GASTROINTESTINAL NURSING
Abdominal Confirmatory Tests and Diagnostics
PROCEDURE MEANING/DEFINITION
Abdominal Ultrasonography is a noninvasive procedure that
uses high-frequency sound waves
which are passed into body
structures and recorded as they
are reflected (bounded). A
conductive gel (lubricant jelly) is
applied to the skin and a
transducer is placed on the area.
NON-INVASIVE PROCEDURES
INDICATION/CONTRAINDICATION
● Useful in the detection
of an enlarged
gallbladder or
pancreas, presence of
gallstones, an enlarged
ovary, an ectopic
pregnancy, or
appendicitis, and
masses (cysts or
tumors).
NURSING RESPONSIBILITES REMARKS/NOTES
● Instruct patient to be Important notes about
NPO 8 – 12 hours bowel preparation:
before UTz. Air or gas
can reduce quality of
images. • Drinking only water can cause an issue
with the
blood salt levels which can lead to heart
problems
or seizures.
• Please check yourself for possible side
e_ects
including nausea, vomiting, abdominal
bloating
and lightheadedness.
• Get medical attention if you experience
ongoing
vomiting, severe stomach pain, bloody
bowel
movements, chest pain and/or fainting.
• Please be prepared! Your colonoscopy
may be
cancelled or need to be repeated if all the
instructions provided to you are not
followed.
CT (Computed Tomography) 2. is a noninvasive radiologic
Scan examination that provides cross
sectional images of abdominal
organs and structures.
● Tool for detecting ● Contraindicated for cachectic
appendicitis, or very thin patients.
diverticulitis, regional
● Since contrast medium is used,
enteritis, ulcerative
colitis, diseases of the the nurse should assess for
any allergies to contrast
liver, spleen, kidney,
pancreas, and pelvic agents, iodine, shellfish, serum
organs. creatinine level, urine human
chorionic gonadotropin before
administration of a contrast
agent.
⦿ If patient is allergic to contrast
agent, may be premedicated
with IV prednisone 24 hours,
12 hours, and 1 hour before
the scan.
MRI (Magnetic Resonance 3. is a noninvasive procedure that ● Useful in evaluating ● Place the patient NPO 6
Imaging) uses magnetic fields and abdominal soft tissues – 8 hours before the
radiofrequency waves to produce as well as blood study and removal of all
an image of the area being vessels, abscesses, jewelry and other
studied. fistulas, neoplasms, metals.
and other sources of
● Instruct the patient to lie
bleeding.
still for 60 – 90 min.
⦿ Contraindication:
● Assess patients with
● Ferromagnetic objects claustrophobia.
= (metals that contain
● Instruct to the patient
iron) jewelries,
pacemakers, dental that the machine will
implants, paperclips, make a knocking sound
during the procedure.
pens, keys, IV poles,
clips on patient’s ● Foil-backed skin patches
gowns, oxygen tanks, (e.g., NicoDerm,
patients with artificial nitroglycerine
heart valves and [Transderm-Nitro],
defibrillators, implanted scopolamine
insulin pumps, or [Transderm-Scop],
implanted clonidine [Catapres-
transcutaneuos TTS]) should be
electrical nerve removed before an MRI
stimulation devices, because of the risk of
patients with internal burns. However,
metal devices physician must be
(aneurysm clips) or consulted first before the
intraocular metallic patch is removed.
fragments.
Fecal Occult Blood is a lab test used to check stool Before the procedure • Macroscopic
It is a microscopic samples for hidden (occult) blood. The following are the nursing interventions
examination: for
prior to a stool analysis.
analysis or by Occult blood in the stool may appearance and color
• Assess the patient’s level of
indicate colon cancer or polyps in comfort. Collecting stool • Microscopic examination:
chemical tests for the colon or rectum — though not specimen may produce a feeling of for cell count and presence
all cancers or polyps bleed. embarrassment and discomfort to of meat fibers; leukocyte
hemoglobin that •
the patient.
Encourage the patient to
esterase, for leukocytes;
urinate. Allow the patient to Benedict’s solution (copper
may be present in urinate before collecting to avoid sulfate) for reducing
contaminating the stool with urine. substances; guaiac, for
stool. *Normally, • Avoid laxatives. Advise patient
that laxatives, enemas, or
occult blood; x-ray paper, for
trypsin
stool contains suppositories are avoided three
days prior to collection.
• Instruct a red-meat free and
small amount of high residue diet. The patient is
indicated for an occult blood test,
blood (2 – must follow a special diet that
includes generous amounts of
2.5ml/day) chicken, turkey, and tuna, raw and
uncooked vegetables and fruits
such as spinach, celery, prunes
Used to detect GI and bran containing cereal for two
(2) days before the test.
bleeding and early After the procedure
The nurse should note of the following
signs of colorectal nursing interventions after fecal analysis:
• Instruct patient to do
handwashing. Allow the patient to
cancer. thoroughly clean his or her hands
and perianal area.
• Resume activities. The patient
may resume his or her normal diet
and medication therapy unless
otherwise specified.
• Recommend regular
screening. The American Cancer
Society recommends yearly occult
blood test as part of the screening
for colorectal cancer starting at the
age of 45 years old for people with
average risk.
Hemoccult slide test A wooden applicator is used to
apply a thin smear of the stool
specimen on a guaiac-
impregnated filter paper
exposed in box A; or if done with
a digital examination, smear the
gloved finger on the filter paper.
Apply a 2nd smear from another
part of the specimen to the
filter paper exposed in box B.
Allow the specimen to dry for
3-5 minutes. Add 2 drops of
Hemoccult developing solution on
the paper over each smear.
After 30 - 60 seconds, (+)
result will show BLUE .
Hematest reagent tablet test A wooden applicator is used to
smear a bit of stool specimen on
a filter paper; or if done with a
digital examination, smear the
gloved finger on the filter paper.
Place smeared filter paper on a
glass plate.
Place the reagent tablet at the
center of the stool specimen and
add a drop of water to soak for
5-10 seconds.
Add 2nd drop on the tablet and
let it run from the specimen.
After 2 minutes: (+) results =
filter paper turns BLUE *Do not
read the color that appears on
the tablet or on the paper after
2 minutes.
Instant-view fecal occult blood Looks at a sample of your stool (feces) to is a health test that indicates if Add a stool sample to the
test check for blood. Occult blood means that there is human blood in stool
collection tube. Shake to mix the
you can't see it with the naked eye. Blood in which may be an early warning of
colorectal cancer, gastrointestinal sample with the extraction
the stool means there is likely some kind of disorders, diverticulitis, colitis,
bleeding in the digestive tract buffer, then dispense 4 drops
and/or polyps.
into the sample well of the
cassette.

