstruction or impaction.
o hiatus hernias o Barium impaction (distended abdomen,
o tumors constipation) should be observed.
o reflux from the stomach o Increase oral fluid intake to help pass barium
o disorders of swallowing o Monitor stools for the passage of barium.
o test takes about 10 minutes. o Stools will appear milky/chalky white for 24-72
hours.
o Follow up 2-3 days to ensure the patient has had a
 NPO 6-8 HRS PRE TEST
normal brown stool.
 NO SMOKING (24 hrs.), CHEWING GUM, MINT = Inc.
Gastric acid production
4. barium enema
2. barium meal
 Barium is instilled into the colon by enema
 X- ray pictures are taken on the abdomen to look for
problems in the stomach and the duodenum.
 In cases:
 ulcers
o Active inflammatory disease of the colon
 small fleshy lumps (polyps)
o Fistulas
 tumors
o Signs of colon perforation or obstruction
 Patient assumes different lying positions

 Types:
 Patient may be asked to swallow some bicarbonate powder
o Single column barium enema
and citric acid before swallowing the barium.
 bubbles, make some gas. (Patient may have to resist the o Air contrast (Double contrast) barium enema
urge to burp.)
 Gas expands the stomach and duodenum and also pushes  Detects the presence of:
the barium to coat the lining of the stomach and duodenum. o polyps
 X-ray pictures much clearer o tumors
o lesions of large intestine
 Contraindication o anatomic abnormalities
o Complete bowel obstruction o malfunctioning of the bowel.
o Suspected perforation
o Pregnancy  Preprocedure:
o Low residue-diet for 1-2 days

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 ADULT GASTROINTESTINAL DISORDER

o Clear liquid diet and laxative or suppository the o Assess dye injection
evening before the test.
o NPO after midnight the day of the test or 8 hours
pretest.
o Enemas until clear the morning of test

 Post procedure:
o Laxatives/fluids to assist in expelling barium
o May assume different positions
o Radiologist may press firmly on your abdomen and
pelvis – for better viewing
o Usually takes 30 - 45 minutes, x-ray images are
taken
o Cramping

 GASTROGRAFIN - a water soluble iodinated contrast agent

o Assess for allergy to iodine.
o Eliminated readily after procedure

COMPUTED TOMOGRAPHY SCAN

MAGNETIC RESONANCE IMAGING
 A type of x-ray that uses a computer to make pictures of the
inside of the body.  A non-invasive technique that uses magnetic fields and radio
 Scanning may or may not require injection of a dye waves to produce an image of the area being studied
 Helps detect and localize many inflammatory conditions of the
colon  Used to evaluate
o Appendicitis o abdominal soft tissues
o Diverticulitis o blood vessels
o Regional enteritis & ulcerative colitis diseases of the o abscesses
liver, spleen, pancreas, & pelvic organs o fistulas
o Structural abnormalities of the abdominal wall. o neoplasm
o sources of bleeding
 PREPROCEDURE:
 Clear liquid in AM  Pre-procedure
 Inform consent if a dye is used  Remove all metal objects from the client.
 NPO for 2-4 hrs before the test.  Examples:
 Lie still and flat  Jewelry
 Keys (pockets).
 Assess for allergies (DYE)  Eyeglasses
o iodine, contrast dye, shellfish
 Clothes with metal zippers
o serum creatinine level
 Watches
o urine human chorionic gonadotropin
 buckles and buttons
 Pins
 Dye injected
 Credit, bank and parking cards (erase the magnetic codes)
o Hot flushed sensation
 Hearing aids
o metallic taste
 Dental appliance
 IV poles, and oxygen tanks.
 ALLERGY
 Hair clips
o antihistamine and corticosteroids before the injection to
 Pens
reduce the severity of a reaction (Prednisone 24 hrs,12
 ETC
hrs., & 1 hr. before the scan).
Contraindicated
 Assess for claustrophobia.
 Inform the client:  magnetic field could cause these to malfunction.
o mechanical noises as the scanning occurs o Permanent pacemaker
o procedure is painless. o Artificial heart valves
o intravenous line if prescribed o Defibrillators
o Implanted insulin pumps
 Post procedure: o Implanted TENS
o Replacement fluids - diuresis
o Allergic reaction monitored.
 for patients with

