2. Introduction
Diagnostic test is an examination to identify an individual’s specific areas of
weakness and strength in order to determine any disease or illness. These tests
are easy to interpret, but other must be interpreted by expert clinicians. All the
tests should be explained to the patient. Some necessitate special preparation
before they are performed and special monitoring by nurse after the procedure.
3. Anatomy and physiology of digestive
system
The alimentary tract of digestive system consists of mouth pharynx
oesophagus stomach small intestine large intestine rectum and anus.
Mouth: It consists of lips and buccal cavity. The oral cavity contain teeth, used
in mastication of food and tongue which contain taste buds. Within the oral
cavity, there are three pairs of salivary glands i.e, parotid, submaxillary and
sublingual. Digestion begins in the mouth.
Pharynx: It is divided into nasopharynx, oropharynx and laryngopharynx.
Oropharynx secrete mucus which aid in swallowing.
Oesophagus: The propulsion of food occurs through peristalsis.
4. Stomach- It stores food, mixes the food with gastric secretion, empty the
contents into small intestine.
Small intestine- It’s primary function is digestion and absorption. It is coiled
tube composed of duodenum, jejunum and ileum. It has villi on its surface.
Large intestine- It consists of caecum, colon, rectum and anus. It’s important
function is the absorption of water and electrolyte. It also form feces and serves
as reservior of fecal mass until defecation.
Liver- It is the largest internal organ present in the right epigastric region. It
secretes biles and help in detoxification.
Pancreas- Pancreas has digestive and hormonal function.
Gall bladder- it’s primary function is to store bile and concentrate it.
6. Change in bowel habits and stool
characteristics
Diarrhoea is an abnormal increase in frequency and liquidity of stool. When stool
moves too rapidly through the intestine and colon, there is an inadequate time
for GI secretion and oral content to be absorbed.
Constipation is decrease in the frequency of stool or stool i.e, hard dry and of
smaller volume than typical may be associated with anal discomfort and rectal
bleeding.
If blood is shed in sufficient quantity into the upper GI tract, it produces tarry
black melena whereas blood entering the lower portion of GI tract or passing
through it will appear bright Or dark red. Lower rectal and anal bleeding is
suspected if there is streaking of blood on the surface of stool or if blood is noted
in the toilet.
7. Diagnostic Evaluation
The majority of tests are performed on the outpatient basis in special settings.
General nursing interventions for the patient who is going a GI diagnostic evaluation. These include-
– Establishing the nursing diagnosis.
– Providing necessary information about the tests.
– Explain the procedure and obtain the written consent.
– Providing instructions about post procedure care and activities restrictions.
– While preparing the patient it is important to ask about any unknown allergies to drugs or contrast media.
– Nurses must monitor the patient closely to ensure adequate hydration and nutrition during testing period.
– Providing health information and procedural education to patient and significant others.
– Informing the primary provider of unknown medication or abnormal laboratory values that may affect the
procedure.
8. Diagnostic tests
Barium swallow test
Xray studies with fluoroscopy with contrast medium.
It is used to diagnose abnormalities in oesophagus stomach and duodenum.
Nursing responsibility-
– Explain procedure to the patient.
– Explain the patient about need to drink contrast medium and need to assume
various positions on x-ray table.
– Keep the patient NPO 8-12 hr before procedure.
– Tell patient to avoid smoking after midnight, the night before the study.
9. Imaging Studies
Upper GI tract study- The GI studies enables the examiner to detect or exclude atomic or
functional disorders of upper GI organs or spinchter. It also aid in diagnosis of ulcer, tumors and
malabsorption syndrome.
– Variations of upper GI studies include double contrast studies or enteroclysis.
– The double contrast method of examining upper GI tract involves administering of thick barium
suspension to the stomach and oesophagus after which tablet that release carbon dioxide in
the presence of water are administered.
– This technique has advantages of showing finer detailed double contrast study of entire small
intestine that involves continuous infusion of 500-1000ml of barium sulfate suspension. After
this methyl cellulose is infused through the tube.
