GASTROINTESTINAL SYSTEM
Assessing the Abdomen:
 Supine with knees flexed (dorsal recumbent position)
 Sequence: Inspection, Auscultation, Percussion,
Palpation (IAPePa)
 Auscultation before Percussion and Palpation
because it can increase intestinal activity-altering
bowel sounds.
 No abdominal palpation with tumor of the liver
or kidney to prevent rupture of the tumor and
massive internal hemorrhage
 Inspection – condition of the skin and contour.
Normally, peristalsis movements are not visible.
 Auscultation – 5 to 35/minute
 Rapid, high-pitched, low bowel sounds are
hyperactive (e.g., in gastroenteritis)
 Hypoactive bowel sounds at a rate of one every
minute or longer (paralytic ileus) or after bowel
surgery
 Percussion- avoid abdominal percussion with
suspected abdominal aneurysms (AAA) and with
abdominal organ transplants
Laboratory Tests:
CEA (Carcinoembryonic Antigen)
• + in Colorectal Ca
• Avoid Heparin for 2 days
• Specimen is obtained by venipuncture
Xylose Absorption Test
 Initial blood/urine specimen are collected
 NPO for 10-12 hours
 Blood/urine levels are measured
 Done for diagnosis and malabsorption
Exfoliative Cytology
 Done to detect malignant cells
 Written consent is obtained
 Liquid diet is given
 Upper Gl: Nasogastric tube (NGT) insertion is
done
 Lower Gl: Laxative the night before and enema
in the morning
 Cells are obtained from saline lavage - via NGT
for UGI / via proctoscope for LGI
Helicobacter pylori Test (H-Pylori test)
• Stool antigen tests –
• Stool polymerase chain reaction (PCR) test
• Breath test - swallow a pill, liquid or pudding
that contains tagged carbon molecules. If you
have an H. pylori infection, carbon is released
when the solution is broken down in your
stomach
•Upper endoscopy exam
Fecal Analysis
• Stool for Occult Blood (Guaiac Stool Exam)
 Done to detect Gl bleeding
 No red meats, poultry, fish, turnips,
horse radish, cauliflower, broccoli and
melon
 Red meats, poultry, fish contain
hemoglobin fibers which may be
mistaken as blood
 Turnips, horseradish, cauliflower,
broccoli and melon are high in
peroxidase and will cause false positive
result (the reagent used for the test is
hydrogen peroxide) D
 Vitamin C causes false negative
reading
 Withold for 48 hours: Iron, Steroids,
Indomethacin, Colchicine
•Stool for Ova and Parasites
 send fresh, warm stool specimen,
especially if the purpose of the test is to
detect amoebiasis
•Stool Culture - use sterile test tube and cotton-
tipped applicator to collect specimen
•Stool for lipids - done to assess fats in the diet
 To assess the ability of the GI to
metabolize fats
 Avoid alcohol for 3 days. Alcohol
mobilizes fats. This will cause false
positive results
 72 hour stool is collected. Store the
specimen on ice
Gastric Analysis
•Measures secretion of HCI and pepsin
•NPO for 12 hours
•NGT is inserted, connected to suction
 •Gastric contents are collected every 15 minutes
to 1 hour
Increased HCL: Zollinger-Ellision Syndrome
Duodenal Ulcer
Decreased HCL: Gastric Ca
Pernicious Anemia
Bernstein Test (Acid Perfusion Test)
• To assess if chest pain is related to gastroesophageal
reflux (GERD)
• NPO 6-8 hours
• NGT insertion
• Alternate installation of NSS and 0.1% HCL
• If no pain is experienced (-) for gastroesophageal reflux, if
pain is experienced (+) gastroesophageal reflex
• Antacid is administered after the procedure to relieve
discomfort
Radiographic Tests
 Scout Film/Flat Plate of the Abdomen
• Plain X-ray of the abdomen
• Avoid belts or jewelries. Metals are radiopaque
 UGIS (Upper GI Series/Barium Swallow)
• To visualize the esophagus, stomach,
duodenum, and jejunum
• NPO for 6-8 hours
• Barium Sulfate (BaSO4) per orem is
administered. Barium sulfate is white, chalky
substance.
• X-rays are taken on standing, lying position
• After the procedure:
•Laxative is administered, BaSO4 causes
constipation
•Increase fluid intake to prevent constipation
• Inform client that stools are white for 24-72
hours
• Observe for Barium impaction manifestations:
distended abdomen, constipation
 LGIS (Lower GI Series/Barium Enema)
• To visualize the colon
• Low residue/clear liquid diet for 2 days
• Laxative for cleansing the bowel
• Suppository/cleansing enema in A.M.
• BaSO4 is administered per rectum
 Computed Tomography
• Uses beam of radiation to assess cross sections
of the body
• Clear liquid diet in the morning
• If the procedure is done with contrast medium
•NPO for 2-4 hours
•Assess for history of allergy to seafoods and
iodine
• Inform the client that the procedure is painless
• Assess for claustrophobia
• Advise to remain still during the entire
procedure• Care after the procedure – same as
UGIS
 Endoscopy
• UGI Endoscopy
 Direct visualization of esophagus, stomach, and
duodenum
 Obtain written consent
 NPO for 6-8 hours
 After the procedure:
 Place the client on side-lying position to prevent
aspiration
 NPO until gag reflex returns
 Assess: bleeding, neck crepitus, fever,
neck/throat pain, dyspnea, dysphagia,
back/shoulder pain
 Avoid driving for 12 hours if sedative was used
LGI Endoscopy
• Proctosigmoidoscopy (sigmoid, rectum)
• Clear liquid diet 24 hours before the procedure
• Administer cathartic/laxative as ordered
• Cleansing enema
• Place in knee-chest/lateral position during the procedure
• Assess for signs of vasovagal stimulation. The GI tract is
supplied by the vagus nerve
 After the procedure: Supine position for few
minutes to prevent postural hypotension
  Assess for signs of perforation – bleeding, pain,
and fever
 Hot Sitz bath to relieve discomfort in the
anorectal area

