Sunday, March 15, 2009

Digestive System: Assessment and Diagnostics

Assessment of Digestive System



Health History

- Nature of problem

- Major illnesses and hospitalization

- Medications

- Nutritional status

- Family history

- Social history


Physical Examination


- Height and weight


- Mouth and pharynx

- Inspect lips for symmetry, color, and presence of abnormalities

- Using penlight and tongue depressor, inspect the inner surfaces of the of the lips and oral mucosa

- Inspect teeth and gums

- Note significant mouth odors

- Assess pharynx and tonsils foe signs of inflammation, ulceration

- Ask the person to say ‘ah’



- Abdomen


General Principles

- Inspection, auscultation, percussion, palapation

- Proceed systematically from upper right quadrant moving clockwise

- Examine areas of pain and tenderness last



Preparing for examination

- Ask pt to empty bladder

- Have pt lie supine w/ knees slightly bent and arms at side



Inspection

- Skin – from neck to abdomen

- Architecture – symmetry of abdomen, shape,

- Movement - normal rise and fall during respiration (adults are not normally abdominal breathers), pulsations, peristaltis (not normally seen)



Auscultation

- Bowel sounds – normal: every 5-15 seconds, 5-35 per minute

- Circulatory sounds – pulsations, bruit


Percussion

- Determines the size and density of organs

- Percussion on abdomen is tympanic over air filled or dull in solid organs



Palpation

- Light palpation for masses and tendern

ess

- Deep palpation size and shape of organs and masses

- Rebound tenderness



Laboratory and Diagnostic Tests


Blood Level Assessments

- Amonia – elevation seen w/ liver disorders

- Amylase – elevated with pancreatitis

- Lipase – elevated during pancreatitis

- AST and ALT – elevated during liver disorders

- Urobilinogen – liver, gallbladder aor bile duct disorders



Urine and Stool Analysis


- Schilling’s test - test to determine perniciuos anemia

- Urine Urobilinogen- use to detect abnormality in bile excretion may be due to billary tract obstruction or inflammatory diseases of the liver and gallbladder


- Stool for occult blood: Hemoccult Guaiac Tests

- Usually 3 stools are collected and must reach laboratory w/n 6 hours

- For 3 days before the test:

- Avoid red meat in the diet

- Avoid foods with a high peroxidase, turnips, cauliflower, broccoli, radish, and melon.

- Avoid iron preparations, enemas and laxatives


- Analyze stool for fecal fat

- May be a random stool or pt may adhere to 3-day high fat diet followed by 72-hour collection of stool



- Culture

- Detect presence of bacteria, ova, or parasites

- Obtain freshly passed specimen and transport immediately to the laboratory



Gastric Analysis

- Measures the stomach’s secretion of hydrochloric acid and pepsin

- NPO for 12 hrs before the test

- NGT is inserted and residual contents are discarded

- During analysis, NGT is hooked to suction and contents are collected every 15 mins interval for 1 hour

- Increase levels may indicate ulcers

- Decrease levels may indicate carcinoma




- Radiologic test



- Upper Gastrointestinal Series and Small-Bowel Series

- used to detect esophageal disorders, gastric ulcers, tumors and small bowel disorders

- Explain procedure to patient.

- Clear liquid dinner, the night before the procedure. NPO after midnight. Narcotics and anticholinergics to be held 24 hours.

- pt drinks mixture of barium sulphate. Traces after 30 minutes. Small bowel are taken every 30 mins for 2-6 hours

-post procedure: laxative is given. Stool will be light in color for the next 2 to 3 days from the barium. Notify health care provider if he or she has not passed the barium in 2 to 3 days

- Water-soluble iodinated contrast agent (such as Gastrografin) may be used for a patient suspected perforation



- Barium Enema

- Purpose: visualization of the large intestine to detect masses, structure, inflammation

- Preparation: pt on clear liquid diet for 24 hours and NPO after midnight. Laxative or enema is given evening before the test

- Procedure: barium mixture is inserted through a rectal catheter. Air may be introduced after the barium. Patient is placed on various position and instructed to hold the enema. Test usually take 1 hour.

- Follow- up: laxative is ordered.



- Ultrasonography (ultrasound)

- Purpose: noninvasive and uses high frequency sound waves to image soft tissues and organs. Doppler may be used for vascular assessment

- Preparation: maintain NPO for 8-12 hours. If indicated, use laxative or enema.

- Procedure: a lubricated microphone transducer is placed on the abdomen and rubbed over the skin. There is no follow-up.



- Computed Tomography

- visualizes differences in tissue densities thus detects tumors and masses. x-ray technique that provides excellent anatomic definition

- NPO for 8-12 hours. Ask the patient if she a pregnant. If yes do not proceed with scan and notify health care provider. Ask if there are known allergies to iodine or contrast media.

- intravenous contrast media may be given to enhance imaging. Report symptoms of itching or shortness of breath. Pt is placed on a radiograph table and moved inside the scanning machine that emits loud clicking sounds as it moves to different positions. No follow-up.



- Endoscopic Procedures


- Esophagogastroduodenoscopy

- Uses flexible endoscope to provide direct visualization of upper GIT

- client is placed on NPO for 4-6 hours. Medications such as atropine to lessen secretions and IV sedative may be given. Topical anethetics applied to the throat to depress gag reflex. Remove dentures.

- client is positioned on left side. lubricated endoscope passes down to GIT, pt is asked to swallow. Monitor V/S and airway. Air is inserted, pt may feel bloated.

-post procedure put client on NPO until gag reflex returns. May experience sore throat. Monitor for complications.


- Colonoscopy and Proctosigmoidoscopy

-uses flexible endoscope to provide direct visualization of large intestine, sigmoid and rectum

- pt is on clear liquid diet 24 hours before the test.

- IV sedative may be given to help the client relax.

- to remove feces and better visualization, laxative or enema are given.

- client is positioned on left side. lubricated endoscope passes through the anus, pt is asked to deep breath. Monitor V/S. Air may be inserted.

- after the procedure monitor V/S. Monitor for complications such as bleeding.





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