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 ADULT GASTROINTESTINAL DISORDER

o internal metal devices (e.g., aneurysm clips, hip prosthesis) o If breastfeeding at the time of the exam, it may
o dental implants help to pump breast milk ahead of time and keep it
o intraocular metallic fragments on hand for use after the PET radiopharmaceutical
and CT contrast material are no longer in the
 Remove intravenous fluid pumps during the test. body.
 Provide precautions - client attached to a pulse oximeter coiled
around the body (BURN)  PET scanners work by detecting the radiation given off by a
substance called a RADIOTRACER - fluorodeoxyglucose
 Removed foil backed skin patches nitroglycerine (Transderm-Nitro)
(FDG) is used, which is similar to naturally occurring glucose
consult physician
The areas using more glucose are hyper metabolic and
o the risk of burns
generally more worrisome. 

 Assess for claustrophobia. Administer medication as prescribed for the

client with claustrophobia.
 Patient may wear a blindfold during the procedure.

 Pre procedure:
o NPO
o Procedure 60 – 90 min.
o Remain still during the procedure
o Knocking sound – head set or listen to music

 Post procedure
o Normal ADL resumed
o Diuresis

PET SCAN

 A positron emission tomography (PET) scan is a type of

imaging test. It uses a radioactive substance called a HEPATOBILIARY SCINTIGRAPHY SCAN (HIDA)
TRACER to look for disease in the body.
o The radiotracer, injected into a vein, emits gamma  A hepatobiliary (HIDA) scan is an imaging procedure used to
radiation as it decays diagnose problems of the liver, gallbladder
o A gamma camera scans the radiation area and  Special gamma camera is positioned over the abdomen
creates an image
 preparation
o Tracer is absorbed by the body (about 1 hour.) o Need to remain still.
o The atoms o NOT performed in pregnant women
 Decay quickly o Breast-feeding women may need to stop for a few days
 Do not harm the body after the HIDA scan.
 Have a lower radiation levels than a
typical x-ray or CT scan  Before the procedure
 Eliminated in the urine or feces. o Fast for four hours
o o might be allowed to drink clear liquids.\

 A PET scan shows how organs and tissues are working  During the procedure
 Evaluate the spread and activity of cancer. o Radioactive chemical or tracer is injected into a vein in
 Helps the physician to make an early diagnosis. the arm
o Allows them to pinpoint the location of the cancer o Sincalide (Kinevac), which makes the gallbladder
within the body and has the ability to monitor a contract and empty.
patient’s response to therapy o A gamma camera is positioned over the abdomen to
take pictures
 A PET scan can reveal the size, shape, position, and
some function of organs.  RESULTS OF A HIDA SCAN INCLUDE:
 This test can be used to measure important body functions: o Normal
o blood flow o the radioactive tracer moved freely along with
o oxygen use the bile (Liver - gallbladder - small intestine).
o sugar (glucose) metabolism
o Slow movement of radioactive tracer
 Preparations: o may indicate a blockage or obstruction.
o NPO except water for 4-6 hours
o If advised not to take medications on an empty o No radioactive tracer seen in the gallbladder.
stomach, eat nothing more than a few soda o may indicate acute inflammation (acute
crackers within 4-6 hours of the exam.
cholecystitis).
o If afraid of close spaces (claustrophobia).
o Medicine - feel sleepy and less anxious.

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 ADULT GASTROINTESTINAL DISORDER

 Abnormally low gallbladder ejection fraction. The amount of tracer o The patient must be in a fasting state for 12 hours
leaving the gallbladder is low after have been given a drug to o Contamination w/ saliva neutralizes the gastric acidity
make it empty, which might indicate chronic inflammation (chronic therefor it should be prevented
cholecystitis). o Time specimen should be collected for the purpose of
comparison
 Radioactive tracer detected in other areas. Radioactive tracer
found outside of the biliary system might indicate a leak.  2 types of gastric juice collection (using an evacuated tubes)
o Levine tube
 After the procedure  Inserted in the nose (nasal intubation)
o The small amount of radioactive tracer will lose its
reactivity or pass through the urine and stool over the o Rehfuss tube
next day or two. Drink plenty of water to help flush it out  Inserted in the mouth (oral intubation)
of the system.

