Chapter 26 Other Procedures and Tests

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Chapter 26Other Procedures and Tests

• By Lynn Elsloo RN CGRN

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Objectives

• Describe two radiographic and two
  non-radiographic studies including indications
  and contraindications and patient care
  instructions.
• List three diagnostic tests that analyze either
  blood, urine and feces.

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General Principles

• Education of patient prior to exam
• Include family, if indicated or possible
• Review history, discuss preparations
• After procedure, monitor for adverse effects
• Provide discharge instructions, how to obtain
  results and give recommended follow-up

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Radiographic and Nonradiographic Imaging

• Radiographic
• Flat and upright plain x-rays films of abdomen
  and upright chest x-ray (1st test for acute
  abdominal symptoms)
• Contrast medium accentuates tissue density
• Barium sulfateorally, rectally or via intestinal
  stoma
• Contraindicated with digestive tract obstruction
  or perforation

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Radiographic and Nonradiographic Imaging

• Report failure to pass barium within 2-3 days
• Iodine-based contrast media - IV for viewing
  gallbladder, pancreas, spleen and various ducts
• Check allergy hx. Iodine, shellfish/seafood

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Radiographic and Nonradiographic Imaging

• Barium Swallow
• Upper Gastrointestinal (GI) Series
• Enteroclysis
• Barium Enema
• Capsule Endoscopy
• Patency Capsule
• MRCPPTC with Cholangiography
• Abdominal Ultrasonography

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Radiographic and Nonradiographic Imaging

• Oral Cholecystography
• Arteriography
• Computerized Tomography (CT)
• Scintigraphy Hepatic and Biliary
• Radionuclide evaluation of gastric emptying
• Scintigraphic scanning
• TIPS (Transjugular intrahepatic portosystemic
  shunts)

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Secretory Studies

• Biliary Drainage
• Pancreatic Stimulation
• Gastric analysis
• 24 hour pH monitoring
• Bravo

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Blood Tests

• Hemoglobin and hematocrit
• Prothrombin level
• Prothrombin time
• Activated partial thomboplastin time
• International Normalized Ratio (INR)
• Bleeding Time
• Platelet Count
• Serum albumin-globulin ratio
• Protein loss

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Blood Tests

• Galactose tolerance
• Glucose tolerance
• Disaccharide tolerance
• Serum d-xylose
• Serum cholesterol
• Serum AST and ALT
• Serum bilirubin
• Serum alkaline phosphatase

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Blood Tests

• Gamma-glutamyl transferase
• Serum amylase
• Serum lipase
• Serum gastrin
• Hepatitis antigens and antibodies
• Carcinoembryonic antigen (CEA)
• CA-19-9
• Serum antibodies
• Celiac screening panel

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Urinalysis

• Urine Bilirubin
• Urine urobilinogen
• Schilling Test

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Fecal analysis

• Fecal uroblinogen
• Occult Blood
• Fecal Fat
• Fecal chymotrypsin
• Protein loss
• Fecal organisms.

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Miscellaneous

• Hydrogen Breath Test
• Helicobactor Pylori Test
• Urea Breath Test
• Carbon-13 Blood Test
• H. Pylori Stool Antigen

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Review Questions

• The usual position of the patient during a barium
  swallow
• Standing position
• Sitting position
• Prone position
• Supine position

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Review Questions

• 2. Which of the following is true about the TIPS
  procedure?
• TIPS is an invasive radiological procedure
• TIPS is performed under fluoroscopic guidance.
• TIPS are effective in lowering portal pressure
• All of the above

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Review Questions

• 3. Patient Teaching prior to capsule endoscopy
  should include which of the following
• NPO after midnight
• Iron tablets should be avoided one week prior to
  test
• MRIs must be avoided until confirmed excretion of
  the capsule
• Abdominal pain, nausea, or vomiting require
  calling their physician.
• All of the above

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Review Questions

• 4. The three-dimensional image produced by CT is
  based on
• Differences in tissue density
• The differential transmission of sound waves by
  different tissues.
• The differential uptake of radioactive isotopes
• Visualization of radiopaque structures

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Review Questions

• 5. For gastric analysis, gastric acid secretions
  are stimulated by the injection of
• Secretin
• Metoclopramide (Reglan)
• Glucose
• Pentagastrin (Peptavlon)

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Review Questions

• 6. An increase in platelet levels could indicate
• Cancer
• SLE
• Cirrhosis
• Crohns disease

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Review Questions

• 7. Extremely high levels of ALT are indicative
  of
• Viral or alcohol-induced hepatitis
• Biliary obstruction
• Hepatocellular injury
• Hepatic metastasis

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Review Questions

• 8. The Schilling Test is used to evaluate
• Disaccharide tolerance
• Vitamin B12 absorption
• Immunity to hepatitis
• Bilirubin levels