Assessment of Patients with GI Disorders
History
 Demographic data, personal and family
history
 Previous GI disorders and surgery
 Change in bowel habits, GI bleeding,
Jaundice and weight loss, abdominal
pain, despepsia, gas, nausea and
vomiting, diarrhea, constipation, fecal
incontinence, Any medications taken
 Family history of GI disorders
DIET
 Usual foods and liquids that are
consumed
 Quality and quantity of foods
MEDICAL HX
 Illnesses and hospitalizations
 Medications used
 Allergies to foods
 Hx of cancer, ulcers, colitis
PSYCHOSOCIAL HX
 Occupation- meal times and travel
 Stress, alcohol and nicotine
Common Complaints
Abdominal pain
 A major symptom of GI disease
 Onset, Duration, Quality and
characteristics, Severity, pattern and
distribution of referred pain and its
location,
 Precipitating factors, Relieving factors
such as meals rest, activity and
defecation directly affects the pain
DYSPEPSIA/ INDIGESTION
 Upper abdominal discomfort associated
with eating, the most common symptom
of patients with GI dysfunction
 Epigastric pain, discomfort, fullness,
bloating, belching, heartburn and
regurgitation
 Affects 25% to 40% commonly occurs
with patients with GERD
 Fatty foods cause the most discomfort
because they remain in the stomach for
digestion longer than proteins and CHO
 Salads, highly seasoned foods may
cause GI distress
Intestinal Gas
 Accumulation of gas in the GI tract
result to belching (expulsion of gas from
the stomach through the mouth) or
flatulence (expulsion of gas from the
rectum)
 Gases in the small intestines pass in the
colon and releases as flatus
 Bloating, distention feeling of full gas
with excessive flatulence is a symptom
of food intolerance or gallbladder
disease
Nausea and Vomiting
 An uncomfortable sensation of
sickness that may or may not followed
by vomiting
 Can be triggered by odors, activity,
medications or food intake
 Emesis or vomitus may vary in color
and content and may contain
undigested food, blood or bilious
material mixed with gastric juices
CAUSES
 Visceral afferent stimulation like
dysmotility, peritoneal irritation,
infections hepatobiliary or pancreatic
disorders or mechanical obstruction
 CNS disorders- ICP, vestibular
disorders, infections, and psychogenic
disorder
 Irritation of chemoreceptors trigger zone
from radiation therapy and
chemotherapy
 Distention of the duodenum or upper GI
tract common cause of nausea
 Ingestion of substance- vomiting is a
protective response that limits the
noxious agents by emptying the stomach
content and secretions of small
intestines
5.Change in Bowel habits and Stool
Characteristics
 Common manifestation of GI disease
 Assess the color, frequency and
consistency of bowel movement
  Black tarry stools may indicate Upper
GI bleeding or from ingestion of iron
supplement
 Bright red blood in the stools may
indicate hemorrhoids and lower GI
bleeding
 Currant jelly stools (foul or purpled
colored jelly) indicate a massive
bleeding episode
PHYSICAL ASSESSMENT
Assessing Oral cavity-
Nursing Consideration:
 Dentures (if any) should be removed to
allow good visualization of the entire
oral cavity.
ORAL CAVITY INSPECTION
Lips
 for abnormal color, lesions, nodules,
symmetry, moisture, ulceration or
fissures
 should be moist, pink, smooth and
symmetric
Oral mucosa
 Using tongue blade, instruct the patient
to open the mouth to expose the buccal
mucosa to assess color and lesions,
redness, pallor, swelling, ulcers,
Gums-
 look for inflammation, redness, pallor,
ulcer, bleeding, retractions and
discolorations, odor of the breath is also
noted, hard palate-color and shape
Teeth
 dental carries, dentures, missing or
broken teeth
Tongue
 color, ulcers, abnormal coating,
deviation on one side, movement
Pharynx
 use tongue blade to depress the tongue
to visualize the pharynx, inspect for
color, symmetry, exudates, ulceration or
enlargement
ABDOMINAL ASSESSMENT
 to detect abnormalities in the abdominal
area like the presence of mass, abnormal
bowel sounds
Nursing Interventions:
 SUPINE position with Knees flex
(dorsal recumbent)
 Do the following order: Inspection,
Auscultation, Percussion and Palpation.
 The abdomen can be divided into four
quadrants or nine regions
 First, let’s take a look at the four
quadrants, which are created by an
intersecting horizontal (transverse)
plane, also called the transumbilical
plane, and a median (midsagittal) plane.
 consist of a Left upper quadrant (LUQ),
left lower quadrant (LLQ), right upper
quadrant (RUQ), and right lower
quadrant (RLQ).