Macroscopic examination

 Volume
 30-60ml
 Fasting sample
o Contains few ml to 50ml w/ an average of 30ml
 Color:
 Colorless, yellowish or pale gray w/ varying amounts of
mucus and food particles

 Abnormalities in color:
 Brownish red or coffee color
o Presence of large amount of blood
 Opaque gray
o Seen after a test meal
 Yellow
o Presence of fresh bile
 Greenish
o Presence of old bile
 Red
GASTRIC ANALYSIS o Presence of small amount of blood

 Gastric analysis is a method to measure secretion of  Odor

hydrochloric acid under basal (Baseline) and augmented  Odorless or maybe slightly sour or faintly pungent
(stimulated) conditions.
 Abnormalities in odor
 NPO 8 -12 HRS  Fecal odor
 NO SMOKING 6 HOURS o Seen in intestinal obstruction or gastric-fistula
 Foul or putrid odor
1. 30-minute “baseline” sample will be collected. o Seen in carcinomatous ulcer
2. Histamine or pentagastrin - given SC stimulate gastric secretions,  Alcoholic odor
produced a flushed feeling. o Seen in alcoholic coma, or after alcohol test meal
3. Additional samples collected for one hour. The samples will then  Ammoniacal odor
be taken to a laboratory for analysis.   o Seen in case of uremia
 Rancid odor
 ADL resumed post procedure
o due to butyric (fatty acid) and lactic acid (present
in sour milk) indicating stenosis and fermentation
GASTRIC FLUID ANALYSIS
 pH or Reaction
o Gastric juice  normally acidic – pH 1.6 -1.8
 A colorless to grayish or yellowish watery fluid w/ a low  high acidity – pH 1.4 or lower
specific gravity secreted by the surface epithelium,  low acidity – pH 2.0 to 2.8
gastric cells and the various glands of the gastric tract
 Euchlorhydria
o Importance of detection o Refers to normal secretion w/ a pH between 1.6 to
 Diagnosis of gastric diseases and assist in the selection 1.8
of therapy i.e. peptic ulcer
 It measures the amount of acid produced by a patient  Hyperchorhydria
w/ symptoms of peptic ulcer o Increase free HCl above normal around 60ml i.e.
 Diagnosis of Zollinger-Ellison syndrome (adenoma of peptic ulcer
islet or Langerhans) a condition of gastric
hypersecretion produced by a gastrin secreting tumor of  Hypochlorhydria
the pancreas o Decreased free HCl
 Carcinoma of the stomach
 Collection of the specimen  Chronic gastritis

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 ADULT GASTROINTESTINAL DISORDER

 Gastric syphilis o also known as systemic sclerosis, is a chronic systemic

autoimmune disease characterised by hardening (sclero)
 Achlorhydria of the skin (derma). In the more severe form, it also
affects internal organs.
o Absence of free HCl o Distal esophageal stricture
 Pernicious anemia o Facial changes
 Pellagra  Pinched nose “mauskopf”
 Advance gastric cancer  Pursed lips
 Cannot evert eyelids
 Lip thinning and retraction
BERNSTEINT TEST (ACID PERFUSION TEST)  Immobile facies4

 Used to assess if chest pain is related to GERD GASTRODUODENAL MANOMETRY

 NPO 6-8 HRS pre procedure
 Used to evaluate:
 ANTACID post procedure o Gastric emptying
o Gastric & intestinal motility disorders
 24 HOURS BEFORE THE TEST.
o Do not take antacids (such as Tums or Rolaids) ANORECTAL MANOMETRY
o Do not drink alcohol or smoke
 Measures the:
o Resting tone of the internal anal sphincter
 8 to 12 HOURS BEFORE TESTING
o Contractibility of the external anal sphincter
o Do not eat or drink
 Helps evaluate chronic constipation or fecal incontinence.
 BEFORE THE TEST  Cleansing enema is administered 1 hour before the procedure
o As per doctor’s instructions may use acid reducers or  Place patient in a prone or lateral position.
blockers, such as famotidine(Pepcid)
or omeprazole (Prilosec),.  A small catheter with a balloon attached to the end will be placed
about four inches into the rectum.
Acid perfusion test o BALLOON MANOMETER

