COMMON LABORATORY PROCEDURES

FECALYSIS-1
.Examination of stool consistency, color and the presence of occult blood
.Special tests for fat, nitrogen, parasites, ova, pathogens and others
.Occult Blood Testing: blood in the feces that is not visibly apparent-2
Instruct patient adhere to 3day meatless diet - no intak NSAIDS, aspirin, anticoagulant - screen test for colonic cancer
.Upper GIT study: barium swallow: examines the upper GI tract - Barium sulfate is usually used as contrast-3
Pre-test: NPO post-midnight
.Post-test: Laxative is ordered, increase fluid intake, instruct that stools will turn white, monitor for obstruction
Lower GIT study: barium enema-4
.Pre-test: Clear liquid diet and laxatives, NPO -midnight, cleansing enema prior to the test
.Post-test: Laxative ordered, increase fluid intake, instruct that stools will turn white, monitor for obstruction
.Gastric analysis: aspiration of gastric juice to measure pH, appearance, volume and contents-5
.Pre-test: NPO 8-12h, any medications that affect gastric secretions are withheld for 24-48h before the test
.Smoking is not allowed on the morning of the test
Post-test: resume normal activities
.EGD: (esophagogastroduodenoscopy): visualization of the upper GIT by endoscope-6
Pre-test: ensure consent, NPO 8 hours, pre-medications like atropine and anxiolytics are given
.Intra-test: position, LEFT lateral to facilitate salivary drainage and easy access
Post-test: NPO until gag reflex return, SIMS position until awak, monitor complication, saline gargles mild oral discomfrt
Avoid drinking orange juice and eating tomatoes until the esophagus heals
.Lower GI-scopy: Sigmoidoscopy and colonoscopy: use of endoscope to visualize the anus, rectum, sigmoid, colon-7
.Pre-test: consent, NPO 8 hours, cleansing enema until return is clear
.Intra-test: (initially) position is LEFT lateral, right leg is bent and placed anteriorly
.Post-test: bed rest, monitor for complications like bleeding and perforation
.Complication: Bowel perforation. Therefore check signs of hypotension: decreased BP and increased pulse

Dysphagia: difficulty in swallowing

Neurological deficit: Infection - Stroke - Brain damage - Achalasia-1
Achalasia: failure of the lower esophageal sphincter to relax because of lack of innervation
Muscular disorder: Impairment from muscular dystrophy-2
Mechanical obstruction- 3
.Congenital atresia: developmental anomaly - Upper and lower esophageal segments are separated-
S/S: drooling of saliva -Stenosis •Narrowing of the esophagus •Developmental or acquired •May be secondary to
• fibrosis, chronic inflammation, ulceration, radiation therapy •Stenosis or stricture may also result from scar tissue
Treatment: repeated mechanical dilation
Esophageal diverticula: outpouchings of the esophageal wall - Congenital or acquired following inflammation-
Causes irritation, inflammation, scar tissue
Signs: dysphagia, foul breath, chronic cough, hoarseness
Tumors: internal or external-
.Hiatal Hernia: Part of the stomach protrudes into the thoracic cavity-2
.Sliding hernia: more common - portions of stomach and gastroesophageal junction slide up above the diaphragm •
.particularly when the person is in the supine position
Rolling or paraesophageal hernia: part of the fundus of stomach move up through enlarg or weak hiatus in diaphragm •
.and become trapped. the blood vessels in the wall of stomach compressed, leading to ulceration
Food may lodge in pouch of hernia: cause inflammation of mucosa - reflux of food up esophagus - chronic esophagitis
Sign: heartburn or pyrosis - frequent belching - discomfort when lay down - substernal pain radiate to shoulder and jaw
The role of the nurse in caring for patient with hiatal hernia: health teaching - Encourage to avoid eat in late evening
and avoid foods associated with reflux - follow a restricted diet and exercise to reduce body weight if overweight.