– This process can be take upto 6 hours and can be quiet uncomfortable to the patient.
– The value of this technique is diminished as better technology has emerged.
10. Nurses responsibility
The nurse should advise not to do smoking or chewing gums because they can
stimulate gastric mobility.
Medication should be given in the evening but In each patient, medication
should be evaluated on individual basis.
Fluids may be increase to facilitate evaculation of stool and barium.
11. Lower Gastrointestinal tract study-
Visualisation of lower GI is obtained after the recal installation of barium.
The barium enema can be used to detect the presence of polyp tumors or
other lesions of large intestine and demonstrate any malfunctioning of bowel.
A barium enema is a x-ray exam that can detect change or abnormalities in
hte large intestine. The procedure is called as colon X-ray.
12. Nurses responsibility
–A nurse makes sure that barium enema is scheduled before any
upper GI studies.
–Nurse need to evacuate the bowel properly and clean the
surface.
–Monitor for diarrhoea and check stool for occult blood.
–After barium enema instruct the patient to resume usual diet,
fluid, medication or activity as directed by doctors.
13. Computed tomography
It is a non invasive radiologic examination which provides cross sectional
image of abdominal organs and structure. Multiple x-ray are taken from
numerous angles and viewed on computer monitor.
It is used in evaluating the abdomen for disease of liver, kidney, pancreas and
pelvic organs.
14. Nurses responsibility
– A CT scan may be performed with or without oral or IV contrast but the
enhancement of study is greater with use of a contrast agent.
– Explain procedure to the patient and determine sensitivity to iodine if contrast
medium is used.
– Patient allergic to contrast agent may be premedicated with corticosteroids and
antihistamines.
15. Magnetic resonance imaging
This technique use magnetic field and radio waves to produce image of the
area being studied.
It is useful in evaluating abdominal soft tissue as well as blood vessel,
neoplasms, fistulas and other sources of bleeding.
MRI is not totally safe for all people as it interrupt with metal that contains iron
which gets attracted to the magnet causes injury.
16. Nurses responsibility
The nurses should remove all jewellery and other metal.
The patient and family should be informed that study may take 60-90 minutes.
Patient may choose to wear a headset and listen to the music and wear
blindfold during the procedure.
17. Positron emission
tomography
It produces the image of the body by detecting the radiation emitted from
radioactive substances. These radioactive substances are injected to the body
through IV and are usually tagged with radioactive atom such as carbon-11 .
The atom decays and don’t harm the body.
18. Nurses responsibility
– Make sure that patient should not eat or drink several hours before tests.
– Check the patient for any allergy or diabetes, if she is pregnant or
breastfeeding mother.
– Make sure patient shouldn’t do any exercise 24 hours before the test.
19. Abdominal Ultrasonography
A non invasive diagnostic tests in which high frequency soundwaves are
passed into internal body structure and recorded as they are reflected. A
conductive jelly is applied to skin and a transducer is placed on the area.
It is particularly useful in enlargement of gall bladder or pancreas of gall
stones, enlarged ovary or appendicitis.
20. Nurses responsibility
– Patient is instructed to fast for 8-12 hours before ultrasound testing to
decrease the amount of bowel.
– Patient perceive moderate sedation are observed for about 1 hour to
assess the level of consciousness, orientation and ability to ambulate.
– Patient treated on a outpatient basis are given instructions regarding diet,
activity and how to monitor for complications.
21. Liver function tests
Bile formation and excretion
Serum bilirubin- measurement of ability of liver to conjugate and excrete
bilirubin in plasma.
Total- measurement of direct and indirect bilirubin.
Normal finding- 0.2-1.3 mg/dl
Direct- measurement of conjugated bilirubin, elevation of hepatocellular
and hemolytic condition.
Normal finding- 0.1-0.3mg/dl
22. Indirect- measurement of unconjugated bilirubin, elevation of
hepatocellular and hemolytic condition.
Normal finding- 0.1-1.0mg/dl
Urinary bilirubin- measurement of urinary excretion of conjugated
bilirubin.