 Patient sitting with NG tube 30cm from nares, infusion  Do a series of squeezes, like holding in a bowel movement, followed
normal saline 15min, 0.1 N HCl at rate of 6ml/min until by bear downs, like pushing out a bowel movement.
symptoms produced  Inflation and deflation - feel a sensation in rectum or when the urge to
have a bowel movement
o Retrosternal pain for 0.1 N HCl
 The nurse will then take out the catheter, and a different catheter will
 The test is positive in two successive infusion periods acid be inserted that will also have a balloon attached to it. The balloon will
induces pain and saline induces relief be inflated with water, and patient will be asked to sit on a bedside
 Specificity 89%, sensitivity is low because the pain induced commode to test if he can expel (push out) the balloon within 5
by acid infusion does no correlate with the severity of minutes. If unable to do so, the nurse will deflate the balloon and take
esophagitis the catheter out.
 The procedure takes approximately 60 minutes to complete.
MANOMETRY

 is a test to measure the pressure inside the upper and lower part of the
esophagus. ESOPHAGOGASTRODUODENOSCOPY (EGD)

 NPO 8-12 hrs  Upper gastrointestinal fiberoscopy

 Withhold medications- affect motility 24-48 hrs  EGD is an endoscopic procedure that allows your doctor to
examine your esophagus, stomach and duodenum (part of your
 pressure sensitive catheter is inserted connected to a transducer and a
small intestine).
video recorder.
 The tube is pulled slowly back into your esophagus, patient is asked to
swallow  POST-PROCEDURE
 Swallows a small amount of water while the resultant pressure changes are o Assess
recorded.  level of consciousness
 Changes in intraluminal pressure is measured  vital signs frequently
 Coordination of muscle activity in the GI tract  pain level

 Helps diagnose:
o Monitor for signs of perforation
 Achalasia
 pain
 Diffused esophageal spasm
 bleeding
 Esophageal manometry may be used to help diagnose:  unusual difficulty swallowing
 Diffuse esophageal spasm  elevated temperature
o rare swallowing problem is characterized by multiple,
forceful, poorly coordinated muscle contractions of your o NPO until the gag reflex returns (1-2 hours).
esophagus. o Bed rest for the sedated client until alert.
 Achalasia.
o Lozenges, saline gargles, ice chips or oral analgesics
o uncommon condition occurs when the lower esophageal
muscle (sphincter) doesn't relax properly to let food enter
can relieve a minor sore throat
your stomach. o Transport the patient home with a family member –
o Muscles in the wall of the esophagus are often weak as patient was sedated
well.
o This can cause difficulty swallowing and regurgitation of
food back up into your throat.
 Scleroderma, ANOSCOPY, PROCTOSCOPY, SIGMOIDOSCOPY

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 ADULT GASTROINTESTINAL DISORDER

 Preprocedure: o Bed rest

o Enemas are given until the returns are clear. o Bleeding perforation

 Postprocedure:
o Monitor for rectal bleeding and signs of perforation
and peritonitis

 Signs of Bowel Perforation and Peritonitis

o Guarding of the abdomen
o Fever and chills increase
o Pallor
LAPAROSCOPY
o Abdominal distention and abdominal pain
progresses  surgical procedure in which a fiber-optic instrument is inserted
o Restlessness through the abdominal wall to
o Tachycardia o view the organs in the abdomen
o permit a surgical procedure.
ANOSCOPY

 a procedure that uses a small tube called an anoscope to  Laparoscopy is used to find problems such as cysts, adhesions,
view the lining of your anus and rectum fibroids, and infection. Tissue samples can be taken for biopsy
through the tube (laparoscope).
 nursing consideration
o INFORMED CONSENT  Laparoscopic surgery, also called minimally invasive surgery
(MIS), bandaid surgery, or keyhole surgery, is a modern surgical
o VS MONITORED
technique in which operations are performed far from their
location through small incisions (usually 0.5–1.5 cm) elsewhere in
 Examines
the body.
o Polyp
 Pain and hemorrhaging are reduced due to smaller incisions and
o Hemorrhoid
recovery times are shorter

PROCTOSCOPY

 is a procedure to examine the insides of the rectum and the

anus. A proctoscope is a hollow tube, usually with a tiny light
at the end, that can also be used to take tissue samples for
biopsies as a cancer screening tool

