GASTROINTESTINAL SYSTEM

ASSESSMENT
PYRAMID POINTS
Technique for abdominal assessment
Assessment of risk factors associated with
gastrointestinal (GI) disorders
Preprocedure and postprocedure interventions for
diagnostic studies
Common laboratory studies related to the
gastrointestinal tract and their relationship to
gastrointestinal disorders
RISK FACTORS OF GI
DISORDERS
Family history of GI disorders
Chronic laxative use
Tobacco use
Chronic alcohol use
Chronic high stress levels
Allergic reactions to food or medications
Chronic use of aspirin or nonsteroidal
antiinflammatory drugs (NSAIDs)
RISK FACTORS OF GI
DISORDERS
Long-term GI conditions such as ulcerative colitis
may predispose to colorectal cancer
Previous abdominal surgery or trauma may lead to
adhesions
Neurological disorders can impair movement,
particularly with chewing and swallowing
Cardiac, respiratory, and endocrine disorders may
lead to constipation
Diabetes mellitus may predispose to oral candida
infections
UPPER GI TRACT STUDY (BARIUM
SWALLOW)

From Zakus SM: Clinical procedures for medical assistants, ed. 3, St. Louis, 1995, Mosby.
UPPER GI TRACT STUDY (BARIUM
SWALLOW)
POSTPROCEDURE
A laxative may be prescribed
Instruct the client to increase oral fluids to help pass
the barium
Monitor stools for the passage of barium (stools will
appear chalky white) because barium can cause a bowel
obstruction
LOWER GI TRACT STUDY
(BARIUM ENEMA)
DESCRIPTION
A fluoroscopic and radiographic examination of the
large intestine after rectal instillation of barium sulfate
May be done with or without air
LOWER GI TRACT STUDY
(BARIUM ENEMA)

From Heuman DM, Mills AS, McGuire HH: Gastroenterology, Philadelphia, 1997, W.B. Saunders.
LOWER GI TRACT STUDY (BARIUM
ENEMA)
PREPROCEDURE
A low-residue diet for 1 to 2 days prior to the test
A clear liquid diet and a laxative the evening before the
test
NPO after midnight prior to the day of the test
Cleansing enemas on the morning of the test
LOWER GI TRACT STUDY (BARIUM
ENEMA)
POSTPROCEDURE
Instruct the client to increase oral fluids to help pass
the barium
Administer a mild laxative as prescribed to facilitate
emptying of the barium
Monitor stools for the passage of barium
Notify the physician if a bowel movement does not
occur within 2 days
GASTRIC ANALYSIS
DESCRIPTION
The passage of a nasogastric (NG) tube into the
stomach to aspirate gastric contents for the analysis of
acidity (pH), appearance, and volume; the entire gastric
contents are aspirated and then specimens are collected
every 15 minutes for 1 hour
Histamine or pentagastrin may be administered
subcutaneously to stimulate gastric secretions; may
produce a flushed feeling
GASTRIC ANALYSIS
DESCRIPTION
Esophageal reflux of gastric acid may be performed by
ambulatory pH monitoring; a probe is placed just above
the lower esophageal sphincter, is connected to an
external recording device, and provides a computer
analysis and graphic display of results
MANOMETRY TUBES AND pH
PROBE

From Beare, P. & Myers, J. (1998). Adult health nursing, ed 3, St Louis: Mosby.
 GASTRIC ANALYSIS
PREPROCEDURE
Fasting for 8 to 12 hours prior to the test
Avoid tobacco and chewing gum for 6 hours prior to
the test
Medications that stimulate gastric secretions are
withheld for 24 to 48 hours
POSTPROCEDURE
May resume normal activities
Refrigerate gastric samples if not tested within 4 hours
UPPER GI FIBEROSCOPY
DESCRIPTION
Also known as esophagogastroduodenoscopy (EGD)
Following sedation, an endoscope is passed down the
esophagus to view the gastric wall, sphincters, and
duodenum; tissue specimens can be obtained
ESOPHAGOGASTRODUODENOS
COPY