Urinary urobilinogen- measurement of urinary excretion of urobilinogen,
maximum excretion from mid-afternoon to early evening.
Normal finding- 0.5-4.0mg/day
Fecal urobilinogen- measurement of fecal urobilinogen in stool
specimen. Normal finding- 30-220mg/100dl stool.
23. Serum enzyme test
Alkaline phosphate (ALP)- originating in bones and liver. Serum level
rises when excretion is impaired as a result of obstruction in biliary tract.
Normal finding- 30-120U/L
Aspartate aminotransferase (AST)- Elevation in liver damage and
inflammation.
Normal finding- 7-40U/L
Alanine aminotransferase (ALT)- Elevation in liver damage and
inflammation.
Normal finding- 5-36U/L
24. Nurses responsibility
– Explain the patient that he might experience slight discomfort from the
tourniquet and needle puncture.
– Inform the patient that he or she need not to restrict food and fluid.
– Notify the laboratory and physicians of medication that the patient is taking
that may affect normal finding.
25. Endoscopic procedure
Upper GI endoscopy- fibrescopy of upper GI allow direct visualisation of
esophageal gastric and duodenal mucosa through a lighted endoscope.
– In EGD, the doctor view the GIT through a viewing lens and can obtain image
through a scope to document finding.
– Sclerosing solutions can be injected through a scope to control GI bleeding.
26.
27. Nurses responsibility
– Ensure the patient should be at NPO for 8 hrs prior to examination.
– The nurse should lubricate the endoscope with water soluble lubricant to
prevent bleeding from smooth passage.
– Someone has to stay with the patient until morning after examination.
28. Fibreoptic colonoscopy
Direct visual inspection of the large intestine is possible by this technique.
– The procedure can be used to remove all visible polyp with special snare
and cautery through colonoscopy.
– It is used to treat area of bleeding.
– It is performed while patient is lying on left side with leg drawn up towards
chest.
29.
30. Nurses responsibility
– The patient should maintain a clear liquid diet starting at noon the
day before the procedure.
– The use of lavage solutions is contraindicated in patients with
intestinal obstruction.
– Immediately after test patient is monitored for sign and symptoms of
bowel perforation.
31. Anoscopy, Proctoscopy and
sigmoidoscopy
Endoscopic examination of anus, rectum, sigmoid and descending colon
is used to evaluate chronic diarrhoea, fecal incontinence and lower GI
bleeding and to observe for ulceration, tumor and polyp.
The sigmoidoscopy permit the colon, anus and rectum to be visualised.
32. Nurses responsibility
– The nurse should monitor the vital signs, skin colour, pain tolerance and
vagal response.
– The nurse monitor for rectal bleeding and sign of intestinal perforation.
– Dietary restrictions are usually not necessary and sedation isn’t required.
33. Small bowel studies
There are several methods available for visualisation of small intestine
include capsule endoscopy and double balloon endoscopy.
Capsule endoscopy
Allow non invasive visualisation of mucosa in small intestine. The
technique consists of patient swallowing a capsule embedded with
miniature camera, a light source and an image transmission system and
pass through intestine and pass through rectum in one or two days.
34.
35. Nurses responsibility
– Explain procedure to the patient.
– Patient might feel uncomfortable, reassure the patient.
– Patient must stop eating 12hrs before the test.
– In some cases laxatives are given to flush out small intestine before
procedure.
36. Double balloon endoscopy
Known as push or pull endoscopy consists of balloon one attached to
distal end and other to transparent over tube. This technique involves
alternately inflating and deflating the balloon causing telescopy of small
intestine onto the over tube.
37. Nurses responsibility
– The nurse should sedate the patient as it is a painful process.
– The nurse should tell the patient that procedure will take one or more
hours.
38. Endoscopy through ostomy
Endoscopy through an ostomy stoma is used to visualise a segment of small
intestine or large intestine and may be indicated to evaluate the the
anastomosis for recurrent disease or to bleeding in a segment of bowel.
Nurses responsibility
– The patient should be on clear fluid diet
– The nurse should educate patient about procedure.