SIGMOIDOSCOPY

 a diagnostic test used to check the sigmoid colon,

COLONOSCOPY

 an exam used to detect changes or abnormalities in the large ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY
intestine (colon) and rectum. (ERCP)
 During a colonoscopy, a long, flexible tube (colonoscope) is
inserted into the rectum.  study the ducts (drainage routes) of the gallbladder, pancreas,
 A tiny video camera at the tip of the tube allows the doctor to view and liver
the inside of the entire colon  is a specialized technique most commonly performed to diagnose
conditions of the pancreas or bile ducts, and is also used to treat
 Diagnoses: those conditions.
o Diverticulitis  Preparations similar to EGD.
o Cancer  The most common reasons to do ERCP include abdominal pain,
o Polyp weight loss, jaundice (yellowing of the skin), or an ultrasound or
o Flat polyp / lesion CT scan that shows stones or a mass in these organs.
o Adhesions
 NURSING CONSIDERATION AND EQUIPTMENTS
o Ulcerative colitis
o O.P.
o Appendicitis
o Informed consent
o Conscious sedation
 Pre op
o Mouth piece
o Enema
o Duodenoscope
o Clear liquid diet
o Dye
 Day before the test
o C-arm I.I.
o NPO at midnight o Private room in the X-ray dept
o Consent form sedation
 SPHINCTEROTOMY – aids in the flow of bile (stent)
 Post op

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 ADULT GASTROINTESTINAL DISORDER

 Simethicone may be given when the capsule is swallowed to

reduce bubbles and improved visualization
o SIMETHICONE is an oral anti-foaming agent used to
reduce bloating, discomfort and pain caused by excess
gas in the stomach or intestinal tract.

 The Real Time Viewer enables the physician to test the proper
functionality before the procedure
LIVER BIOPSY  Confirms the location of the capsule in the GI tract
 A needle is inserted through the abdominal wall to the liver to
 Able to drink clear liquids after two hours and eat a light meal
obtain a tissue sample for biopsy and microscopic examination.
after four hours following the capsule ingestion
 A small slender core of tissue is removed with a biopsy needle
 Avoid vigorous physical activity such as running or jumping during
the study
 Preprocedure:
 The capsule endoscopy procedure is complete after eight
o Coagulation tests - assessed
hours or when you see the camera capsule in the toilet after
o Sedative as prescribed given
a bowel movement, whichever comes first. 
o Position: supine or left lateral position to expose the
right side of the upper abdomen.
 In 6-10 hours, return to the office and the data recorder is
removed so the images (small bowel) can be put on a computer
 Postprocedure screen for physician review
o Maintain bed rest for several hours.
o Place the client on the right side with a pillow under the  Capsule is eliminated painlessly in the stool.
costal margin to decrease the risk of hemmorhage, and  Complication: stuck - Obstruction
instruct the client to avoid coughing and straining.
o Instruct the client to avoid heavy lifting and strenuous
exercise for 1 week.

CAPSULE ENDOSCOPY PARACENTESIS

 is a technology that uses a swallowed video capsule to take  Transabdominal removal of fluid from the peritoneal cavity for
photographs of the inside of the esophagus, stomach, and small analysis
intestine.
 Images are transmitted to a recorder worn on a waistband/belt for  Pre-procedure:
8 hours. o Void before the procedure - to empty the bladder and to
move the bladder out of the way of the paracentesis
 It helps diagnose: needle.
o Obscure gastrointestinal bleeding o Measure abdominal girth, weight, and baseline vital
 cause of gastrointestinal bleeding. signs.
o Inflammatory bowel diseases o Client is positioned upright on the edge of the bed with
 reveal areas of inflammation in the small the back supported and the feet resting on a stool
intestine (Fowler’s position is used for the client confined to bed)
o Cancer
 identify tumors in the small intestine  >,<,= TO 2-3 LITTERS OF FLUID CAN BE DRAINED
o Celiac disease
 detects intestinal changes associated with  Post-procedure:
celiac disease o Monitor vital signs
o Polyps o Measure fluid collected, describe and record.
 in the small intestines o Label fluid samples and send to the laboratory for
analysis.
 10 hour overnight fast – small bowel study