.Obesity increases intra-abdominal pressure and worsens both hernia and symptoms of reflux
.Teach about position: Sleep at night with head of bed elevated 6 inches - Remain upright for several hours after eat
.Avoid straining or excessive vigorous exercise - refrain from wearing cloth, tight or constrictive around abdomen
Open surgical approach for Nissen fundoplication for: gastroesophageal reflux disease - hiatal hernia repair-
.The fundus is wrapped around the esophagus and sewn into plac-
Gastroesophageal Reflux Disease (GERD): periodic reflux of gastric contents into distal esophagus-3
Cause: erosion and inflammation - seen in conjunction with hiatal hernia - Delayed gastric emptying may be factor
.Severity depends on competence of the lower esophageal sphincter
Avoidance of: Caffeine, fatty, spicy foods, alcohol, smoking, certain drugs, over the counter drugs
Diagnostic Test: barium swallow - esophagoscopy allow visualization and confirmation of pathologic chang in mucosa
.Complication: Esophagial cancer
.Treatments: Do not lie down for 3-4h after eating - Head of bed raised 15-20cm
.Bland diet: avoid garlic, onion, peppermint, fatty food, chocolate, coffee (decaffeinated), citrus juice, cola, tomato
Antacid: aluminum hydroxide: reduce gastric reflex - GI stimulants: metoclopramide(reglan), bethanechol(urecholine)
H2-receptor antagonists: cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid)
.Proton pump inhibitors: esomeprazole (Nexium), omeprazole (Prilosec)
Interventions
.sleep in reverse Trendelenburg’s position (with head of bed elevated 6-12 [15-30cm]) (use bed block) 30 degrees
avoid lying down after eating - Advise to avoid alcohol and tobacco - Avoid: acidic food: orange/tomato juice
.Advice small and frequent food to avoid distended abdomen - Avoid bending or stooping - Avoid tight-fitting clothe
:After surgery using thoracic approach
.watch chest tube drainag and respiratory status - chest physiotherapy and oxygen - NG tube in semi-fowler’s position
Stretta procedure, physician applies radiofrequency (RF) energy through endoscope using needles placed near the .1
.gastroesophageal junction. The RF energy decreases vagus nerve activity, thus reducing discomfort for patient
gastroplication procedure, the physician tightens the LES through endoscope /open using sutures near sphincter. .2
In laparoscopic Nissen fundoplication, there are four (4) to five (5) incisions
Esophageal diverticula: sacs result from herniation esophageal mucosa,protrudes through weak portion -4
musculature
.The most common type of diverticulum: Zenker’s diverticulum (known as pharyngoesophageal diverticulum)
.It is seen in people older than 60 years. Other types of diverticula include: midesophageal - epiphrenic diverticula
Signs: Dysphagia, with feeling food is caught in throat, regurgitation (reflux), nocturnal cough, halitosis (bad breath).
Diagnosis: esophagogastroduodenoscopy (EGD), Complication: perforation - Barium swallow
.Management: semisoft food, smaller meal, chewing food thoroughly, drinking lots of water after meals
Nocturnal reflux managed by sleep with head of bed elevated (prevent aspiration) and avoid supine position for at
.least 2h after eating. Dinner 2h prior to bed - avoid vigorous exercise after meals - Avoid constrictive cloth
.Surgical management: Cricopharyngeal Myotomy
Diverticulosis: outpouching or herniations of intestinal mucosa, occur in any part but most common in sigmoid -5
colon Cause: constipation - Prevent constipation: 2500ml water per day, avoid eating seeds, walk 30mts
Diverticulitis: Inflammation of the diverticula
.Stasis of material in diverticula leads to inflammation (diverticulitis) and infection
Cramping, tenderness, nausea, vomiting, slight fever, elevated white blood cell count-
Treatment: NPO, NGT - Antibiotic: aminoglycoside: allergy - dietary modifiction to prvent stasis - daily bowel movment
Gastroenteritis: Inflammation of stomach and intestine mucosa-6
Cause: infection, allergic reaction to food or drug, Microbe transmitte by fecally contaminated food, soil, water: E.coli
-Clostridium botulism: infection self-limit - epidemic outbrak in refugee or disaster sett - safe sanitation esential prvntion
.Rotavirus most common cause of severe diarrhoea among infants and young children-
Noroviruses most common cause of viral gastroenteritis in human. transmitte by fecally-contaminated food or water:-
by person-to-person contact; via aerosolization of virus, subsequent contamination of surfaces
Campylobacter: genus of bacteria, Gram-negative, spiral, microaerophilic. site of tissue injury: jejunum, ileum, colon-
.Gastrointestinal perforation is a rare complication of ileal infection
Gastritis: Acute Gastritis: (inflammation of the gastric or stomach mucosa)
Signs: Anorexia, nausea, vomiting – Epigastric pain, cramps – Abdominal discomfort, hiccupping
Acute gastritis usually self-limiting - complet regeneration of gastric mucosa - supportiv treatment for prolong vomit
may require treatment with antimicrobial drugs
.Gastritis: Chronic Gastritis: characterized by atrophy of stomach mucosa
loss of secretory gland - reduce production of intrinsic factor: pernicious anemia - Helicobacter pylori infection present
Signs may be vague: Mild epigastric discomfort, anorexia, intolerance for certain foods