39. Virtual colonoscopy
Technique combine CT scanning or monitoring the computer virtual reality
software to detect colon and bowel disease including polyp colorectal
cancer, diverticulosis and lower GI bleeding.
Images are obtained while patient is on back or stomach.
Computer combines image to form 2-D and 3-D picture which are viewed
on monitor.
40. Nurses responsibility
– To ensure patient safety when colonoscopy is reprocessed
– Initiating sedation
– Monitoring pt during procedure and providing post procedure care
and instructions.
41. Gastric analysis , Gastric acid
stimulation test And pH
monitoring
Analysis of gastric juice yield information about secretory activities of
gastric mucosa. The volume and pH of specimen are measured to
determine the presence or absence of malignant cell.
Nurses responsibility
– The patient is at NPO for 8-12 Hrs before the test.
– Smoking isn’t allowed on the morning of test.
– Nurse monitor patient bp and pulse to detect hypotension.
42. Laparoscopy
It is a surgical diagnostic procedure used to examine organ inside
abdomen. It’s a low risk minimally invasive procedure that require only
small incision.
An instrument called laproscope is used to look at abdominal organs.
Nurses responsibility
– Nurse should visualise and assess the liver, gall bladder and spleen to
assist with surgical intervention.
– A laxatives and cleansing enema may be needed the day before
procedure.
43. Manometry and
Electrophysiologic studies
These are the method of evaluating the patient with GI mobility disorders. The
manometry test changes the intraluminal pressure and coordination of
muscle activity.
GI motility testing is used to correctly diagnose the abnormal pattern and
physiology. The tube back into into oesophagus the patient then swallow the
tube during the time computer measure and record pressure in different
sections of oesophagus.
44. – Oesophagus manometry: It uses specialised catheter that can
evaluate disorder of motor function of oesophagus and it’s spinchter
muscle.
– Bowel manometry: It is a motility test that uses a catheter with
pressure sensor to record the contraction of GI tract. It is also known
as anorectal manometry is given to patient with fecal incontinence or
constipation.
45. Nurses responsibility
– The nurses should give enema before anorectal manometry.
– Establish IV line.
– The procedure takes 20min to hour.
– The nurse should tell the patient will have discomfort during
oesophageal manometry.
46. Urea breath test
A rapid diagnostic test procedure used to identify by Helicobacter
pylori , a spiral Bacteria is implicated in gastritis, is the based on
ability of Helicobacter pylori to convert urea to ammonia and carbon
dioxide.
This test require you to swallow a capsule containing a small amount
of 14-C urea with small cup of water to drink.
47. After 7 min the patient is required blow a
balloon.
Nurses responsibility
Administer prescribed medication.
Encourage patient to eat regularly in relaxed
atmosphere.
Encourage relaxation techniques.
Monitor oxygen saturation.
48. Miscellaneous tests
Gastric analysis- purpose is to analyse the gastric content for
acidity and volume.
Nasogastric tube is inserted and gastric content is aspirated. Content
are analysed mainly for HCl but pH, pepsin and electrolyte may be
determined.
49. Nurses responsibility
–Keep patient at NPO for 8-12 hours.
–Explain insertion of nasogastric tube.
–Withhold drugs affecting gastric secretion 24-48 hours before
test.
–Ensure no smoking on the morning of tests.
50. Fecal analysis- form, consistency and color are noted. Specimen
examined for mucus blood pus parasite and fat content.
Nurses responsibility
– Observe patient stool. Collect the specimen.
– Check the stool for blood with haemocult or heme test.
– Keep diet free of red meat.
51. Summary
Today we reviewed various diagnostic tests in digestive
system and related nurse’s responsibility during before and
after the specific diagnostic tests.
52. Conclusion
To conclude I would like to say that there are many more
tests from which we cover some important one.
I hope you all understood well.
53. Bibliography
– Brunner and Siddharth’s medical surgical nursing Vol II ,
13th edition pg no- 1197-1212.
– Black hawk medical surgical nursing volume II, Pg 572-
574
– www.diagnostictestfordigestivesys.com