Colonoscopy

• Preparation of the client is same as proctosigmoidoscopy

• Sedation is done to relax the client

• Left side, knees flexed

• After the procedure:

 Monitor VS (bradycardia, hypotension)

 Assess for signs of perforation

Ultrasonography of the Abdomen

• NPO for 8-12 hours

• Laxative as ordered (to reduce bowel gas) NEURODIAGNOSTIC TEST

MRI (Magnetic Resonance Imaging) • Skull Films

• Produces cross-sectional images of organs by using X-ray visualization of the skull. It confirms skull
magnetic fields fracture
Remove metallic items from hair
• NPO for 6-8 hours
• Spine Films
• Instruct to remain still during the procedure
X-ray visualization of the spine
• Inform the procedure ay last for 60-90 minutes Remove metallic item from around the neck/body
Avoid flexion/rotation of spine when fracture is
• Remove jewelries/metals
suspected
• Contraindications:

 Pacemakers
• CAT Scan
 Aneurysm clips
 Orthopedic screws Computerized reconstruction of body part by
passage of multiple X-ray beams
GLASGLOW COMA SCALE Remove metallic objects from hair. These may be
mistaken as lesions
Must remain absolutely still during entire
procedure
Assess for claustrophobia. Procedure is done in a
tunnel-like device.
Sedation is done if the client is restless or is
unable to remain still
Observe for allergic reaction to iodinated contrast
material
Treatment may include injectable epinephrine
and antihistamines, as well as the use of IV fluids
for low blood pressure and shock

• Electroencephalography (EEG)

