Lipase – digestion of fat

Pancreatitis – increased levels of both amylase

and lipase

Pancreatic damage – decreased levels both

Can be:

- Traumatic damage
Diagnostic Tests: - Previous damage
- d/t meds

- A big umbrella for serum, blood,

imaging, urine  CEA, CA 19-9, alpha-fetoprotein
- Pt education has to be with the - For cancer
physician first - CEA (most common)
- Metabolism dx test = out-patient CEA (+) = cancer
CA 19-9 = tumor marker
(mutaas lang pag nay tumor)

Pwede CEA +, CA – pero not cea -, ca +

SERUM LABORATORY

– initial dx test

 Complete metabolic panel

o Blood chem (Philippines) STOOL TEST
o Complete metabolic panel
(abroad) - Small amount of specimen
- Random collection of specimen
Basic: FBS, Hba1c, total chole, hdl, ldl,
– patient should not unaware, not by sched,
triglyceride, serum creatinine
random
(additional: serum amylase lipase)
R: Basig pugngan, it will alter result
 Amylase and lipase
- Pancreatic function amylase for starch
lipase for fats  Fecalysis
-presence of ovum, consistency, color
Amylase -digestion of starch
p
 FOBT (Fecal Occult Blood Test)
– initial dx for patient that has risk for
bleeding that are not visible to the
naked eye
- Specially for colon cancer, lower bowels
(small intestine)
 Fecal immunologic test
- Detect globin protein in human
hemoglobin
 Stool DNA
- Detect DNA related to colon cancer
- Prone to colon cancer (female)
Mas fatal in male
Not detectable unless with accidental
detection
Stage 3 – reversible
Stage 4- irreversible
Increased fatality rate – because of late
detection
increased co2, if (–) H. Pylori = result
will show with ammonia)
 Abdominal ultrasonography
- Endoscopic ultrasonography
 Endoscopic ultrasonography NI
- 8-12 hrs. fasting
- Gallbladder = no fat intake the night
before
- if with barium, ultrasound first before
barium then pwede na another
ultrasound
- Sedated pt. = Assess level of
consciousness
- If stat CT scan, min 6 hrs.
 Genetic testing
- Only prep for the pt
- Risk assessment
- Preclinical diagnosis
- Prenatal diagnosis

 Breath test
- Hydrogen breath test
- Urea breath test
+ most common
+ Will break into 2 chemicals in the GI:
ammonia and co2

 For detection of H.Pylori

(ammonia is absorbed by the H.pylori,
so mabilin ang co2 and is absorbed by
the blood to the lungs = result is

! Pag involved ang GI – at least 8hrs ang fasting
IMAGING STUDIES
 Upper GI Tract Study
- Delineates entire GI tract with use of
contrast
- Anatomic disorders
- Can be fluoroscopic
Fluoroscopic – better and colorful
image
- Double-contrast studies
+ Single contrast – plain barium (swallowed
or enema)
+ Double contrast – thick barium first AND
after, gas
- Enteroclysis – not common
Mgt:
- NPO post-midnight
- No gum or smoke during NPO
Gum – stimulate peristalsis
Smoking – general negative effect on
the GI
- NO meds in the morning -purely NPO
- Inc OFI post-procedure – especially if
swallowed barium and contrast na
gipaagi sa dugo to minimize injury sa
kidney
- When inc crea, ga duha duha if ipa
barium
 Lower GI Tract Study
- Rectal installation of barium
- Double-contrast and water-soluble
contrast studies
- Water-soluble iodinated contrast agent
Water soluble – sa anus ipaagi
Mgt:
- Lower bowel cleansing
Cleansing:
+ PicoPrep – given night before or hrs before or
Dulcolax
- Low residue diet 1-2 dayse before (PRE)
- NPO post-midnight
CI:
- Active inflammation disease – basig pag
sulod dretso gawas
- Perforation - basig muderetso sa
peritoneum (Peritonitis)
 CT (Computed Tomography) and MRI
(Magnetic Resonance Imaging)
- CT scan – cheaper
- MRI -expensive and lesser availability;
better “enhanced” image
Commonly done in sports injury, muscle
tears apil image of the cranium
- Non-invasive images with or without
contrast
Mgt:
- Assess allergies: seafood and iodine
+ Usually given diphenhydramine (IV)
and epinephrine (IM) or hydrocortisone (150
mg IV)
 - Kidney protective measures Mgt:

+ Kidney protective (inc OFI, n-acetyl, diphen?) - evaluate colonic motility and defecation
process
- NPO 6-8 hours
- Claustrophobia - x-rays are taken every 24 hours until are
+ If claustrophobic (diphenhydramine) markers as passed usually for 4-5 days
– refer to the dr, never advice pt to tell
dr for meds
- Metals – risk for MRI

 The radiographic procedure designed to

study the large intestine is most
 PET (Positron Emission Tomography) commonly termed a barium enema.
- Produces image by detecting radiation Alternate designations include BE, BaE,
that doesn’t harm the body and lower GI series.
- Ginapangita is “hot spots” (when the
radiation introduced to the body
gathers in 1 part of the body)

