COLONGIOGRAM/COLON ANGIOGRAPHY

DEFINITION

X ray study of the blood vessels in the colon. It uses a radiopaque substances, or dye to make vessels
visible under x ray.

PURPOSE

 Used to detect abnormalities or blockages in the blood vessels( called occlusions).

 Used to detect anuerysm, tumor, blood clot, or arteriovenous malformations in the colon

INDICATION

 Aneurysm- an area of a blood vessel that bulges or balloons out

 Gastrointestinal bleeding

CONTRAINDICATION

 Patients with kidney disease or injury may suffer further kidney damage from the contrast
mediums used for angiography.
 Patients who have blood clotting problems
 Have known allergy to contrast mediums
 Those who are allergic to iodine, a component of contrast mediums, may also not be suitable
candidates for an angiography procedure
 Pregnant women are also advised to avoid this procedure

DISADVANTAGES

 It involves puncturing of an artery, internal bleeding or hemorrhage are possible

 Infection of the puncture site or bloodstream
 A stroke or heart attack may be triggered by an angiogram if blood clots or plaque on the inside
of the arterial wall are dislodged by the catheter and form a blockage in the blood vessels or
artery
 The colon may also be irritated by the movement of the catheter through its walls during the
procedure
 Patient may develop an allergic reaction to contrast medium used

PATIENT’S PREPARATION

 Prior to the angiography procedure, patients will be briefed on the details of the test, the
benefits and risks, and the possible complications involved, and asked to sign an informed
consent form.
 Patients are advised to stop eating and drinking 8 hours prior to the procedure
 Jewelries are removed before the procedure and change into the hospital gown
 A sedative may be administered to relax the patient for the procedure
 An IV line may be inserted into a vein in the patient’s arm before the procedure begins in base
medication or blood products are required during the procedure

NURSING RESPONSIBILITY

 We are primarily responsible for the patient’s preparation, monitoring and documentation of
each procedure.
 Our role would include screening for any potential contraindication to contrast
 Starting IV access and monitoring the patient during injection of contrast
  Vital signs taking and monitoring for signs of hemorrhage
 Contrast administration and patient assessment are the main nursing responsibilities.

ABDOMINAL ULTRASOUND

(LIVER, PANCREAS, AND HEPATOBILIARY TREE)

DEFINITION

is a form of medical ultrasonography (medical application of ultrasound technology) to visualise

abdominal anatomical structures. It uses transmission and reflection of ultrasound waves to visualise
internal organs through the abdominal wall (with the help of gel which helps transmission of the sound
waves).

PURPOSE

Used to diagnose abnormalities in various internal organs, such as the kidneys, liver, gallbladder,
pancreas, spleen and abdominal aorta. If Doppler imaging is added, the blood flow inside blood vessels
can be evaluated as well (for example, to look for renal artery stenosis).

INDICATION

Commonly used in the setting of:

 abdominal pain
 Suspicion of enlargement of one or more organs
 Tumors
 abdominal trauma
 an obvious or suspected abdominal mass

Liver

 In patients with deranged liver function tests

 Hepatomegaly

Pancreas

 Abnormal pancreatic enzymes(pancreatic amylase and pancreatic lipase)

Hepatobiliary tree

 Gallbladder or bile duct diseases

CONTRAINDICATION

Circulatory Problems

Anyone with circulatory problems, such as deep vein thrombosis or occlusive vascular disease, avoid
getting ultrasound treatments on any part of the body. Because ultrasounds can speed up circulation
and move blood flow to a specific area, a major problem can occur if someone with a circulatory
problem had an unknown blood clot, for example, which could be moved toward the heart or the brain
by use of an ultrasound.
Infections

Anyone who has an acute infection, whether in the bone or in tissue, should not receive an ultrasound.
It states that getting an ultrasound when you have an infection would increase blood flow to the
infected area, which can force pus out of the infection and into the surrounding areas. This would cause
the infection to spread and be perpetuated instead of healed.

Pacemakers

Anyone who has a cardiac pacemaker should not get an ultrasound in the thoracic area. An ultrasound
too close to the heart could alter the speed at which the pacemaker functions, causing irregular
heartbeats. Irregular heartbeats can be very dangerous, especially for people who have heart problems
or pacemakers. People with pacemakers can get ultrasounds in the lower extremities, but they may
want to avoid them altogether.

People with Diminished Sensitivity to Pain

Although it is not a common disorder, some people have a diminished sensitivity to pain or do not feel
pain at all. This could cause health problems in certain situations. People with diminished sensitivity to
pain do not get any ultrasounds because the treatment may be set at an intensity that is too high for
them and they would not be able to realize it. This could lead to burns or other injuries from the
ultrasound.