Increased risk of peptic ulcers and gastric carcinoma
Management: avoid NSAIDs, naproxen (Naprosyn), ibuprofen (Motrin, Advil, Amersol, Novo-Profen) available as OTC
limit intak of food and spices cause distress, caffeine, high acid(tomato,citrus juice), heavily season with strong hot spic
.Bell peppers, onions commonly irritating food - Alcohol and tobacco avoided
Peptic Ulcer: Gastric and Duodenal Ulcers
.Peptic ulcers: open sores that develop on inside lining of stomach and upper portion of small intestine
.Most caused by: H.pylori infection - Risk: Drugs NSAID, aspirin, ibuprofen, other: spicy food
Usually occur in proximal duodenum (duodenal ulcers) - found in antrum of stomach (gastric ulcers)
:Damage to mucosal barrier predisposes to development of ulcers and associated with
Inadequat blood supply: vasoconstriction (stress, smok, shock, circulatory impairment older adult, scar tissue, anmia) -
Interferes with rapid regeneration of epithelium
Excessive glucocorticoid secretion or medication-
- Ulcerogenic substanc breakdown mucous layer (aspirin, NSAID, alcohol)
Atrophy of gastric mucosa: chronic gastritis-
Gastric: Gnawing sharp pain in left of mid-epigastric region occur 30-60min after meal (food ingestion accentuate pain)
.Hematemesis is more common
Duodenal: Burning pain in mid-epigastric area 1½-3h after meal and during night(awake client) Pain reliev by food
.Melena is more common
:Diagnostic test
Esophagogastroduodenoscopy (EGD) with biopsy (confirm disease) - Barium x-ray - Gastric: endoscopy with biopsy
Treatment:combination of antimicrobial and proton pump inhibitor to eliminat H.pylori - check BP hypotension bleed
Reduction of exacerbating factor - If anemic blood transfusion - life style modification: stress, diet: avoid coffee, spicy
NSG.DIAGNOSIS: potential for alteration in gastric emptying caused by edema or scarring associate with peptic ulcer
.disease, which may cause feeling of fullness, vomiting of undigested food, abdominal distention
:Complications of peptic ulcer
Hemorrhage: erosion of blood vessel. common complication. first sign of peptic ulcer. NGT insertion and saline lavage-
Perforation: ulcer erodes completely through the wall. chyme enter peritoneal cavity. result in chemical peritonitis-
,Peritonitis: rigid board like abdomen rebound tenderness is classic sign and symptom of peritonitis
Obstruction: may result later because of the formation of scar tissue-
partial stomach removal subtotal gastrectomy - pyloroplasty to open pylorus - vagotomy vagus nerve cut, control acid
Stress Ulcers: associated with severe trauma or systemic problems: Burns, head injury, Hemorrhage, sepsis
Rapid onset multiple ulcer (gastric) form within hours of precipitating event. First indicator: hemorrhag and sever pain
CUSHING'S ULCER: occurs when the brain suffers from some serious injury, stroke or surgery complications.
CURLING'S ULCER: Individual who suffered from traumatic injurie, sever burn, intracranial lesions
Gastric Cancer: arises primarily in mucous gland, mostly in antrum or pyloric area
.Early carcinoma: Confined to mucosa and submucosa - Asymptomatic in early stage: prognosis is poor on diagnosis
.Later stages: muscularis - invades serosa and spreads to lymph nodes
Diet a key factor, particularly smoked, salted, pickled food - low fruit and vegetable increas risk. averag age 70 years-
.history of GERD, H.pylori infection, smoking, Genetic influences
Symptom: dyspepsia (indigestion), early satiety, weight loss, abdominal pain above umbilicus, loss or decreas appetit,
.bloating after meals, nausea and vomiting
Investigation: palpable mass, Esophagogastroduodenoscopy with biopsy, CT, Gastric analysis absenc hydrochloric acid
.Management: Surgery together with chemotherapy and radiation relieve symptoms
Gastrectomy: total gastrectomy: esophagojejunostomy.1
Radical subtotal gastrectomy: Billroth 1: stomach joined to duodenum - Billroth 11: stomach joined to jejunum.2
Dumping Syndrome: rapid empty of gastric content in small intestine after gastric surgery, pyloric sphincter remove.
Symptom occur 30min after eat. control gastric empty lost, gastric content dump in duodenum without complet dige
Hyperosmolar chyme: draw fluid from vascular compartment in intestine: Intestinal distention - Increase intestinal
motility, (Signs: abdominal cramps, nausea, diarrhea) - Decreased blood pressure BP → syncope
The rapid gastric emptying and absorption leads to high blood glucose and increased insulin secretion, which results
.in rapid drop in blood glucose level with no reserve nutrients advancing slowly from the stomach
Occurs during or shortly after meals: Abdominal cramps, nausea, diarrhea-
Hypoglycemia 2-3h after meal: High blood glucose in chyme stimulate increase insulin → drop in blood glucose -
May be resolved by dietary change: Frequent small meal, high in protein, low in simple carbohydrate -
Often resolves over time-
Early symptom: Nausea and Vomiting - Abdominal fullness - Abdominal cramping - Palpitation - Diaphoresis
LATE symptoms: Drowsiness - Weakness and Dizziness (bcz of vasomotor disturbance) – Hypoglycemia
INTERVENTION: LOW-carbohydrate, LOW-fat, HIGH-protein diet - SMALL frequent meal, MORE dry item
.AVOID FLUID with meal - LIE DOWN after meal - administer antispasmodic medication to delay gastric emptying