In 5-10 minutes, results will

appear. It will show the level of
Hgb if > 0.05mcg/ml of stool.

INVASIVE PROCEDURES
PROCEDURE MEANING/DEFINITION INDICATION/CONTRAINDICATION NURSING RESPONSIBILITES REMARKS/NOTES
Colonoscopy ⦿ Is performed while ⦿ Contraindication:
the patient is lying on
○ Cannot be
the left side with the
legs drawn up toward
the chest. The
patient’s position may
be changed during
the test to facilitate
advancement of the
scope.
⦿ (commonly ordered prior to
procedure)
⦿ Before the test:
performed if there
is suspected colon ○ Place the patient in clear liquid
perforation. diet 24 hours prior to procedure.
⦿ 1 gal of Polyethylene Glycol
(Go-LYTELY, CoLyte, Nu-
Lytely), an electrolyte lavage
solution, is given to the patient
evening before the procedure (8
oz glass q 10min)
⦿ Drink the preparation as cold as
possible to make it more
palatable.
⦿ The stool will become watery,
clear and free of any solid
material.
⦿ Side effects: nausea, bloating,
cramps or abdominal fullness,
fluid and electrolyte imbalance,
and hypothermia. Fleet’s
phosphosoda, a laxative, is
administered.
● 1st dose (1.5 oz) is taken in the
afternoon before the procedure,
followed by 10 oz of clear liquid
and then 3 – 5 additional glasses
of clear liquid.
● 2nd dose (1.5 oz) is taken before
bedtime, followed by 10 oz of
clear liquid and then 3 – 5
additional glasses of clear
liquid.Informed consent is
obtained.
⦿ During the test:
○ Midazolam
(Versed), an opioid
analgesic or
sedative, is
administered to
provide moderate
sedation and
relieve anxiety.
○ Glucagon may be
administered to relax the
colonic musculature and
to reduce spasm.
○ After the test:
○ Abdominal cramp is normal
due to increased peristalsis.
○ Monitor for complications:
● Bowel perforation, most
common complication
(rectal bleeding,
abdominal pain or
distension, and fever)
● Cardiac dysrhythmias,
respiratory depression,
vasovagal reactions,
circulatory overload or
hypotension.
ENDOSCOPIC PROCEDURE
EGD (ESOPHAGOGASTRODUODENOSCOPY)
⦿ used to directly ○ Test to detect
visualize mucosal
lining of esophagus,
stomach, duodenum
with flexible, fiberoptic
scope.
⦿ Before the test:
inflammations,
○ Keep NPO for 8 hours. Make
ulcerations, tumors,
varices, or Mallory- sure signed consent is on the
Weiss tear and chart.
neoplasms in the ○ Local anesthetic may be
esophagus, sprayed on throat before
stomach, and insertion of scope.
duodenum.
Biopsies may also ○ Midazolam (Versed) is
be taken. administered to provide
moderate sedation and
relieves anxiety.
⦿ Atropine may be
administered to reduce
secretions.
⦿ Glugacon may be
administered to relax smooth
muscles.
⦿ The patient is placed in left
lateral position.
⦿ After the test:
○ Assess for the return of gag
reflex, level of consciousness,
vital signs, oxygen saturation,
and pain level.
○ Monitor for signs of perforation
(pain, bleeding, unusual
difficulty swallowing, and
rapidly elevated temperature.
Capsule endoscopy
Laparoscopy (peritoneoscopy)
⦿ PillCam ESO, a pill-
sized instrument
equipped with
cameras is swallowed
by the patient and
provides 57,000
images of the GI
tract.
⦿ Contraindication:
⦿ Laparoscopy
(peritoneoscopy) =
is a diagnostic
procedure where the
peritoneal cavity,
pelvis, and abdomen
are examined. Gas
(carbon dioxide) is
insufflated into the
peritoneal cavity to
separate the
intestines from the
pelvic organs.
○ For the diagnosis of ○ Bowel preparation
Crohn’s disease, is similar to
celiac disease, colonoscopy. NPO
malabsorption for 4 – 6 hours after
syndrome, and swallowing the
identify sources of capsule.
possible GI
bleeding.
○ Previously
anastomosed
section of the
bowel.
○ Test used to detect ○ Patient is instructed to fast for
cysts, adhesions, 8 hours before the surgery.
fibroids infections
○ The patient is catheterized to
of the uterus,
fallopian tubes, and ensure the bladder is empty.
