Diagnostic Tests

Digestive System

DIAGNOSTIC TESTS FOR DISEASES OF THE DIGESTIVE SYSTEM

LABORATORY TESTS

CEA (Carcinoembryonic Antigen) (+) colorectal cancer NO heparin for 2 days Specimen by venipuncture The carcinoembryonic antigen (CEA) test measures the amount of this protein that may appear in the blood of some people who have certain kinds of cancers, especially large intestine (colon and rectal) cancer. It may also be present in people with cancer of the pancreas, breast, ovary, or lung.

CEA is normally produced during the development of a fetus. The production of CEA stops before birth, and it usually is not present in the blood of healthy adults. Why It Is Done The carcinoembryonic antigen (CEA) test is used to: Find how widespread cancer is for some types of the disease, especially colon cancer.

Check the success of treatment for colon cancer. CEA levels may be measured both before and after surgery to evaluate both the success of the surgery and the person's chances of recovery. CEA levels may be measured during treatment with medicines to destroy cancer cells (chemotherapy). This provides information about how well the treatment is working. Check to see if cancer has returned after treatment.

D – Xylose Absorption Test Initial blood/urine specimen collected NPO 10 – 12 hours Blood/urine levels measured For diagnosis of malabsorption Exfoliative Cytology Detect malignant cells Written consent

Liquid diet UGI: NGT insertion LGI: laxative; enema Cells are obtained from saline lavage – NGT Fecal Analysis Stool for Occult Blood (Guaiac Stool Exam) Detect G.I. bleeding ↑ fiber diet 48 – 72 hours No red meats, poultry, fish, turnips, and horseradish 3 stool specimen (3 successive days) Withold for 48 hrs: Iron, Steroids, Indomethacin, Colchine

Iron causes blackish/greenish discoloration of stool Steroids, indomethacin, colchicine may cause G.I. irritation thereby, bleeding. Stool for Ova and Parasites Send fresh,warm stool specimen Stool Culture Sterile test tube/cotton – tipped applicator Stool for Lipids Assess steatorrhea ↑ fat diet, no alcohol (3 days) 72 – hours stool specimen (store on ice) No mineral oil, neomycin SO4

Gastric Analysis Measures secretion of HCl and pepsin NPO for 12 hours NGT is inserted, connected to suction Gastric contents collected every 15 minutes to 1 hour ↑ HCl : Zollinger- Ellison Syndrome or Doudenal Ulcer, ↓ HCl: Gastric Ca or Pernicious Anemia

Bernstein Test (Acid Perfusion Test) To assess of chest pain is related to gastroesophageal reflux NPO 6 – 8 hrs NGT insertion Alternate instilation of NSS and 0.1% HCl X pain (-) ; √ pain (+) Antacid after the procedure

RADIOGRAPHIC TESTS Scout Film/Flat Plate of the Abdomen Plain X-ray of the abdomen No belts/jewelries or any metal UGIS (Upper G.I. Series/ Barium Swallow) To visualize the esophagus, stomach, doudenum and jejunum NPO for 6 – 8 hours Barium Sulfate (BaSO4) per Orem X-rays taken on standing, lying position After the procedure: Laxative Increase in fluid intake Inform client thta the stool is white for 24 – 72 hours Observe for Ba impaction: distended abdomen, constipation

LGIS (Lower G.I. Series/ Ba Enema) To visualize the colon Low residue/clear liquid diet for 2 days Laxative for cleansing the bowel Suppository/cleansing enema in A.M. BaSO4 per rectum Care after the procedure – same as UGIS Computed Tomography Uses beam of radiation to assess cross sections of the body Clear liquid diet in A.M. If done with contrast medium – NPO 2 – 4 hours – Assess history of allergy to seafoods and iodine

Inform the client that the procedure is painless Advise the client to remain still during the entire procedure ENDOSCOPY UGI Endoscopy Direct visualization of esophagus, stomach and duodenum Obtain written consent NPO for 6 – 8 hours Anticholinergic (At SO4) as ordered. To reduce mucus secretions Sedatives, narcotics, tranquilizers. To relax the client E.g. Diazepam, Meperidine HCl Remove dentures. To prevent airways obstruction

Local spray anesthetic on posterior pharynx – instruct: Do not swallow saliva. To depress the gag reflex. After the procedure Side-lying position. To prevent aspiration NPO until gag reflex returns (2 – 4 hours) NSS gargle; throat lozenges. To soothe the throat. Monitor VS Assess: bleeding, crepitus(neck), fever, neck/throat pain, dyspnea, dysphagia, back/shoulder pain Advise to avoid driving for 12 hours if sedative was used.

LGI Endoscopy Proctosigmoidoscopy (sigmoid, rectum) Clear liquid diet 24hours before Administer laxative as ordered

Cleansing enema Knee-chest/lateral position After the procedure – Supine position for few minutes. To prevent postural hypotension – Assess for signs of perforation _ bleeding, pain, fever – Hot sitz bath for discomfort in the anorectal area

Colonoscopy Sedation is done Position: left side, knee flexed After the procedure: – Monitor VS (note for vasovagal reponse, e.g. bradycardia, hypotension) – Assess for signs and symptoms of perforation

Ultrasonography NPO for 8 – 12 hours Laxative as ordered (↓ bowel gas) MRI (Magnetic Resonance Imaging) Produces cross – sectional images of organs by using magnetic fields NPO for 6 – 8 hours Instruct to remain still during the procedure Inform that procedure last for 60 – 90 minutes Remove all metals like jewelries Contraindications Pacemakers Aneurysm clips Orthopedic screws