Graphical recording of spontaneous electrical

impulses of the brain from scalp electrodes
 Hair shampoo before the procedure to remove
oil/sprays. For better transmission of electrical
impulses of the brain
Avoid caffeine and other stimulants,
anticonvulsants for at least 24 hours before the
procedure.
Wash hair after the procedure to remove EEG
paste
• Electromyography (EMG)
Records electrical activities in muscles at rest,
during voluntary contraction, and in response to
electrical stimulation
NCV studies, record speed of conduction in
motor and sensory fibers of peripheral nerves
Detects neuromuscular disorders, e.g.,
Myasthenia Gravis, Parkinson’s disease, etc.
May be with mild discomfort due to the needles
Time is approximately 45 minutes for one muscle
• Brain Scan
Involves administration of radionuclide (oral, IV,
intra-arterial, inhalation) agents
Detects brain tumors, cerebral vascular diseases
Radiation hazard is negligible
Time is about 45 minutes, procedure is painless
Must lie still during the procedure
• Cerebral Angiography (Arteriogram)
Intra-arterial injection of contrast medium with
simultaneous radiographs of head and neck to
visualize intracranial and extracranial vessels
Before the procedure:
May experience hot, flushing sensation as dye is
injected
Contrast material injected into femoral, brachial,
or carotid arteries
NPO 4-6 hours
IV fluids to ensure adequate hydration
Premedicate as ordered
• Cerebral Angiography (Arteriogram)
After the Procedure:
Observe for the following:
Arterial puncture site for bleeding or hematoma,
apply pressure dressing or small sandbag or ice
pack to the area
Pulse distal to the puncture site, diminished or
absent pulse may indicate impaired circulation
due to blockage of vessel by thrombus or by
hematoma
Affected limb for color and temperature. Pallor,
cyanosis, and cold skin indicate impaired
circulation.
Bradycardia and hypotension due to vagal
irritation in carotid artery
• Cerebral Angiography (Arteriogram)
After the Procedure:
Observe for the following:
Any changes in neurological status; risk of stroke
or ischemia following angiography secondary to
embolus, thrombus, or vasospasm
Bed rest (may have head elevated) for 6-8 hours;
if femoral puncture, must keep leg extended and
immobile for several hours to prevent
dislodgment of clot
• Lumbar Puncture (Lumbar Tap)
Introduction of needle into spinal subarachnoid
space usually at L3, L4, L5, L6, S1, intervertebral
space, to assess cerebrospinal fluid
Before and during the procedure:
Encourage client to void before the procedure to
promote comfort
Assist client to assume “fetal position” (lateral
recumbent position with back arched, head and
knees flexed on chest) to widen intervertebral
spaces. This facilitates insertion of the spinal
needle
Local anesthetic is used to numb lumbar area
Label the specimen collected (e.g., 1, 2, 3)
After the Procedure:
Lie flat in bed for 6-8 hours (may turn to sides) to
prevent spinal headache, due to leakage of CSF
through the puncture hole
Headache, treated with bedrest, analgesics, and
ice to head
Observe for changes in neurological status
Encourage fluids if not contraindicated
 Normal values for CSF:
 Pressure: 75-180 mmH20 or 0-15 mmHg.
Elevated in increased ICP
 Glucose: 50-80 mg/dl. Decreased in
infection
 Protein: 20-50 mg/dl. Elevated in infection
or presence of tumor in the brain or spinal
cord
Thyroid Function Tests
a. Thyroid – Stimulating Hormone Assay
INCREASED: Hypofunction of thyroid gland; primary
hypothyroidism
DECREASED: Pituitary disorders; hyperthyroidism
b. Radioactive Iodine Uptake (RAtU)
: Hyperthyroidism
: Hypothyroidism Hypoparathyroidism

Patient Teaching: b. Qualitative Urinary Calcium (Sulk witch Test)

 Radioactive dose is small and harmless  Collect urine specimen

 Contraindicated in pregnancy
 Seafoods may elevate results
 Collect 24-hour urine specimen after oral tracer
dose is given
 Thyroid is scanned after 24 hours
 Fine white precipitate should form when Sulk
witch reagent is added to urine specimen
 Absent or decreased precipitate indicates low
serum Calcium and hypoparathyroidism

c. Thyroid antibodies
c. Quantitative Urinary Calcium (Calcium Deprivation
: Thyroiditis Test)
d. T3, T4 Radioimmunoassay  Collect 24 hour urine specimen
: Hyperparathyroidism
Hyperthyroidism
: Hypoparathyroidism
Hypothyroidism
d. Serum Phosporous
e. Free Thyroxine Concentration
 Collect venous blood specimen
T3 Resin Uptake : Hypoparathyroidism
: Hyperparathyroidism
Thyroid Binding Globulins
e. Serum Alkaline Phosphatase
Hyperthyroidism
 Collect venous blood specimen
Hypothyroidism
: Hyperparathyroidism