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 ADULT GASTROINTESTINAL DISORDER

o Apply a dry sterile dressing to the incision site; monitor  500 – 1000 ml – given in 4 – 5 min. (Vol. – distention)
for site of bleeding.  Cramping occurs slow the speed of instillation.
o Measure abdominal girth and weight.  Assess for dizziness, light- headedness, abdominal
o Monitor for hypovolemia, electrolyte loss, mental status cramps, nausea.
 Monitor electrolyte levels if client is to received
changes
repeated enemas.
o Monitor for hematuria caused by bladder trauma.
o Instruct the client to notify the physician if the urine o Hypertonic solution.
becomes bloody, pink, or red.  70 to 120 cc
 Attracts water into the colon, causing distension,
stimulating peristalsis and defecation
 Given high or low
 Low – standard procedure
 High – attempts to clear as much the large intestine

o Position
 left lateral – initial
 Dorsal recumbent
 Right lateral

2. RETENTION
o usually administered to lubricate or soften a hard fecal mass to
facilitate defecation.

1. Oil
 90-120 ml - least 30 minutes in order for it to take
effect.
2. Carminative
 60 – 180 ml

o Medicated enema -
 to instill antibiotics to fight infection (Rectum, anus)
 To introduce antihelmentic agents

o Nutritive enema
 dehydrated, frail

3. RETURN FLOW
o To help a patient expel a flatus and relieve abdominal
distension
o 100- 200ml

DIGITAL ENEMA

 breaking up the hardened feces

 if a person is thought to have a fecal
impaction, the nurse will perform a
digital examination
 during the digital examination, a
finger is inserted into the person’s
rectum to feel for the impacted mass

INTERVENTIONS

ENEMA
GASTROSTOMY TUBE
 Instillation of fluid into the rectum, usually for the purpose of
stimulating defecation.  The gastrostomy tube (GT) is a short feeding tube that goes
 Cleansing enema - to treat constipation or feces impaction directly into your stomach through a surgical incision called a
stoma
1. CLEANSING  it is secured with sutures
o promote removal of feces from the colon  Alternative method of feeding either temporary or permanent
o primary action of the soap suds is to irritate the mucosa
PERCUTANEOUS ENDOSCOPIC GASTROSTOMY
o Treat severe constipation or impaction
o Clear the colon in preparation for visualization procedures  is a method of placing a tube into the stomach percutaneously,
o Empty the colon when starting a bowel training program aided by endoscopy.
 mild sedation
o DURING PROCEDURE
 Breath through the mouth ENDOSCOPIC PEG TUBE PLACEMENT
 Insert rectal tube: 4-5 inches
 2-PERSON TEAM:
o Hypotonic solution o one endoscopist and one "skin person" to handle the
 Saline, tap water and soap non-endoscopic portions of the procedure

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 ADULT GASTROINTESTINAL DISORDER

 Reduction in aspiration pneumonia associated with

swallowing disorders. Comatose (LES remains intact –
regurgitation and aspiration less likely)

 Initial G tube can be removed and replaced once the tract is

established
o 6 weeks to 3 months after initial insertion.

 ROUTINE REPLACEMENT:
o Balloon G tube – 3-6 mos.
o Non Balloon G tube – 6-12 mos.

 REPLACEMENT:
o Clogged or fractured G tube
o Ruptured balloon

LOW PROFILE GASTROSTOMY DEVICES

 G button feeds directly into the stomach.

 A GJ button uses the same stoma as a G button but has one
port that opens into the stomach and one port that opens into
the jejunum

 Indicated:
o Gastric route not accessible
o To lower aspiration risk (stomach not working well
to process and empty food and fluids

USES OF GASTROSTOMY TUBE

NURSING CARE:
 Feeding
o neurological (e.g. stroke) 1. Maintain skin integrity: inspect and cleanse skin around stoma
o anatomical (e.g., cleft lip and palate during the process frequently; keep deep area dry to avoid excoriation.
of correction)
o other (e.g., radiation therapy for tumors in head & neck 2. Maintain patency of the gastrostomy tube
region) a. Assess for residual before each feeding. Check orders
concerning withholding feeding.
 Decompression b. Irrigate the tube before and after meals This helps
o malignant bowel obstruction prevent blockage from formula or medicine. Use at
least 2 tablespoons (30 milliliters) of water to flush the
Benefits include: tube
i. Clogged - Flush tube with a 60 milliliter (mL)
 It is well tolerated (better than nasogastric tubes) - longer syringe filled with warm water
than 4 weeks enteral nutrition support c. Measure and record any drainage
 Nutritional status is improved -