From Ignatavicius, D. & Workman, M. (2002). Medical-surgical nursing: Critical thinking for
collaborative care, ed 4, Philadelphia: W.B. Saunders.
UPPER GI FIBEROSCOPY
PREPROCEDURE
NPO for 6 to 12 hours prior to the test
A local anesthetic (spray or gargle) is administered
along with midazolam (Versed) IV (provides conscious
sedation and relieves anxiety) just before the scope is
inserted
Atropine may be administered to reduce secretions,
and glucagon may be administered to relax smooth
muscle
UPPER GI FIBEROSCOPY
PREPROCEDURE
Client is positioned on the left side to facilitate saliva
drainage and to provide easy access of the endoscope
Airway patency is monitored during the test and pulse
oximetry is used to monitor oxygen saturation;
emergency equipment should be readily available
UPPER GI FIBEROSCOPY
POSTPROCEDURE
NPO until the gag reflex returns (1 to 2 hours)
Monitor for signs of perforation (pain, bleeding,
unusual difficulty swallowing, elevated temperature)
Maintain bed rest for the sedated client until alert
Lozenges, saline gargles, or oral analgesics can relieve
minor sore throat after the gag reflex returns
ANOSCOPY, PROCTOSCOPY,
AND SIGMOIDOSCOPY
ANOSCOPY
Use of a rigid scope to examine the anal canal; client
is placed in the knee-chest position with the back
inclined at a 45-degree angle
PROCTOSCOPY AND SIGMOIDOSCOPY
Use of a flexible scope to examine the rectum and
sigmoid colon; client is placed on the left side with
the right leg bent and placed anteriorly
Biopsies and polypectomies can be performed
ANOSCOPY, PROCTOSCOPY,
AND SIGMOIDOSCOPY
PREPROCEDURE
Enemas until the returns are clear
POSTPROCEDURE
Monitor for rectal bleeding and signs of perforation
FIBEROPTIC COLONOSCOPY
DESCRIPTION
A fiberoptic endoscopy study in which the lining of the
large intestine is visually examined; biopsies and
polypectomies can be performed
Cardiac and respiratory function is monitored
continuously during the test
Performed with the client lying on the left side with the
knees drawn up to the chest; position may be changed
during the test to facilitate passing of the scope
FIBEROPTIC COLONOSCOPY

From Chabner D: The Language of Medicine, ed. 6, Philadelphia, 2001, W.B. Saunders.
FIBEROPTIC COLONOSCOPY
PREPROCEDURE
Adequate cleansing of the colon is necessary
A clear liquid diet is started at noon on the day before
the test
Consult with the physician regarding medications that
must be withheld prior to the test
Client is NPO after midnight on the day before the test
Midazolam (Versed) IV is administered to provide
sedation
Glucagon may be administered to relax smooth muscle
FIBEROPTIC COLONOSCOPY
POSTPROCEDURE
Provide bed rest until alert
Monitor for signs of perforation
Instruct the client to report any bleeding to the
physician
LAPAROSCOPY
(PERITONEOSCOPY)
DESCRIPTION
Performed with a fiberoscopic laparoscope that allows
direct visualization of organs and structures within the
abdomen
Biopsies may be obtained
LAPAROSCOPY: PLACEMENT OF
TROCARS

From Chabner D: The Language of Medicine, ed. 6, Philadelphia, 2001, W.B. Saunders.
CHOLECYSTOGRAPHY
DESCRIPTION
Performed to detect gallstones and to assess the ability
of the gallbladder to fill, concentrate its contents,
contract, and empty
CHOLECYSTOGRAPHY
PREPROCEDURE
Assess allergies to iodine or seafood
Contrast agents are administered 10 to 12 hours
(evening before) before the test
Client is NPO after the contrast agent is administered
Instruct the client that if a rash, itching, hives, or
difficulty breathing occurs after taking the contrast
agent, to report to the emergency room
CHOLECYSTOGRAPHY
POSTPROCEDURE
Inform the client that dysuria is common because the
contrast agent is excreted in the urine
A normal diet may be resumed (a fatty meal may
enhance excretion of the contrast agent)
 CHOLANGIOPANCREATOGRA
PHY (ERCP)
DESCRIPTION
Examination of the hepatobiliary system via a flexible
endoscope inserted into the esophagus to the
descending duodenum; multiple positions are required
during the procedure to pass the endoscope
If medication is administered prior to the procedure,
the client is monitored closely for signs of respiratory
and central nervous system depression, hypotension,
oversedation, and vomiting
PHY (ERCP)

