UPPER GI
Diagnostic Tests:
• Esophagogastroduodenoscopy:
o Pre procedure:
§ Obtain informed consent
§ NPO 8 hrs prior to test
§ Assure that the pt has a driver à local anesthetic & sedated
§ Empty bladder
§ Take vital signs & start IV
o Post procedure:
§ Frequent VS à at least 2 hrs
§ Check gag reflex
§ NPO until gag reflex returns
§ Tell pt to expect flatus or belching à air is fed into esophagus to inflate
§ Monitor for complications à p!, SOB, tachycardia, temp spike
• Barium swallow:
o Fluoroscopic X-ray study using contrast
o Used to dx structural abnormalities of esophagus, stomach, & duodenum
o Nursing responsibilities:
§ Need to drink contrast medium
§ Assume various positions
§ NPO 8 hrs before
§ Fluids
§ Laxatives
§ White stools up to 72 hrs post-op
3 post procedure
• Barium enema:
o Fluoroscopic X-ray exam of colon using contrast medium à admin rectally
§ Detects polyps & tumors
o Nursing responsibilities:
§ Laxatives & enemas until colon is clear of stool evening before
§ Clear liquids evening before
§ NPO 8 hrs before test
§ After test give fluids, laxatives, or suppositories à eliminate barium
§ During procedure à cramping & feel like they need to defecate
§ White stool after procedure
• Colonoscopy:
o Directly visualize entire colon up to ileocecal valve w flexible fiberoptic scope
o Allows for biopsy if needed
§ Detects inflammatory bowel diseases, tumors, & polyps
o Nursing responsibilities:
§ Before procedure à bowel prep à drink entire prep, expect clear-yellow stool
§ Flexible scope will be insertd while pt is in side lying position
§ Sedation will be given
§ After procedure patient may experience cramps d/t air in bowel
§ Observe for rectal bleeding & signs of perforation à should not have discomfort 24 hrs after
, • Capsule endoscopy:
o Pt swallows a capsule w camera
o Provides endoscopic eval of GI tract
o Used to visualize SI
§ Chron's disease
o Camera takes 50,000 images over 8 hrs
o Nursing responsibilities:
§ Dietary preparation & bowel prep are similar to colonscopy
§ After swallowing capsule à clear liquids after 2 hrs & food after 4 hrs
§ NPO 8 hrs prior
§ Capsule passes in stool
Gerd:
• Backward flow of stomach content into the esophagus w/o vomiting
• Irritation of the stomach at least once a week
o pH of stomach acid ranges from 1.5-5.0
• chronic syndrome of mucosal damage d/t reflux of stomach aid into lower esophagus
o also have heartburn
• most common problem in adults
• multifaceted
ETIOLOGY & PATHOPHYSIOLOGY
• increased pressure in stomach à acidic gastric content overwhelms esophageal defenses
o causes irritation & inflammation
• primary factor à incompetent lower esophageal sphincter (LES)
FACTORS AFFECTING LES PRESSURE
• increased LES pressure:
o alcohol
o chocolate
o fay foods
o nicotine
o peppermint
o tea/coffee
o Drugs à narcotics, Ca channel blockers, osteoporosis meds, K+
• Increase abd. pressure:
o Obesity
o Pregnancy
o Girdles, belts, restrictive garments
o Large meals
o Supine position
CLINICAL MANIFESTATIONS
• Heartburn (pyrosis) à most common
o Burning, tight sensation under lower sternum spread into throat or jaw
§ Mimics angina but relieved w antacids à cardiac etiology is always r/o
Diagnostic Tests:
• Esophagogastroduodenoscopy:
o Pre procedure:
§ Obtain informed consent
§ NPO 8 hrs prior to test
§ Assure that the pt has a driver à local anesthetic & sedated
§ Empty bladder
§ Take vital signs & start IV
o Post procedure:
§ Frequent VS à at least 2 hrs
§ Check gag reflex
§ NPO until gag reflex returns
§ Tell pt to expect flatus or belching à air is fed into esophagus to inflate
§ Monitor for complications à p!, SOB, tachycardia, temp spike
• Barium swallow:
o Fluoroscopic X-ray study using contrast
o Used to dx structural abnormalities of esophagus, stomach, & duodenum
o Nursing responsibilities:
§ Need to drink contrast medium
§ Assume various positions
§ NPO 8 hrs before
§ Fluids
§ Laxatives
§ White stools up to 72 hrs post-op
3 post procedure
• Barium enema:
o Fluoroscopic X-ray exam of colon using contrast medium à admin rectally
§ Detects polyps & tumors
o Nursing responsibilities:
§ Laxatives & enemas until colon is clear of stool evening before
§ Clear liquids evening before
§ NPO 8 hrs before test
§ After test give fluids, laxatives, or suppositories à eliminate barium
§ During procedure à cramping & feel like they need to defecate
§ White stool after procedure
• Colonoscopy:
o Directly visualize entire colon up to ileocecal valve w flexible fiberoptic scope
o Allows for biopsy if needed
§ Detects inflammatory bowel diseases, tumors, & polyps
o Nursing responsibilities:
§ Before procedure à bowel prep à drink entire prep, expect clear-yellow stool
§ Flexible scope will be insertd while pt is in side lying position
§ Sedation will be given
§ After procedure patient may experience cramps d/t air in bowel
§ Observe for rectal bleeding & signs of perforation à should not have discomfort 24 hrs after
, • Capsule endoscopy:
o Pt swallows a capsule w camera
o Provides endoscopic eval of GI tract
o Used to visualize SI
§ Chron's disease
o Camera takes 50,000 images over 8 hrs
o Nursing responsibilities:
§ Dietary preparation & bowel prep are similar to colonscopy
§ After swallowing capsule à clear liquids after 2 hrs & food after 4 hrs
§ NPO 8 hrs prior
§ Capsule passes in stool
Gerd:
• Backward flow of stomach content into the esophagus w/o vomiting
• Irritation of the stomach at least once a week
o pH of stomach acid ranges from 1.5-5.0
• chronic syndrome of mucosal damage d/t reflux of stomach aid into lower esophagus
o also have heartburn
• most common problem in adults
• multifaceted
ETIOLOGY & PATHOPHYSIOLOGY
• increased pressure in stomach à acidic gastric content overwhelms esophageal defenses
o causes irritation & inflammation
• primary factor à incompetent lower esophageal sphincter (LES)
FACTORS AFFECTING LES PRESSURE
• increased LES pressure:
o alcohol
o chocolate
o fay foods
o nicotine
o peppermint
o tea/coffee
o Drugs à narcotics, Ca channel blockers, osteoporosis meds, K+
• Increase abd. pressure:
o Obesity
o Pregnancy
o Girdles, belts, restrictive garments
o Large meals
o Supine position
CLINICAL MANIFESTATIONS
• Heartburn (pyrosis) à most common
o Burning, tight sensation under lower sternum spread into throat or jaw
§ Mimics angina but relieved w antacids à cardiac etiology is always r/o