 The navel (belly button) is the landmark
you’ll use to visualize these quadrants
while doing assessments. This is the
point at which the two planes cross.
 Right Upper Quadrant: Liver,
stomach, gallbladder, duodenum, right
kidney, pancreas, and the right adrenal
gland.
 Left Upper Quadrant: Liver, stomach,
pancreas, left kidney, spleen, and the left
adrenal gland.
 Right Lower Quadrant: appendix,
reproductive organs, right ureter.
 Left Lower Quadrant: left ureter,
reproductive organs
NOTE: All four quadrants contain
portions of the small and large intestines.
The Nine Abdominal Regions
 The nine abdominal regions divide the
abdomen into even smaller sections by
using two parasagittal planes that run
down the middle of the clavicle bones
(also called midclavicular planes) and
two horizontal (transverse) planes.
 Epigastric, umbilical, Hypogastric, right
hypochondriac, Left hypochondriac,
Right Lumbar, Left Lumbar, Right
inguinal, Left inguinal

Hypochondriac Regions (Left and Right):
 the prefix “hypo” means below or under.
The word “chondriac” means cartilage,
which is referring to the cartilage of the
ribs. When we put them together, this is
the abdominal region that is under the
ribs.
 Lumbar Regions (Left and Right):
The word lumbar refers to the vertebrae
in your lower back, which are the bones
nearest to the lumbar region.
Iliac Region (Left and Right):
 The top of the hip bone has what is
called the iliac crest, and that’s the bone
closest to the iliac region.
Epigastric Region:
 The prefix “epi” means above, or over,
and “gastric” means stomach or belly.
Therefore, this is the region over and
above the belly.
Umbilical Region:
 This is easy to remember because the
umbilical region contains your navel,
which is also called the umbilicus. The
navel is the landmark for the four
quadrant point of intersection, and it can
also help you remember that the
umbilical region makes up the middle of
the nine abdominal regions.
Hypogastric Region:
 We’ve already learned that hypo means
“below,” and gastric refers to the
stomach or belly. So when we put the
two together, we know that the
hypogastric region is the region below
the belly.
Right Hypochondriac Region: You’ll find
organs such as the liver, gallbladder, right
kidney, and portions of the small and large
intestine in this region.
Epigastric Region: This region contains
portions of the liver, as well as the stomach,
pancreas, duodenum, spleen, and adrenal glands.
Left Hypochondriac Region: This contains the
spleen, large/small intestines, left kidney,
pancreas, stomach, and tip of the liver.
Right Lumbar Region: You’ll find portions of
the ascending colon, small intestine, and right
kidney in this region.
Umbilical Region: Here you’ll find the
duodenum, the small intestine, as well as the
transverse colon.
Left Lumbar Region: You’ll find parts of the
descending colon, small intestine, and left
kidney in this region.
Right Iliac Region: Here you’ll find the
appendix, cecum, ascending colon, and small
intestine.
Hypogastric Region: You’ll find the bladder,
portions of the sigmoid colon, small intestine,
and reproductive organs in this region.
Left Iliac Region: You’ll find parts of the
sigmoid colon, descending colon and small
intestine in this region.
INSPECTION
 Abdomen-skin and contour and
symmetry, localized bulging, distension
is abnormal
 Skin – smooth and intact, nodules, skin
changes, lesions scarring, inflammation,
striae or bulging
 Contour- flat, concave, rounded or
scaphoid,
AUSCULTATION
 performed before percussion and
palpation
  To determine the character, location
and frequency of Bowel sounds
 Empty the bladder before auscultation of
the abdomen. Full bladder can interfere
with sounds
 Use diaphragm of the stethoscope for
soft clicks and gurgling
 Use bell of the stethoscope for bruit
sounds in the oartic, renal, iliac or
femoral arteries and Borborygmi-
“stomach growing” which is loud and
prolonged gurgle.
 Auscultate over the aorta and renal
arteries to
identify vascular bruits suggestive of
turbulent blood flow: Aortic
bruits: auscultate 1-2 cm superior to the
umbilicus, a bruit here may be
associated with an abdominal aortic
aneurysm. Renal bruits: auscultate 1-2
cm superior to the umbilicus and slightly
lateral to the midline on each side. A
bruit in this location may be associated
with renal artery stenosis.
 Assessing Bowel sounds- Normal is 5-
30gurgle sounds/min.