From Beare, P. & Myers, J. (1998). Adult health nursing, ed 3, St Louis: Mosby.
CHOLANGIOPANCREATOGRA
PHY (ERCP)
PREPROCEDURE
Client is NPO for several hours prior to the procedure
Sedation is administered prior to the procedure
POSTPROCEDURE
Monitor vital signs
Monitor for the return of the gag reflex
Monitor for signs of perforation or infection
TRANSHEPATIC
CHOLANGIOGRAPHY
DESCRIPTION
Involves the injection of dye directly into the biliary
tree
The hepatic ducts within the liver, the entire length of
the common bile duct, the cystic duct, and the
gallbladder are clearly outlined
PERCUTANEOUS
TRANSHEPATIC
CHOLANGIOGRAPHY

From Beare, P. & Myers, J. (1998). Adult health nursing, ed 3, St Louis: Mosby.
 TRANSHEPATIC
CHOLANGIOGRAPHY
PREPROCEDURE
Client is NPO
Sedating medication is administered
POSTPROCEDURE
Monitor vital signs
Monitor for signs of bleeding, peritonitis, and
septicemia; report the presence of pain immediately
Administer antibiotics as prescribed to reduce the risk
of sepsis
PARACENTESIS
DESCRIPTION
Transabdominal removal of fluid from the peritoneal
cavity for analysis
PARACENTESIS

From Beare, P. & Myers, J. (1998). Adult health nursing, ed 3, St Louis: Mosby.
 PARACENTESIS
PREPROCEDURE
Obtain informed consent
Void prior to the start of procedure to empty bladder
and to move bladder out of the way of the paracentesis
needle
Measure abdominal girth, weight, and baseline vital
signs
Note that the client is positioned upright on the edge of
the bed with the back supported and the feet resting on
a stool (Fowler’s position is used for the client confined
to bed)
PARACENTESIS
POSTPROCEDURE
Monitor vital signs
Measure fluid collected, describe, and record
Label fluid samples and send to the laboratory for
analysis
Apply a dry sterile dressing to the insertion site;
monitor site for bleeding
Measure abdominal girth and weight
PARACENTESIS
POSTPROCEDURE
Monitor for hypovolemia, electrolyte loss, mental status
changes, or encephalopathy
Monitor for hematuria due to bladder trauma
Instruct the client to notify the physician if the urine
becomes bloody, pink, or red
LIVER BIOPSY
DESCRIPTION
A needle is inserted through the abdominal wall to the
liver to obtain a tissue sample for biopsy and
microscopic examination
LIVER BIOPSY