: Hypoparathyroidism
Diagnostic Imaging Studies

a. Thyroid Scan f. Parathormone (PTH) Radioimmunoassay

 Radioactive iodine taken orally; dose is harmless  Collects venous blood

 Scanning done after 24 hours
 Avoid iodine containing foods, dyes, medications : Hyperparathyroidism
 Cold nodules: cancer
 When elevated in conjunction with serum
 Hot nodules: benign
calcium levels, this is the most specific test for
b. Ultrasound hyperparathyroidism

No special preparation Diagnostic Tests of Adrenocortical Disorders

c. Magnetic Resonance Imaging (MRI) a. Cortisol level with dexamethasone suppression test

 Test cannot be done in clients with metal
implants (e.g., pacemakers, arthroplasties, skull
plates)
 Assess for allergy to contrast media
 Give dexamethasone before phlebotomy to suppress
diurnal formation of ACTH
: Pituitary tumor, Cushing’s syndrome

d. Computed Tomography : Addison’s disease

 If contrast medium is used, note allergy history b. Cortisol plasma level

Diagnostic Tests of Parathyroid Disorders  Fasting is required, patient should be on bed for 2 hours
before the test because activity
a. Total Serum Calcium
increases cortisol level
 Venous blood is collected
: Cushing’s
Hyperparathyroidism
 : Addison’s  In pheochromocytoma, clonidine does not
suppress the release of catecholamines
c. 17 – Hydroxysteroids  Normal response: 2-3 hours after a single oral
dose of Clonidine, the total plasma
 24 hour urine collection to be kept on ice catecholamine value decreases at least 40% from
the client’s baseline
: Cushing’s disease
 CT scan, MRI and Ultrasound
: Addison’s disease
 To localize the pheochromocytoma

Diagnostic Tests of Pancreatic Disorders (Diabetes

d. 17 – Ketosteroids Mellitus)

 24 hour urine test; keep collection cold; may need a. FBS (Fasting Blood Sugar); FBG (Fasting Blood
preservative Glucose)

: Cushing’s disease  Normal: 70-110 mg/dl

: Addison’s disease
Diagnostic Tests of Adrenal Medullary Disorders
a. Vanillylmandelic Acid Test (VMA test)
 VMA is a metabolite of epinephrine
 24-hour urine specimen is collected
 Instruct the client to avoid the following which
may alter result:
O Coffee
O Chocolate
O Tea
O Bananas
O Vanilla
O Aspirin
Normal Value: 0.7 – 6.8 mg/24 hour
b. Total Plasma Catecholamine
 Patient should lie supine and rest for 30 minutes
 Butterfly needle is inserted 30 minutes before
blood specimen is collected (to prevent elevation
of catecholamine levels by the stress of
venipuncture)
 Normal values:
 Epinephrine: 100 pg/ml (590 pmol/L)
Norepinephrine: 100-550 pd/ml (590-3240
pmol/L)
 DM: 140 mg/dl for 2 readings
b. 2-hour PPBS (Postprandial Blood Sugar)
 Initial blood specimen is withdrawn
 100 gm. of carbohydrate in diet is taken
 2 hours after meal, blood specimen is withdrawn:
blood sugar returns to normal level
c. OGTT/GTT (Oral Glucose Test/Glucose Tolerance Test)
 Take high carbohydrate diet (200 – 300 gm.) for
3 days
 Avoid alcohol, coffee and smoking for3 36 hours
before the test
 NPO for 10-16 hours
 Initial blood and urine specimen are collected
 150 to 300 gm. Of glucose per orem or IV is
given
 Series of blood specimen is collected after
administration of glucose (30 mins., 1 hour, 2
hours, hours, 3 hours, 4 hours, and 5 hours after)
 F glucose levels peak at higher than normal at 1,
and 2 hours after ingestion or injection of
glucose, and are slower than normal to return to
fasting levels, then DM is confirmed.
 Done when results of FBS and 2- hour PPBS are
borderline (high normal)
d. Glycosylated Hgb (HBA1C)
 Most accurate indicator of DM
 Reflects serum glucose levels for the past 3 to 4
months
 Normal value is 4% to 6% (up to 7%) for
nondiabetics
 The goal for the client with DM is 7.5% or less

 Clonidine Suppression Test

 Clonidine (Catapres), a centrally acting

adrenergic blocker suppresses the release of
catecholamines
 Excess glucose in the blood

Attaches to hemoglobin (hgb)

Hgb (component of rbc) lifespan is 90 – 120 days