 Tinkling bowel sounds: typically
associated with bowel obstruction
 Rapid and hyper active loud bowel
sound (Gastroenteritis)-5-6 sounds in
less than 30 sec
 Hypoactive- one -two every min or
longer, paralytic ileus
 Absence- no sounds in 3-5 minutes.
Suggests ileus which is a disruption
of the normal propulsive ability of
the intestine due to a malfunction of
peristalsis. Causes of ileus include
electrolyte abnormalities and recent
abdominal surgery. To be able to
confidently state that a patient has
‘absent bowel sounds’ you need to
auscultate for at least 3 minutes
PERCUSSION
 method of tapping body parts with
fingers, hands, or small instruments as
part of a physical examination.
 To determine the size and location of
abdominal organs and to detect fluid, air
and masses.
 useful tool for evaluating abdominal
tenderness, Localized pain is suggestive
of peritoneal or intrabdominal
inflammation
 All quadrants are Percussed for
Tympani and Dullness
 Tympanic High Pitch Loud musical over
air
 Tympani- results from the presence of
air in the stomach and small intestines
 Dullness-is heard over organs or solid
masses
 Avoid percussion to patients with
AAA and organ transplant
PALPATION
 Assess for masses, rebound tenderness
and abdominal rigidity
 Lightly depressing 1-2 cm the abdomen
in quadrant to quadrant manner,
 Deep palpation is used to identify
masses for 3-4cm
 Rebound tenderness is not performed by
many examiners because it can cause
severe pain.
 Contraindicated in patients with Wilm’s
tumor and AAA or abdominal organ
transplant
Rectal Inspection and Palpation
 Rectum, perianal region and anus
 Gloves, water soluble lubrication,
penlight, and drapes are tools for
evaluation
 Knee Chest, Left lateral with Knees flex
 Inspection of lumps, rashes,
inflammation, tears, scars, tenderness,
 Buttock are spread and visually
inspected once the external sphincter is
relaxed
 Fissures, fistulas, rectal prolapse, polyps
and internal hemorrhoids- ask the client
to bear down.
 In assessing hemorrhoids, use gloves
lubricated index finger
ANTHROPOMETRIC MEASURES
  are a series of
quantitative measurements of the
muscle, bone, and adipose tissue
 used to assess the composition of the
body.
 The core elements
of anthropometry are height, weight,
body mass index (BMI), body
circumferences (waist, hip, and limbs),
and skinfold thickness
 Height and weight
 BMI= weight in kg/Height (M2)
 Less than 18.5 means that a person is
underweight
 18.5-24.9---Normal
 25-29.9- Overweight
 30 above- Obese
DIAGNOSTIC TESTS
Serum Lab Studies
 CBC- group of tests that evaluate the
cells that circulate in blood, including
red blood cells (RBCs), white blood
cells (WBCs), and platelets (PLTs).
The CBC can evaluate your overall
health and detect a variety of diseases
and conditions, such as infections,
anemia and leukemia
 Complete metabolic panel- is a blood
test that measures your sugar (glucose)
level, electrolyte and fluid balance,
kidney function, and liver function.
 PT and PTT- screening test that helps
evaluate a person's ability to
appropriately form blood clots. It
measures the number of seconds it takes
for a clot to form in a sample of blood
after substances (reagents) are added
 Amylase and Lipase- increased of
these enzymes indicates
PANCREATIS >200 U/L, Normal
amylase level is around 23-85 units per
liter (U/L), some lab ranges for normal
amylase go up to 140 U/L. Normal
lipase level can range from 0-160 U/L
depending on the lab.
 Carcino embryonic Antigen (CEA)
and Alpha Feto Protein- sensitive and
specific test for colorectal cancer
hepatocellular carcinoma. CEA is
protein that is not normally detected in a
healthy person, if positive cancer is
present but it cannot detect what type of
cancer
 CA 19-9- a protein useful as a tumor
marker to follow the course of cancer.it
is elevated to patient with pancreatic
cancer, stomach, colorectal and bile
duct.