From Black, J., Hawks, J., & Keene, A. (2001). Medical-surgical nursing: Clinical management for
positive outcomes, ed 6, Philadelphia: W.B. Saunders.
LIVER BIOPSY
PREPROCEDURE
Obtain informed consent
Assess results of coagulation tests (prothrombin time,
partial thromboplastin time, platelet count)
Administer a sedative as prescribed
Note that the client is placed in the supine or left
lateral position during the procedure to expose the
right side of the upper abdomen
 LIVER BIOPSY
POSTPROCEDURE
Assess vital signs
Assess biopsy site for bleeding
Monitor for peritonitis
Maintain bed rest for several hours
Place client on the right side with a pillow under the
costal margin to decrease the risk of hemorrhage, and
instruct the client to avoid coughing and straining
Instruct the client to avoid heavy lifting and strenuous
exercise for 1 week
GI MOTILITY STUDIES
RADIONUCLIDE TESTING
Assesses gastric emptying and colonic emptying
time
A capsule containing radioactive material is
administered to the client and the time it takes for
the radioactive material to move through the colon
indicates colonic motility
ELECTROGASTROGRAPHY
Used to detect motor or neurological dysfunction in
the stomach; records gastric electrical activity
GI MOTILITY STUDIES
ESOPHAGEAL MANOMETRY
Detects motility disorders of the esophagus and lower
esophageal sphincter
Client is NPO for 8 to 12 hours before the test and
medications that affect GI motility are withheld
GASTROINTESTINAL, SMALL INTESTINAL, AND
COLONIC MANOMETRY
Evaluates delayed gastric emptying and gastric and
intestinal motility disorders; often is an ambulatory
outpatient procedure that lasts 24 to 72 hours
GI MOTILITY STUDIES
ANORECTAL MANOMETRY
Measures the resting tone and contractibility of the
anal sphincters to evaluate the client with chronic
constipation or fecal incontinence; phosphosoda or a
cleansing enema is administered 1 hour prior to the test
RECTAL SENSORY FUNCTION TEST
Evaluates rectal sensory function and neuropathy to
evaluate the client with chronic constipation, diarrhea,
or incontinence
DEFECOGRAPHY
Measures anorectal function
Thick barium is instilled into the rectum, fluoroscopy
is performed, and the function of the rectum and anal
sphincter is visualized while the client attempts to
pass the barium
Digital subtraction methods may be used for more
rapid imaging and mapping of rectal evacuation
No preparation is required
STOOL SPECIMENS
Includes inspecting the specimen for consistency and
color and testing for occult blood
Tests for fecal urobilinogen, fat, nitrogen, parasites,
pathogens, food substances, and other substances;
these tests require that the specimen be sent to the
laboratory
Random specimens are promptly sent to the
laboratory
STOOL SPECIMENS
Quantitative 24- to 72-hour collections must be kept
refrigerated until they are taken to the laboratory
Some specimens require that a certain diet be
followed or that certain medications be withheld;
check agency guidelines regarding specific procedures
HYDROGEN BREATH TEST
Evaluates carbohydrate absorption by determining
the amount of hydrogen expelled in the breath after it
is produced in the colon and absorbed in the blood
Used to aid in the diagnosis of bacterial overgrowth
in the intestine
UREA BREATH TEST
Detects the presence of Helicobacter pylori, the
bacteria that causes peptic ulcer disease
The client consumes a capsule of carbon-labeled urea
and provides a breath sample 10 to 20 minutes later
UREA BREATH TEST
Client is instructed to avoid antibiotics or bismuth
subsalicylate (Pepto-Bismol) for 1 month before the
test; sucralfate (Carafate) and omeprazole (Prilosec)
for 1 week before the test; and cimetidine (Tagamet),
famotidine (Pepcid), ranitidine (Zantac), or nizatidine
(Axid) for 24 hours before breath testing
Helicobacter pylori can also be detected by assessing
serum antibody levels
 LIVER AND PANCREAS
LABORATORY STUDIES
ALKALINE PHOSPHATASE
Released during liver damage or biliary obstruction
PROTHROMBIN TIME (PT)
Prolonged with liver damage
SERUM AMMONIA
Assesses the ability of the liver to deaminate protein
by-products
LIVER ENZYMES (TRANSAMINASE STUDIES)
Elevated with liver damage
LIVER AND PANCREAS
LABORATORY STUDIES
CHOLESTEROL
Increase indicates pancreatitis or biliary obstruction
BILIRUBIN
Increase indicates liver damage or biliary obstruction

AMYLASE AND LIPASE

Elevations indicate pancreatitis
Refer to module entitled Laboratory Values for
information regarding normal liver and pancreas
laboratory levels
ABDOMINAL ASSESSMENT
Inspect skin for color, abnormalities, contour, and
tautness, and the abdomen for distension
Auscultate for bowel sounds
Percuss for air or solids
Palpate for tenderness
SYSTEMATIC ROUTE FOR
ABDOMINAL PERCUSSION

From Beare, P. & Myers, J. (1998). Adult health nursing, ed 3, St Louis: Mosby.
ASSESSMENT FOR BOWEL
SOUNDS
Auscultate bowel sounds before percussion and
palpation
Normal bowel sounds occur 5 to 30 times a minute or
every 5 to 15 seconds
Auscultate in all abdominal quadrants
Listen at least 5 minutes in each quadrant before
assuming sounds are absent
QUADRANTS OF THE
ABDOMEN

From Black, J., Hawks, J., & Keene, A. (2001). Medical-surgical nursing: Clinical management for
positive outcomes, ed 6, Philadelphia: W.B. Saunders.