ovaries, ectopic ○ Make sure signed consent is
pregnancies, liver on the chart.
lacerations, and
cirrhosis. ○ The test is performed under
local or general anesthetic
agent.
○ Observe for bleeding and
bowel perforation after the
procedure.
Proctosigmoidoscopy
Endoscopic Retrograde
Cholangiopancreatography (ERCP)
⦿ directly visualizes ○ Used to detect
rectum and sigmoid
colon with lighted
flexible endoscope.
⦿ fiberoptic endoscope ○ Used to retrieve a
is inserted through
the oral cavity into the
duodenum, then
common bile and
pancreatic ducts are
cannulated.
○ Secure consent.
internal
○ Clear liquids day before or no
hemorrhoids,
polyps, fissures, dietary restrictions.
and rectal and anal ○ Administer enema (soap-suds,
abscesses. tap water, or Fleet enema)
evening before and morning of
procedure.
○ Explain to the patient knee-
chest position, need to take a
deep breaths during insertion
of the scope, and possible
urge to defecate as scope is
passed.
○ Conscious sedation is often
used.
○ Monitor patient for rectal
bleeding and intestinal
perforation.
⦿ Before the procedure:
gallstone from
○ NPO for 8 hours.
distal common bile
duct, dilate Ensure consent
strictures, obtain form is signed.
biopsy for tumor, ⦿ After the procedure:
and diagnose
pseudocysts. ○ Check vital signs,
signs of perforation
or infection, gag
reflex.
○ Be aware that
pancreatitis is the
most common
complication.
Paracentesis 2. is the aspiration of ○ Both diagnostic and ○ Have the patient
fluid from the therapeutic void, and obtain
abdominal cavity. procedure for end- body weight before
stage liver or renal the procedure.
disease when there
○ Place the patient in
is ascites.
a high-Fowler’s
● Aspiration in position.
this instance is
○ The skin is
therapeutic, if a
culture prepared, before
specimen is anesthetized and
obtained, it is punctured with a
diagnostic. trocar (a large
bored abdominal
paracentesis
needle.
○ Observe the patient
for blood pressure
changes that can
result from rapid
removal of fluid.
Radiologic Procedures ○ Postprocedure: apply a
sterile dressing to the
Radiologic Procedures
puncture site.
Barium Swallow (Upper Gastrointestinal
○ Record the color,
Study) amount, consistency of
drainage.
⦿ Barium Swallow
(Upper
Gastrointestinal
Study) = also known
as esophagography,
is a fluoroscopic
visualization of the
esophagus following
the ingestion of
barium sulfate.
Barium Enema (Lower Gastrointestinal Study)
⦿ rectal infusion of
barium sulfate, is the
roentgenographic
study of the lower
intestinal tract (colon).
○ Used to diagnose structural
abnormalities of the
esophagus, stomach, and
duodenum.
most commonly used to check
bowel health; they can help
diagnose and evaluate the extent of
inflammatory bowel diseases such
as ulcerative colitis and Crohn's
disease.
⦿ Before the procedure:
○ Tell the patient to
avoid smoking 24
hours prior to
procedure.
○ Explain to the
patient the need to
drink contrast
medium.
○ Keep NPO for 8 –
12 hours before the
procedure.
⦿ After the procedure:
○ White stool is
normal within 72
hours after the test.
○ Force fluids and
administer laxatives
to prevent contrast
medium impaction.
○ Clear liquid diet evening before
the procedure.
○ NPO 8 hours before the
procedure.
○ Administer enema or laxative
evening before the procedure.
○ Explain that cramping and urge
to defecate may occur during
administration of barium
enema.
 ○ Enforce fluids and administer
laxatives after the procedure to
prevent intestinal obstruction.

Acid Perfusion Test Helps to distinguish may be used to diagnose

Note: Absence of pain or
(Bernstein Test) pain caused by gastroesophageal reflux disease
burning during infusion of
esophagitis (GERD)
solutions indicates a healthy
(heartburn) from pain
esophageal mucosa.
caused by angina
pectoris or other
disorders.

It requires infusion of
saline and acidic
solutions into the
esophagus through a
nasogastric tube.