FECAL ANALYSIS
 To inspect the consistency, color. and to
detect blood, fats, urobilinigen,
nitrogen, Clostridium difficile,
leukocytes, parasites and other pathogen
Occult blood Test
 Done to detect GI bleeding and most
frequently used in detection of early
cancer
 Avoid red meat poultry, fish cauliflower
broccoli,turnips, horseradish for 72
hours it is associated with false positive
results
 Withhold iron, steroids, endomethacin,
Colchicine, aspirin, NSAIDS
 Avoid Vit C supplements or foods
because it causes false negative results
 Should not be performed when there is
hemorrhoidal bleeding
Stools for Ova and Parasite, Culture
 Fresh warm stool to detect amoebiasis
 Use sterile test tube and cotton tip
applicator to collect specimen
Stool for lipids
 Done to assess steatorrhea
 Include fats in the diet to assess the
ability of the GI to metabolize fats
 Avoid alcohol for 3 days. Alcohol
mobilizes fats cause false positive result
 72 hour collected. Store the specimen
on ice
 Avoid mineral oil, neomycine sulfate
and oily medications
Fecal Immunologic test
  Use monoclonal or polyclonal
antibodies to detect globin protein in
human hemoglobin
 Dietary restrictions are not required
Stool DNA testing
 New means to detect DNA related to
colon cancer
 Does not require dietary or medications
restrictions
BREATH TEST
Types
a. Hydrogen breath test
 to evaluate CHO absorption and aids in
diagnosis of bacterial overgrowth in the
intestine
 Determines the amount of hydrogen
expelled in the breath after it has been
produced in the colon and absorb in the
blood
b. Urea breath test
 detect the presence of Helicobacter
Pylori that live in the mucosal lining of
the stomach and cause PUD
 Patient is ingest a capsule of carbon
labeled urea, a breath sample is obtained
10-20 minutes later, the labeled carbon
is absorbed quickly, then can measure
the carbon dioxide in the expired breath
to determine h.Pylori present
NURSING INTERVENTIONS
 No antibiotics, or bismuth salicylate for
1 month.
 No probiotics for 2 weeks
 No proton pump inhibitors (Sucralfate,
Omeprazole), laxatives and supplements
for 1 week before the test
 NO to Cimitidine, famotidine and
ranitidine for 24 hours
 No to spicy foods, butter or margarine,
sugar or creamer
 No smoking or second smoke one hour
prior to the test, exercise or taking gums
 Consume steamed white rice, baked
chicken or fish, tea and water (12hours
before the test
 Brush your teeth before the test
 No mouth wash
ABDOMINAL ULTRASONOGRAPHY
 A non-invasive test in which high
frequency sound waves are passed into
internal body structures and the
ultrasonic echoes are recorded on an
oscilloscope as tissue strikes in different
densities.
 It can detect enlarged gallbladder, or
pancreas, presence of gallstones, enlarge
ovary, ectopic pregnancy, and
appendicitis
 Cannot be used to examine structures
that lie behind bony tissue, as bone
prevent s sound waves from travelling
into deeper structures.
 Gas and fluids in the abdomen or air in
the lungs prevent the transmission of
ultrasound.
 HEALTH TEACHINGS: If Whole
abdomen – NPO,
Endoscopic Ultrasonography (EUS)
 aids in diagnosis of GI disorders that
provides direct imaging of a target area
 used to evaluate submucosal lesion
location and depth penetration
 it evaluates Barretes esophagus, portal
hypertension, chronic pancreatitis,
biliary tract disease and ulcerative colitis
 Moderate sedation is indicated
NURSING INTERVENTIONS
 If Whole abdomen – patient should be
NPO 8-12 hours to decreased the
amount of gas in the GI tract
 If gallbladder studies- eat fat free meal
at night before the test
 If with Barium- should scheduled after
ultrasonography- barium interfere the
transmission of sound waves
 For sedated patient, assess the LOC,
orientation, and ambulation, advised not
to drive cars
BARIUM SULFATE
 class of medications called radiopaque
contrast media. It works by coating the
esophagus, stomach, or intestine with a
material that is not absorbed into
the body so that diseased or damaged
areas can be clearly seen by x-ray
examination or CT scan.
Effects of Barium
 SE: light or white stools for a few days
after the test. Your stools will go back
to normal color within a few days.
 diarrhea, or constipation severe stomach
pain;
 chest pain, trouble breathing or
swallowing; ringing in your ears;
sweating, confusion, fast heart rate
BARIUM SWALLOW (Upper GI)
 The oral administration of a radiopaque
barium sulfate suspension to
radiographically demonstrate possible
defects in the esophagus, stomach, and
small intestines
 Assessment of esophagus, stomach,
jejunum and duodenum
Nursing Interventions
 Keep the patient NPO 6-8 hours before
the procedure
 Administer laxative after the procedure
 Increase fluid intake for at least two
days after
 Inform client that the stool is white
for 24-48 hours
BARIUM ENEMA (Lower GI)
 A rectal infusion of barium sulfate
(radiopaque contrast medium) which
retained in the colon during studies
 assesses of large colon for the presence
of obstruction, tumors and other
abnormalities
Nursing Interventions
 Low residue/Liquid diet before the
procedure. It limits high-fiber foods, like
whole-grain breads and cereals, nuts,
seeds, raw or dried fruits, and
vegetables. "Residue" is undigested
food, including fiber, that makes up
stool. The goal of the diet is to have
fewer, smaller bowel movements each
day
 Laxative before the procedure and after
the procedure to eliminate the barium.