ADVANTAGES

This procedure could be performed:

 Quickly
 Bedside
 Involves no exposure to x-rays(which makes it useful to pregnant women)
 Inexpensive compared to other often-used techniques such as computed tomography (CT scan)
of the abdomen

DISADVANTAGES

 Troublesome imaging if a lot of gas or fats is present inside the bowels

 Quality of the imaging depends on the experience of the person performing it

PATIENT’S PREPARATION

Preparation for the procedure depends on the nature of the problem and your age. Usually patients are
asked to not eat or drink for several hours before the examination. Your health care provider will advise
you about specific preparation.

NURSING RESPONSIBILITIES

 For best visualization, schedule abdominal ultrasonography before any examinations that use
barium.
 Drink five to six full glasses of fluid approximately 1 to 2 hours before the test.
 Explain that the gel is applied over the area where the transducer is placed.
 ABDOMINAL X-RAY
DEFINITION

a test that can be carried out quickly and easily in an emergency department.

PURPOSE

The test can rule out major illnesses such as a small or large bowel obstruction, quickly and
effectively.

INDICATION

 Diagnose a pain in the abdomen or unexplained nausea

 Identify suspected problems in the urinary system, such as a kidney stone or blockage in the
intestine
 Locate an object that has been swallowed

CONTRAINDICATION

There are no absolute contraindications, but, if possible, abdominal X-ray should be avoided in
females until the end of reproduction period and pregnant women to prevent radiation exposure

ADVANTAGES

 There is no discomfort

DISADVANTAGES

 Pregnant women and children are more sensitive to the risks of the x-ray. Women should
tell the health care provider if they are, or may be, pregnant.
 The test is not usually recommended for pregnant women. The ovaries and uterus cannot
be shielded during the abdominal x-ray because of their location.
 Men should have a lead shield placed over the testes to protect against the radiation.

PATIENT’S PREPARATION

No preparation is needed for the investigation.

NURSING REPONSIBILITIES

 Assess vital signs before the examination to provide a baseline and to help to detect
changes in the client’s condition during and after the procedure
 Remove any metal items such as the religious medal or clothing that contains metal such as
the hooks and eyes on a bra. Metal produces a dense image that may be confused with a
tissue abnormality
 Request a lead apron or collar to shield a fetus or vulnerable body parts during x-rays.

THYROID ULTRASOUND
DEFINITION

A thyroid ultrasound is an imaging method used to see the thyroid -- a gland in the neck that
regulates metabolism.
 PURPOSE

It is usually done when you have a growth on your thyroid gland. The exam can help tell the
difference between a sac containing fluid (cyst) and abnormal tissue that may or may not be
cancerous (a tumor).

INDICATION

 Pain in the anterior neck

 Swelling in the anterior neck
 Symptoms of abnormal thyroid hormone:

1. Hypothyroidism -- fatigue, cold intolerance, weakness, depression, hair thinning, weight gain,
muscle cramps
2. Hyperthyroidism -- nervousness, inability to sleep, tremors, sweating, heat intolerance, weight
loss, palpitation

 Symptoms of abnormal parathyroid hormone:

1. Hypoparathyroidism -- muscle spasm, irritability, lack of energy

2. Hyperparathyroidism -- kidney stone, weight loss, muscle weakness, numbness

 To guide invasive procedures -- needle biopsy (i.e., thyroid cancer), sampling or withdrawal of
fluid (abscess, cyst)

ADVANTAGES

This procedure could be performed:

 Quickly
 Bedside
 Involves no exposure to x-rays(which makes it useful to pregnant women)
 Inexpensive compared to other often-used techniques such as computed tomography (CT scan)
of the abdomen

DISADVANTAGES

 Troublesome imaging if a lot of gas or fats is present inside the bowels

 Quality of the imaging depends on the experience of the person performing it

PATIENT’S PREPARATION

 No special preparation is needed.

 You should wear comfortable, loose-fitting clothing.
 You may need to take off you clothes and jewelry, and put on a hospital gown.
 Tell the sonographer, sonologist, or physician sonologist conducting the examination about any
pain, bleeding, or any other symptoms you might have. Also, telling the examiner about past
ultrasounds and surgeries is helpful, and sometimes it is crucial information

NURSING RESPONSIBILITIES

 For best visualization, schedule abdominal ultrasonography before any examinations that use
barium.
 Explain that the gel is applied over the area where the transducer is placed.
 E.VISUALIZATION

ESOPHAGOSCOPY

DEFINITION

  Examination of the esophagus using an esophagoscope. An esophagoscope is a thin, tube-like

instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked
under a microscope for signs of disease.