 Scintigraphy
- Radionuclide testing
- Tagging of RBC and leukocytes
- Concentrations of blood cells are
detected at 24 and 48 hours interval
- Specific sa blood
- Used in adjunct to GI motility studies
ENDOSCOPIC PROCEDURES
 GI motility Studies  Upper GI
- Assess gastric emptying and colonic Fibroscopy/Esophagogastroduodenosco
transit time py
- Nay ipakaon and those food are tagged - Direct visualization and access of the
with markers and marked through upper GI tract
scanner and while naga lower ma - ERCP – endoscope with x-rays for
observe ang food hepatobiliary tract
- Pt is positioned under a scintiscanner
 Mgt:
Mgt:
- Left-side lying with right leg bent
- NPO 8 hours prior
anteriorly
- Local anesthetic to throat: atropine and
- Limited bowel prep
glucagon
R: because limited bowel access
- Left lateral position
- Assess VS
- Assess LOC and gag reflex after
- Post-procedure – assess for rectal
- Health teachings with watcher
bleeding or signs of perforation
 Fiberoptic Colonoscopy Rectal bleeding
- Diagnostic and screening
- Virtual colonoscopy - Infection
- Capsule colonoscopy (Capsule – purely - Foreign object entered
imaging)
- Fiberoptic colonoscopy same as EGD
but larger

Mgt:

- Cleansing of bowels
- Clear liquids at noon 1 day prior and
lavage solution at intervals over 3-4
hours  Small Bowel Studies
+ Lavage – fleet enema - Capsule endoscopy, double- balloon
- left-side lying position with legs up to - Capsule passes through 1-2 days and
the chest only diagnostic
- Complications - Purely diagnostic
- Assess LOC - Double-balloon enteroscopy causes
telescoping of small intestine
 Anoscopy, Proctoscopy, Sigmoidoscopy - NI are the same as other endoscopic
Anos – anus procedures

Procto -rectum  Endoscopy through an Ostomy

Sigmoidocscopy – sigmoid and descending - Through and ostomy stoma
colon - Visualize segment of the small and large
intestine
- Evaluation and direct observation - NI are the same as other endoscopic
- Sigmoidoscopy procedures
2 types:
rigid -stiff
Flexible or optic fiber
 > Gastric Analysis, Gastric Acid, Stimulation
Test, pH Monitoring

- secretory activity

- aspirate gastric contents every 15 mins for the

next hour

- given to patient with problems in gastric

motility
* Colonoscope -mataas but flexible

Mgt:

- NPO for 8-12 hours

- Meds that affect gastric secretion are
withheld for 24-48 hours
– antacids, etc
- Meds is introduced in stimulation tests
- Up to 48 hours for pH monitoring

 Laparoscopy (peritoneoscopy)
- Efficient, cost-effective, useful
- Pneumoperitoneum is done prior to
 Monometry and Electrophysiologic incising
Studies - Not for acute abdominal pain
- EM – evaluating GI motility disorders - Anesthesia and bowel decompression
- strength of the muscle
- A pressure-sensitive catheter inserted
through the nose and patient swallows
water
- -electrodes are placed and records up
to 24 hours

Mgt:

- NPO 8-12 hours prior

- Meds that affect motility are on hold
24-48 hours prior

+ loperamide mga ginapahinay ang

motility

FUNCTION TESTS FOR LIVER
 Serum Bilirubin Test
- Made by the liver excreted in the bile
Elevated = obstruction, processing problem
 Serum Albumin Test
- Low levels = problem in liver function
 International Normalized Ratio
- previously known as prothrombin time (PT)
- how long blood clots
- needs vitamin K and proteins
- prolonged clotting – liver disease
* Elevated bile - obstruction and processing
problem (the way bile is excreted)
LIVER ENZYMES
 Serum Alkaline Phosphatase Test
- Highest concentration in liver, liver
function, liver lesions
 Alanine Transaminase Test
- Also called SGPT
- Found in liver and released into the
blood after cell damage
- liver function
- evaluate treatment
 Aspartate Transaminase Test
- Also called SGOT
- Also indicate heart damage
- Liver, kidneys, pancreas, heart, skeletal
muscle, RBC released into blood after
liver or heart damage
 Gamma-glutamyl Transpeptidase Test
– recent alcohol ingestion
 - Made in liver, pancreas, biliary tract - indicate primary biliary cirrhosis, chronic
- Liver function, liver disease, alcohol active hepatitis, and autoimmune
ingestion

 Lactic Dehydrogenase Test

– protein (isoenzyme), involved in
metabolic processes
-very nonspecific liver test

> 5’- Nucleotidase Test

- specific to liver

Elevated = liver disease, cholestasis

+ Cholestatsis -no movement in the bile

PANCREATIC FUNCTION TESTS

 Serum Amylase, Serum Lipase

- Amylase for starch, lipase for fats
- Elevated = pancreatic disorder
- Below N = injury to pancreas

 Glucose, HBA1AC, Ketone Urine Test

- Function of pancreas through insulin
release

 Stool Elastase, Chymotrypsin,

Immunoreactive Trypsinogen, Fecal Fat
ADDITIONAL DIAGNOSTIC TESTS
- Decreased elastase, absent
 Alpha-fetoprotein chymotrypsin, elevated IRT and fat in
- Blood protein made by fetal tissues and feces = pancreatic insufficiency
tumors
- Predict liver cancer and monitor
effectiveness of therapies of cancer
- Elevated result = Naga grow pa na
tumor
- If developed na = di na elevated
- Starting tumor

 Serum Alpha-1 Antitrypsin Test (A1AT)

- Identify rare emphysema and rare
cirrhosis
Alpha-1 - Enzyme produced by the liver,
protects the lungs

> Mitochondrial Antibodies Test