 Notify the doctor if bowel movement
does not occur in two days.
GASTRIC ANALYSIS
 to analyze acidity, appearance and
volume of gastric secretions or
determine gastric retention due to
pyloric or duodenal obstruction
 to determine the gastric mucosa to
secrete HCl
 Assessment of the ulcers or to rule out
pernicious anemia, Zolinger Ellison
Syndrome or atropic gastritis
 Pernicious Anemia- patients with this
disease secrete no acid under basal
conditions
 Chronic Atrophic gastritis- secrete little
or no acid
 Gastric Ulcer-secretes some acid
 Duodenal ulcer- secrete an excess
amount of acid
NURSING INTERVENTIONS
 Gastric contents are collected every
15minutes to 1 hour through insertion of
NGT tube through the nose at around
50cm (21 inches) by aspiration or via
syringe
 NPO for 8-12 hours prior to procedure
 Withheld medications affecting gastric
secretions
 No Smoking-it can increase gastric
secretions
GASTRIC ACID STIMULATION TEST
 Histamin and pentagastrin is given SC to
stimulate gastric secretions.
 Indicated to diagnose GERD
 Gastric specimens are collected after the
injection every 15 minutes for 1 hr to
measure the pH
 A probe measures pH is inserted through
the nose about 12.7 cm (5inches) above
the LES. It is connected to an external
 recording device worn by pt for 24 hrs
and analyze by computer.
NURSING INTERVENTIONS
 NPO for 6 hours before the test
 Withheld medications that affects gastric
secretions for 24-36 hours prior to the
test
 Labeled to indicate the time of specimen
collection after histamine injection
 Volume and pH are measure
 Inform the patient that the injection may
produce flushed feeling
 Monitor BP and pulses to detect
hypotension
ABDOMINAL PARACENTESIS
 removal of at least 5L of ascitic fluid is
considered large-volume paracentesis.
 a needle is inserted into the abdominal
cavity to collect fluid, or puncturing the
peritoneal cavity to remove fluid or
ascites.
Purposes
 For relieving pressure in peritoneal
cavity,
 For drainage fluid from abdominal
cavity in Ascites condition.
 to relieve shortness of breath when
ventilation is impaired
 Cirrhosis of liver with Ascites,
 For lab diagnosis (Histopathology e.g,
cancer, Biochemistry values e.g.
Albumin),
Nursing Interventions
PRIOR TO Procedure
 Check for the physician’s order
 Explain the procedure to the patient
 Obtain written informed consent
 Shave and Skin prepare should be done,
 Check VS and oxygen saturation
 Provide privacy,
 Instruct the patient to void immediately
prior to the procedure voluntarily or FC.
 Instruct the patient to sit up, with feet
resting on footstool or lying position
 Maintain I. V, line, if any emergency to
give fluids and medications,
 Prepare materials to be use (Providone
Iodine, Lidocaine Anesthesia, Syringe,
5cc or 10 cc, tubings)
 Clean the site with anti-septic solution
 Assist to Doctor, giving needed articles,
such as cotton swabs, sterile towels, etc
 Monitor patient during procedure,
 Observe for fluid color,
 Measure fluid quantity,
 Send test tube for diagnostic tests,
 After finishing the procedure, seal the
punctured wound with sterile dressing,
 Fasten the abdominal binder tightly,
from the top to bottom
AFTER the Procedure
 Evaluate the effect of the procedure by
assessing the Weight, Abdominal girth,
RR
 Notify the physician if the urine
becomes bloody, pink or red. Sign the
bladder is punctured.
 Monitor patient vitals continuously,
 monitor input and out put chart,
 Watch for any reaction for 24 hours,
Complications:-
 Hypo-tension,Internal bleeding,
COMPUTED TOMOGRAPHY
 Provides cross sectional images of
abdominal organs and structures
 Multiple x-rays are taken from the
different angles as viewed in the
computer monitor
 It can detect inflammation of colon such
as appendicitis, diverticulitis, regional
enteritis and ulcerative colitis
 It can evaluate diseases in the liver,
spleen, kidneys, pancreas, pelvic organs
and abnormalities in the abdominal wall.