PURPOSE

 helpful for the diagnosis of inflammation of the esophagus

 detect early cancers too small
 needed for treatment, such as removal of swallowed objects and polyps and stretching of
narrowed areas of esophagus

INDICATION

 dysphagia (difficulty in swallowing)

 hoarseness
 breathing difficulties
 used to obtain a biopsy (tissue sample) of a benign or malignant growth.

CONTRAINDICATION

 presence of aneurysm
 extensive esophageal varicosities
 acute necrotic or corrosive esophagitis
 Water starvation
 Un co-operative patient.

ADVANTAGES

 extremely worthwhile and safe procedure

 Painless
 Done under a light sedative as a day-case patient in a specialised endoscopy unit

DISADVANTAGES

 perforation in which a small tear through the wall may allow leakage of digestive fluid
 aspirating the fluid until the opening seals or may require surgery.
 Bleeding may occur from the site of biopsy or polyp removal
 Localized irritation of the vein may occur at the site of medication injection
 tender lump develops

PATIENT’S PREPARATION

 You should not eat for 4-6 hours before the test. The stomach needs to be empty. (Small sips of
water may be allowed up to two hours before the test.)
 If you have a sedative you will need somebody to accompany you home.
 Advice about medication which may need to be stopped before the test.
NURSING RESPONSIBILITY

BEFORE THE PROCEDURE

 Ensure that the client’s stomach must be empty of advise the client to have nothing to eat or
drink starting at the midnight prior to procedure
 In diabetic patients, advise them to stop taking insulin until after the procedure.
 IV insertion
 Ask the patient to sign an informed consent
 Monitor the vital signs of the patient

DURING THE PROCEDURE

 Assist the patient in the proper position (left side)

AFTER THE PROCEDURE

 Advise the patient to have nothing to eat or drink 1-2 hours and until gag reflex returns
 Inform the patient that he/she may have temporary sore throat
 Tell the patient to do not attempt to drive, operate machinery or return to work on the day of
the examination
 Tell the patient to report the doctor if these symptoms occur: Severe pain, Black, tarry stool,
Vomiting blood, Difficulty swallowing, Difficulty breathing

GASTROSCOPY
DEFINITION

an examination of the inside of the gullet, stomach and duodenum. It is performed by using a thin,
flexible fibre-optic instrument that is passed through the mouth and allows the doctor to see whether
there is any damage to the lining of the oesophagus (gullet) or stomach, and whether there are any
ulcers in the stomach or duodenum.

PURPOSE

The doctor can study the mucous membrane of the stomach from the top to the bottom, and see
irritation, wounds, or tumours.

INDICATION

 recurring indigestion
 recurring heartburn
 pains in the upper abdomen
 repeated vomiting
 difficulty swallowing
 other symptoms thought to be coming from the upper gut.

CONTRAINDICATION

 Acute myocardial infarction

 Hypoxemia with respiratory distress
 Hypotension and shock, regardless of etiology
 Massive upper GI bleeding with hypotension where emergency surgery is clearly appropriate.
 Uncontrolled hypertension
  Un cooperative patient

ADVANTAGES

 Painless
 Done under a light sedative as a day-case patient in a specialised endoscopy unit

DISADVANTAGES

 mild sore throat for a day or so afterwards

 feel tired or sleepy for several hours if patient have a sedative
 slightly increased risk of developing a chest infection or pneumonia
 causes some damage to the gut(bleeding, infection, and rarely, perforation)

PATIENT’S PREPARATION

 You should not eat for 4-6 hours before the test. The stomach needs to be empty. (Small sips of
water may be allowed up to two hours before the test.)
 If you have a sedative you will need somebody to accompany you home.
 Advice about medication which may need to be stopped before the test.

NURSING RESPONSIBILITIES

BEFORE THE PROCEDURE

 Ensure that the client’s stomach must be empty of advise the client to have nothing to eat or
drink starting at the midnight prior to procedure
 In diabetic patients, advise them to stop taking insulin until after the procedure.
 IV insertion
 Ask the patient to sign an informed consent
 Monitor the vital signs of the patient

DURING THE PROCEDURE

 Assist the patient in the proper position (left side)

AFTER THE PROCEDURE

 Advise the patient to have nothing to eat or drink 1-2 hours and until gag reflex returns
 Inform the patient that he/she may have temporary sore throat
 Tell the patient to do not attempt to drive, operate machinery or return to work on the day of
the examination
 Tell the patient to report the doctor if these symptoms occur: Severe pain, Black, tarry stool,
Vomiting blood, Difficulty swallowing, Difficulty breathing

DUODENOSCOPY
DEFINITION

Examination of the luminal surface of the duodenum with an endoscope.

PURPOSE

It is used to localise, identify, and photograph pathologic alterations, to obtain biopsy material and
perform other surgical interventions, and for delivery of medication
INDICATION

 recurring indigestion
 pain in the abdomen
 repeated vomiting
 other symptoms thought to be coming from the upper gut.

