LU 2 : GI Investigation and Diagnostic Procedure 1.0

What is barium studies ?

An x-ray examination of the GIT using barium to outline the contours of the GIT organs

What are the common barium procedures ?

• Barium Swallow : xray examination of pharynx to fundus of stomach

• Barium Meal : xray examination of oesophagus to proximal jejunum

• Barium Enema : colon

What is barium enema ?

• radiographic study of the large bowel by administration of the contrast medium through the rectum

What are the purpose and indication for barium enema ?

• radiographic exam of colon

• GI cancer

• detect tumours and motility problems

What are the patient preparation for barium enema ?

• low residue (low fibre) diet for 2 days prior to the examination

• Bowel cleansing the night before

• NPO after midnight

What are the nursing responsibilities for barium enema ?

• Before : gives laxatives and enemas, clear liquid diet the evening before, NPO 8 hour before test

• After : gives fluids, laxatives, observe stool for passage of contrast medium, tell the patient stool may be white for up to 2-3 days

What are the complications and nursing actions for barium enema ?

• constipation : increase intake of fluids

What are the patient education for barium enema ?

• Stool may appear white for 2-3 days

• Increase fluids and fibre intake to facilitate barium excretion

What are the three different ways of performing cholangiogram?

• Injection of contrast dye intravenously

• Dye injected directly into the biliary tract after gall bladder surgery

• intraoperatively, dye is injected into the ducts

What are the purpose and indications for cholangiogram ?

• used to diagnose bile duct blockages, stones, and other abnormalities

• to examine the gall bladder and the extrahepatic biliary system

• to determine the size, shape and position of the organ

• to examine any calculi (stones) in the gall bladder or leaks

What are the patient preparation for cholangiogram ?

• NPO 6 hours prior

• Assess iodine allergy

What are the nursing responsibilities for cholangiogram ?

• Monitor vital signs

• Reassure patient during imaging

What are the complications of cholangiogram ?

• allergic reaction : hypotension and rash

• bile leak : abdominal pain and fever

What are the patient education for cholangiogram ?

• Report allergic symptoms

• Monitor for jaundice and fever

What is endoscopy ?

direct visualization of body structure through an endoscope

What are the common endoscopic procedures for GI ?

• Esophagogastroduodenoscopy (OGDS)

• Endoscopic Retrograde Cholangiopancreatography (ERCP)

• Sigmoidoscopy

• Colonoscopy

What are the purpose and indications for Esophagogastroduodenoscopy (OGDS) ?

• Directly visualizes mucosal lining of the oesophagus, stomach, and duodenum with a flexible endoscope

• Diagnose ulcers, bleeding, tumours of Upper GIT

What are the patient preparation for OGDS ?

• NPO 6–8 hours

• Remove dentures, jewelry, eyeglasses, contact lenses, and nail varnish

• Informed consent form is signed

• Change into OT gown – follow OT protocol

What are the nursing responsibilities for OGDS ?

What are the complication for OGDS ?

• aspiration risk

• perforation : severe abdominal pain, vomiting blood

What are the patient education for OGDS ?

• patient may feel temporary throat discomfort

• patient might feel bloated

• report any swallowing difficulty

What is the purpose of liver biopsy ?

• to obtain hepatic tissue

• the tissue is used to establish a diagnosis of cancer or liver disease

What are the patient preparation for liver biopsy ?

• check coagulation profile such as bleeding time

• NPO 6-8 hours

• consent obtained

• explain the need to hold breath after expiration when biopsy needle is inserted

What are the nursing responsibilities for liver biopsy ?

• pre : ensure informed consent has been signed, supine or left lateral position, perform baseline assessment, obtain blood type and crossmatch

• during : assist sterile procedure

• after : apply dressing over needle insertion site, lie on the right side for 2 hours to splint puncture site

What are the complications and nursing actions for liver biopsy ?

• Hemorrhage : monitor vitals sign

• Pneumothorax : watch any sign and symptom of respiratory distress

What are the patient education for liver biopsy ?

• rest for 24 hours

• avoid strenuous activity for 1 week