 A painless but radiation should be
considered
 It can be perform with or without oral or
intravenous contrast to enhance the
study
NURSING INTERVENTIONS
  Assess allergy to iodine, shellfish or
contrast medium- it can be premedicated
with corticosteroid or antihistamines
 Assess creatinine levels and pregnancy
status if patient is female
 Oral fluids after the study to eliminate
the contrast via urine
 Administer kidney protective measure
such as sodium Bicabonate IV 1 hour
before and 6 hours after IV contrast and
N-acetylcysteine (Mucomyst) before
and after study. N-acetylcysteine is a
free radical scavenger that sequester the
contrast by products that are destructive
to kidney cells.
MAGNETIC RESONANCE IMAGING
 Used to supplement ultrasonography and
CTY scan
 A non-invasive techniques that uses
magnetic fields and radio waves to
produced images of the area being
studied.
 Uses oral contrast agents to enhance the
image for the diagnosis of GI diseases
 Useful in evaluating abdominal soft
tissues as well as blood vessels,
abscesses, neoplasms, and other sources
of bleeding.
 Contraindicated to patient who has
internal metal implants or any device
containing metal (cochlear implants,
intraocular metallic fragment, jewelry,
pacemakers, dental implants, paperclips,
pens, keys, clips on patient gowns and
oxygen tanks, ) because it will be
attracted by the magnet and cause
further injury.
 Foil backed skin patch (nitroglycerine
(Transderm patch, scopolamine
((Transderm0scop) should be removed
because of the risk of burns
NURSING INTERVENTIONS
 NPO for 8 hours
 Assess for allergy to iodine and shellfish
 Remove all jewelry and other metals
 Inform that the procedure takes 60-90
minutes
 Assess claustrophobia (fear in close
spaces)
 Advise the patient to blindfold during
the procedure
UPPER GIT STUDY
Upper GI Flouroscopy
 A radiopaque/ barium sulfate is
commonly used
 It visualizes the esophagus, stomach and
duodenum for anatomic or functional
disorders of the upper GI such as ulcers,
varices, tumors, regional enteritis
malabsorption syndrome, obstruction,
ileitis and diverticula.
Variations of the Upper GI Study
1. Double Contrast Method
 Examines the GI tract by administering
thick barium suspension to outline the
stomach and the wall of esophagus after
which tablets that release carbon dioxide
in the presence of water are given
 It can detect early neoplasms in the
esophagus and stomach in finer detail
2. Enteroclysis
 Very detailed, double contrast study the
entire small intestine
 involves continuous infusion of 500 -
1000ml of a thin barium sulfate
suspension; after, methylcellulose is
infused
 Barium and methylcellulose fill the
intestines and are observes by
fluoroscopy as they progressed to
jejunum and ileum.
 It takes 6 hours and can be quite
uncomfortable
 Indicated to small bowel obstruction and
diverticula
NURSING INTERVENTIONS
Prior to procedure
 Consent
  Clear liquid diet with NPO midnight, for
6-8 hours( When a patient with IDDM is
NPO, adjust the insulin.
 No smoking or chewing gum-it can
increase gastric secretion and salivation
 Remove dentures and bridges.
 Local spray anesthetic (Lidocaine) on
posterior pharynx.
 Instruct the client not to swallow saliva.
 Administer the anticholinergic,
sedatives, narcotics, tranquilizers
 Polyethylene Glycol (PEG) – most
effective bowel cleansing preparatory
agent.
After the procedure
 Side lying position. To prevent
aspiration due to effects of barium-
nausea and vomiting.
 NPO until gag reflex return
 NSS gargle to relieve the metallic taste
of oral contrast dye
 Advised to avoid driving for 12 hours if
sedative was used.
 Increase fluid intake to facilitate the
evacuation of stool and barium.
UGI ENDOSCOPIC PROCEDURES
1. Upper GI Fibroscopy/
Esophagogastroduodenoscopy
 Direct visualization of the esophagus,
gastric and duodenal mucosa through a
lighted endoscope (Gastroscope) to
detect occult areas of bleeding IBD and
celiac disease
 To assess esophageal and gastric
motility and to collect secretions and
tissue specimen for analysis
 In EGD, the gastroenterologist views the
GI tract through a viewing lens and
obtain images through the scope
 Indicated to esophageal, gastric or
duodenal disorders(inflammation,
tumors and infectious),
 Can be a therapeutic procedure when
combined with other procedures such as
it can be use to remove common bile
duct stones, dilate strictures, and treat
gastric bleeding and esophageal varices
by injecting sclerosing solutions to
control upper GI bleeding.