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 ADULT GASTROINTESTINAL DISORDER

3. Promote adequate nutrition o To provide nutrition by acting as a temporary feeding

a. Administer feeding with client in high Fowler’s tube.
b. position and keep head of bed elevated for 30 minutes o To irrigate the stomach and remove toxic substances,
after meals to prevent regurgitation. such as poisoning.
c. Maintain feeding at room temperature o
d. Ensure that prescribed amount of feeding be given
within prescribed amount of time.
e. Weigh client daily
f. Monitor I and O until feedings are well tolerated TYPES:
g. Monitor for signs of dehydration
A. LEVIN
4. Check the PEG tube daily.
 single lumen, non vented
a. Check the length of the tube from the end to where it
goes into the body. If it gets longer, it may be at risk for  Used to removed gastric contents (aspiration) via intermittent
coming out. If it gets shorter, let your healthcare suction to provide tube feedings.
provider know right away.
b. Check the bumper (piece that goes around the tube,
next to the skin). It should be snug against the skin.

FEEDING

 Bolus feeding
o formula is given over a short period of time.

 Intermittent feeding
o is scheduled for certain times throughout the day. B. SALEM SUMP NASOGASTRIC TRUBE

 Continuous feedings
o run all the time.

 Use a feeding syringe.

o Connect the feeding syringe to the end of the PEG
tube.

 Use a gravity drip bag.

o Connect the tubing from the gravity drip bag to the end
of the PEG tube. Pour the formula into a gravity drip
bag. Hang the bag on a medical pole, a hanger, or
other device.

 Use a feeding pump.

o an electric pump to control the flow of the formula into
your PEG tube.
INSERTION OF NASOGASTRIC TUBE

1. Explain the purpose of the tube and the procedure for insertion.
2. Measure the tube:
o distance from the tip of the nose to the ear lobe plus the
distance from the earlobe to the tip of the xiphoid

 during insertion
o Instruct the client to bend head forward if possible
o Instruct the client to swallow (epiglottis closes
thus preventing the NG tube from slipping into the
trachea)
NASOGASTRIC TUBE
NGT: NURSING CARE
 Soft rubber or plastic tube inserted through a nostril and into the
stomach Monitor functioning of system and ensure patency of the NGT.

 PURPOSE: 1. Assess the position:

o To decompress the stomach by removing fluids and/or  aspirate gastric contents to confirm that the tube is in
gas to promote abdominal comfort. the stomach
o To decrease the risk of aspiration  Inject 10 ml of air through tube and auscultate for rapid
o To allow surgical anastomoses to heal without influx.
distention
2. Check that the tubing is free of kinks
o To administer medications to clients who are unable to 3. Record amount, color and odor of drainage
swallow.

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 ADULT GASTROINTESTINAL DISORDER

Provide measures to ensure maximal comfort.

o Apply water soluble lubricant to lips prevent dryness.

o Keep nares free from secretions.
o Provide periodic warm saline gargles to prevent dryness.
o Provide frequent mouth care with toothbrush/toothpaste or
flavoured mouthwashes.
o Elevate head and chest during and for 1-2 hours after
feedings to prevent reflux (most comfortable position when
suction is used)

Monitor and maintain fluid and electrolyte balance

a. Assess for signs of metabolic alkalosis – suctioning causes

excessive loss of HCl and potassium.
b. Administer fluids as ordered
c. If suction used, irrigate tube with NSS to decrease sodium
loss
d. Keep accurate I and O
e. Monitor Lab. Values and electrolytes frequently

INTESTINAL TUBE

o Intestinal tube is passed nasally into the small intestine

o Uses:
 To decompress the bowel
 To remove intestinal contents
 Decompression of post-op edema at the surgical site.

o NURSING Care
1. Facilitate placement of tube
a. position client high fowler’s during insertion
b. continuously monitor tube markings
c. Tape tube in place only after placement in
duodenum is confirmed.
2. Provide measures for maximal comfort

EARLIS