CONTRAINDICATION

 must be modified in pregnant women

ADVANTAGES

 Painless
 Done under a light sedative as a day-case patient in a specialised endoscopy unit

DISADVANTAGES

 perforation in which a small tear through the wall may allow leakage of digestive fluid
 aspirating the fluid until the opening seals or may require surgery.
 Bleeding may occur from the site of biopsy or polyp removal
 Localized irritation of the vein may occur at the site of medication injection
 tender lump develops

PATIENT’S PREPARATION

 You should not eat for 4-6 hours before the test. The stomach needs to be empty. (Small sips of
water may be allowed up to two hours before the test.)
 If you have a sedative you will need somebody to accompany you home.
 Advice about medication which may need to be stopped before the test.

NURSING RESPONSIBILITIES

BEFORE THE PROCEDURE

 Ensure that the client’s stomach must be empty of advise the client to have nothing to eat or
drink starting at the midnight prior to procedure
 In diabetic patients, advise them to stop taking insulin until after the procedure.
 IV insertion
 Ask the patient to sign an informed consent
 Monitor the vital signs of the patient

DURING THE PROCEDURE

 Assist the patient in the proper position (left side)

AFTER THE PROCEDURE

 Advise the patient to have nothing to eat or drink 1-2 hours and until gag reflex returns
 Inform the patient that he/she may have temporary sore throat
 Tell the patient to do not attempt to drive, operate machinery or return to work on the day of
the examination
 Tell the patient to report the doctor if these symptoms occur: Severe pain, Black, tarry stool,
Vomiting blood, Difficulty swallowing, Difficulty breathing
 COLONOSCOPY
DEFINITION

a procedure that enables an examiner (usually a gastroenterologist) to evaluate the inside of the colon
(large intestine or large bowel). The colonoscope is a four foot long, flexible tube about the thickness of
a finger with a camera and a source of light at its tip. The tip of the colonoscope is inserted into the anus
and then is advanced slowly, under visual control, into the rectum and through the colon usually as far
as the cecum, which is the first part of the colon.

PURPOSE

done to investigate the cause of blood in the stool, abdominal pain, diarrhea, a change in bowel habit, or
an abnormality found on colonic X-rays or a computerized tomographic (CT) scan.

INDICATION

 previous history of polyps or colon cancer

 certain individuals with a family history of some types of non-colonic cancers or colonic
problems that may be associated with colon cancer (such as ulcerative colitis and colonic polyps)
 abdominal pain
 diarrhea
 a change in bowel habit

CONTRAINDICATION

 must be modified in pregnant women

ADVANTAGES

It is the best method available to detect, diagnose, and treat abnormalities within the colon

DISADVANTAGES

 slight discomfort maybe felt such as a feeling of pressure, cramping, and bloating in the
abdomen
 Bleeding may occur at the site of biopsy or removal of polyps
 perforation or a tear through the colonic wall

PATIENT’S PREPARATION

 the patient’s colon must be clean or they are required to drink a large volume of a special
cleansing solution or several days of a clear liquid diet and laxatives or enemas prior to the
examination
 to inform the physician of what medication is taking
 to inform the physician of allergies and any other major illnesses
 A laxative or an enema may be required the night before colonoscopy
 all solids must be emptied from the gastrointestinal tract by following a clear liquid diet for 1 to
3 days before the procedure. Patients should not drink beverages containing red or purple dye.
Acceptable liquids include: fat-free bouillon or broth, strained fruit juice, water, plain coffee,
plain tea, sports drinks, such as Gatorade & gelatin
NURSING RESPONSIBILITIES

BEFORE THE PROCEDURE

 Ensure that the client’s stomach must be empty of advise the client to have nothing to eat or
drink starting at the midnight prior to procedure
 In diabetic patients, advise them to stop taking insulin until after the procedure.
 IV insertion
 Ask the patient to sign an informed consent
 Monitor the vital signs of the patient
  Aspirin products, blood thinners (warfarin [Coumadin], etc.),arthritis medications, insulin, and
iron preparations are examples of medications that may require special instruction and be
informed to the physician.
 Instruct the client to inform the physician of allergies and any other major illnesses
 Instruct the client to avoid certain foods for a couple of days prior to the procedure, such as
stringy foods, foods with seeds, or red Jello.

DURING THE PROCEDURE

 Assist the patient in the proper position (left side or back)

AFTER THE PROCEDURE

 The patient should be able to eat upon returning home

 Tell the patient to do not attempt to drive, operate machinery or return to work on the day of
the examination
 Tell the patient to report the doctor if these symptoms occur: severe abdominal pain, rectal
bleeding of more than half a cup, or fever and chills