 Patient is required to swallow a capsule
(PillCam ESO) that travels by peristalsis
through small intestines. The capsule
will pass within 24 hours
 Patient is sedated, the endoscope is
lubricated with water soluble lubricant
to passed the mouth, down to the
esophagus to the duodenum
 Procedure takes about 30 minutes
2. Endoscopic Retrograde
Cholangiopancreatography
 Uses the endoscope with x-rays to view
the bile ducts,pancreatic ducts and
gallbladder
 Helpful in evaluating jaundice,
pancreatitis, tumors, common bile ducts
stones and biliary tract disease
NURSING INTERVENTIONS
Before
 NPO for 8 hours
 Local anesthesia or spray before the
intro of endoscope
 Left lateral position to facilitate the
clearance of pulmonary secretions and
provide smooth entry of the scope
 Administer Sedative (Midazolam) to
provide moderate sedation with loss of
gag reflex and relieves anxiety
 Atropine Sulfate (drying agent)- to
reduce secretions
 Glucagon- may be given to relax the
muscles
After
 Assess LOC, VS,O2 Sat, pain level and
signs of perforation (pain, bleeding,
difficulty of swallowing, rapid elevated
temperature
 Offer lozenge, saline gargle, or oral
analgesics to relieve throat discomfort
 Temporary loss of gag reflex is expected
 Advise the patient to avoid driving cars
 Remain in bed until fully alert due to
effects of sedative

LGI ENDOSCOPY
 Visualization of the lower GI tract after
instillation of barium
 Barium enema can be used to detect the
presence of polyps, tumors, lesions of
the large intestines and demonstrate
anatomic abnormalities or
malfunctioning of the bowel
 The procedure takes place about 15-30
minutes during which x-rays images are
obtained
TYPES
FIBEROPTIC COLONOSCOPY
 Direct visualization or inspection of the
large intestine (anus, rectum, sigmoid,
transcending and ascending colon
 Used as diagnostic aid and screening
device
 Used to detect colon cancer screening
and remove polyps, diarrhea with
unknown cause, occult bleeding, and
bowel decompression (removal of
intestinal contents to prevent gas and
fluid from the intestines)
 Contraindicated in colon perforation,
acute severe diverculitis
NURSING INTERVENTIONS
BEFORE
 Informed consent
 Cleanse colon by giving laxative, PEG
electrolyte lavage solutions, sodium
phosphate tablet.
 Left lateral position with the legs drawn
up to the chest
 Administer sedative or opioid analgesic
(midazaolam) to provide moderate
sedation and relieve anxiety
 Administer glucagon- to relax the
colonic musculature and to reduce
spasm during the test.
Ways to cleanse colon
1. Laxative
 Give laxative for two nights before the
examination or fleet enema in the
morning before the test- to cleanse
properly and to visualize the colon.
2. Fleet enema
2. PEG electrolyte lavage solutions
 (Golytely, Colyte, Nulytely) are used as
intestinal lavage.
 Clear liquid diet 24 hours before the
procedure.
 Patient ingest large solution orally for 3-
4 hours
 NGT if pt is cannot swallow
 Contraindicated with intestinal
obstruction or inflammatory bowel
disease.
 SE: nausea, bloating, abdominal cramps,
fluid and electrolytes imbalances,
hypothermia
3. Administer sodium phosphate tablet
 for colon cleansing prior to
colonoscopy
 (Dosing 32 tabs, (4tabs q 15mins= 20)
on the evening, 12 tabs (4tabs q
15mins) in the morning with clear
liquids.
DURING
 Monitor oxygen saturation, VS, color
and temperature of skin, LOC,
abdominal distension, vagal response
AFTER
 Monitor signs of bowel perforation
(rectal bleeding, distension, abdominal
pain, fever, peritoneal signs)
 Provide written instructions due to
amnesic effects of midazolam, patient is
unable to recall verbal information
 Instruct the patient to report any signs of
bleeding.
PROCTOSIGMOIDOSCOPY (SIGMOID,
RECTUM)
 Visualization of the anus, sigmoid and
descending colon to evaluate chronic
diarrhea,fecal incontinence, ischemic
colitis, and lower GI hemorrhage and to
observe ulceration, fissures, tumors,
polyps
 Flexible fiberoptic sigmoidoscope
permit the colon to be examine up to 40-
50 cm ( 16- 20 inches) from the anus
NURSING INTERVENTIONS
Before
 Consent
  Take Dulcolax after dinner
 NPO 6-8 hours
 Warm tap enema of Fleet enema until
returns are clear
 Place the client in Knee chest/ lateral
position during the procedure with the
right leg bent anteriorly
 Inform the patient that sensation will be
feel associated with the procedure
During
 Monitor VS, skin color, temperature,
pain tolerance, and vagal response
After the procedure
 Supine position for few minutes
 Assess for signs of perforation-
bleeding, pain and fever
 Hot sit baths
Manometry and Electrophysiologic Studies
 Methods to evaluate GI motility
disorders
Manometry Test
 Measures changes in intraluminal
pressures and coordination of muscle
activity in the GI tract with the presence
of pressure transmitted to a computer
analyzer
ESOPHAGEAL MANOMETRY
 Used to detect motility disorders in the
esophagus including UES and LES
 A pressure sensitive catheter is inserted
to the nose and connected to a
transducer and a video recorder. The
patient swallows small amount of water
while reluctant pressure changes are
recorded.
 To diagnose achalasia (absence of
peristalsis), diffuse esophageal spasm
and GERD
NURSING NTERVENTIONS
 NPO 8-12 hours before the test
 Withhold motility drugs (Ca channel
blockers, anticholinergic agents,
sedatives for 1-2 days
GASTRODUODENAL AND COLONIC
MANOMETRY
 Used to evaluate delayed gastric
emptying and gastric and intestinal
motility disorders such as IBS or atonic
colon
 Last for 24-72 hours
ANORECTAL MANOMETRY
 Measures resting tone of the internal
anal sphincter and contractibility of the
external anal sphincter.
 Indicated to pts with chronic
constipation or fecal incontinence
 Dibasic sodium (Phosphosoda) or saline
cleansing enema is given 1 hour before
the test
 Prone or lateral position during the
procedure
Rectal Sensory Studies
 Used to evaluate rectal sensory function
 A catheter and balloon are passed to the
rectum with increasing balloon inflation,
the patient feels distention. Then the
tone and pressure of the rectum are
measured
 Indicated with patients with chronic
constipation, diarrhea and incontinence
Electrogastrography
 An electrophysiologic study that assess
gastric motility disturbances and can
detect motor or nerve dysfunction in the
stomach
 Electrodes ae place over the abdomen
and gastric electrical activity are
recoded for 24 hours
 Patients may exhibit rapid, slow, or
irregular waveform activity
LAPAROSCOPY/PERITONEOSCOPY
 Visualize the organs and structures
within the abdomen and to detect
growths, anomalies and inflammation
 is a surgical diagnostic procedure used
to examine the organs inside the
abdomen. It's a low-risk, minimally
invasive procedure that requires only
small incisions. Laparoscopy uses an
instrument called a laparoscope to look
at the abdominal organs.
  In this procedure carbon dioxide is  Use throat lozenges to ease the pain of
injected into the peritoneal cavity to a sore throat.
separate the intestines from the pelvic  Wear loose-fitting clothes.
organs
 Requires general anesthesia and stomach
and colon are decompressed
 Small incision is made lateral to the
umbilicus that allows the insertion of a
small tube called a cannula to inflate the
abdomen with CO2 then followed by the
insertion of the fiberoptic laparoscope to
see the abdominal organs
 Can be use to evaluate peritoneal
disease, masses, gallbladder and liver
disease, hernias, appendicitis, PID,
endometriosis
 Biopsy samples can be taken from the
organs
 One of the benefits of this procedure
after the visualization, removal of
gallbladder can be performed
 Contraindicated to pregnant women

NURSING INTERVENTIONS
Before the procedure
 Consent
 avoid eating and drinking for at least
eight hours before laparoscopy.
 IV fluids should be infused. For
hydration
 IFC (PRN basis)

After the procedure

 No to driving cars. arrange for a family
member or friend to drive you home
after the procedure. general anesthesia,
which can make you drowsy and unable
to drive for several hours after surgery.
 Assess the level of pain after the a few
hours. Shoulder pain is common of the
carbon dioxide gas used to inflate your
abdomen to create a working space for
the surgical instruments. The gas can
irritate your diaphragm, which shares
nerves with your shoulder. It may also
cause some bloating
 Administer pain relievers PRN
 Begin light activity as soon as you’re
able, in order to reduce your risk of
blood clots.
 Get more sleep than you normally do.