INVESTIGATIONS DONE IN PATIENTS WITH GIT CONDITIONS - PowerPoint Presentation

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INVESTIGATIONS DONE IN PATIENTS WITH GIT CONDITIONS

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Patient Monitoring

The nurse plays a vital role in such procedures as the ultrasound-guided biopsy when the patient is sedated.

The nurse must monitor the patient, and keep track of the patient's vitals. For example, the nurse needs to inform the doctor if the patient's blood pressure is rising, and the nurse needs to watch the patient's heart rate.

For biopsy procedures without sedation or analgesia, a health care assistant could take the place of the nurse.

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Patient Care

The interventional radiology nurse assesses if certain procedures can be performed in a single day, or if the patient needs to be in the hospital longer.

Since the availability of beds is an issue in a hospital, the nurse must carefully decide if the patient needs to stay overnight.

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Before the investigations for the patient, the nurse makes sure that the patient receives intravenous hydration before contrast injections.

Furthermore, the nurse needs to answer any questions that the patient might have about his procedure.

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Patient Safety

Additionally, the nurse's role on the multidisciplinary team is to plan for the safety of the patient before, during and after the investigation/ procedure.

When a procedure is more complex, more than one nurse might need to be present in the treatment room to ensure the patient's safety.

The nurse also has a role during the procedure to help the patient feel comfortable.

This means monitoring the patient's pain, and providing relief if the patient indicates that she is feeling too much pain.

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The following are some of the investigations and procedures

Endoscopic

Endoscopy is a procedure that lets your doctor look inside your body. It uses an instrument called an endoscope, or scope for short.

Scopes have a tiny camera attached to a long, thin tube. The doctor moves it through a body passageway or opening to see inside an organ. Sometimes scopes are used for surgery, such as for removing

polyps

from the colon.

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Liver Biopsy

A liver biopsy is a procedure whereby small pieces of liver tissue are removed in order to be sent to a

laboratory

for examination.

It is very helpful in the

diagnosis

of diseases that affect the liver.

There are several potential approaches to procuring tissue for a liver biopsy. These are discussed below.

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LIVER FUNCTION TESTS

As the liver performs its various functions it makes chemicals that pass into the bloodstream and bile.

Various liver disorders alter the blood level of these chemicals. Some of these chemicals can be measured in a blood sample.

Some tests that are commonly done on a blood sample are called liver function tests (LFTs). These usually measure the following:

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Alanine transaminase (ALT)

. This is an enzyme that helps to process proteins. (An enzyme is a protein that helps to speed up chemical reactions. Various enzymes occur in the cells in the body.) Large amounts of ALT occur in liver cells. When the liver is injured or inflamed (as in hepatitis), the blood level of ALT usually rises.

Aspartate aminotransferase (AST)

. This is another enzyme usually found inside liver cells. When a blood test detects high levels of this enzyme in the blood it usually means the liver is injured in some way. However AST can also be released if heart or skeletal muscle is damaged. For this reason ALT is usually considered to be more specifically related to liver problems.

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Alkaline phosphatase (ALP)

. This enzyme occurs mainly in liver cells next to bile ducts, and in bone. The blood level is raised in some types of liver and bone disease.

Albumin

. This is the main protein made by the liver, and it circulates in the bloodstream. The ability to make albumin (and other proteins) is affected in some types of liver disorder. A low level of blood albumin occurs in some liver disorders.

Total protein

. This measures albumin and all other proteins in blood.

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Purpose of the liver function tests

To help diagnose liver disorders if you have suggestive symptoms (such as jaundice). The pattern of the blood results may help to say which disorder is causing the problem. For example, depending on which enzyme is highest it may point to a particular disorder.

To monitor the activity and severity of liver disorders.

As a routine precaution after starting certain medicines to check that they are not causing liver damage as a side-effect.

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Blood tests

which may be done include:

Blood clotting tests

. The liver makes many of the proteins needed to make blood clot. In certain liver disorders the liver cannot make enough of these proteins and so blood does

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Radiological diagnostic examinations and procedures

Barium-

This is a radio opaque substance and tests like chalk usually

flavoured

with milk to make it taste and it is a naturally occurring element that appears white on X-ray

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Barium swallow

It is a radio opaque examination of the

oesophagus

. In these tests, the barium is given as a cup of

flavoured

drink — like a milkshake. When swallowed, barium coats the walls of the digestive tract, which allows the shape of your upper digestive tract to be outlined on an X-ray. Without the barium the upper digestive tract would be barely visible on X-ray.

Indications for barium swallow

– suspected esophageal varices, tumours, stenosis and dysphagia. Both a barium swallow and a barium meal test involves one swallowing a liquid suspension of barium sulphate before a series of X-rays are taken of the digestive tract. In a barium swallow test, X-ray images are taken of the pharynx (throat) and the

oesophagus

.

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Barium meal

It is the radiographic examination of the stomach and duodenum. In a barium meal test, X-ray images are taken of the stomach and the beginning of the duodenum

N.B

: A barium meal test is often performed straight after a barium swallow test.

Indications –suspected peptic

ulcers,gastric

ulcers,cancer

of the stomach and hiatus hernia.

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Preparation of the patient for barium meal

Explain the procedure to the patient and relatives to gain cooperation and confidence.

Starve the patient for 6-8 hours before the procedure to enable the results to be conclusive because food in the stomach prevents the barium from outlining the stomach wall and the radiography test will be misleading.

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What happens after a barium swallow or barium meal?

After the test you can resume eating normal food. Note that Barium is likely to cause constipation, so

one

should eat high-

fibre

foods such as

fruits

and vegetables and drink plenty of liquids. The stools will be

whitish

colour

for 2 or 3 days after consuming the barium. If the patient experiences problems with constipation in

for

days following the barium test

, the

doctor must be contacted.

Barium enema

It

is the introduction of a radio opaque material into the rectum and colony followed by radiography.

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Indications

When the patient is suspected of polyps, tumours, ulcerations and diverticulitis.

Preparation of the patient

A clear explanation of the procedure must be done to gain the patients cooperation and confidence. The patient should have been starved for 6-8 hours and the bowels must be free of

feacal

matter in order to have a clear visualization of the intestines. An aperient is given the evening before and the morning of the exam. Emphasis should be stressed on retaining the enema.

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Procedure

The barium enema is instilled through the rectal tube and the radiologist using the fluoroscope and a monitor observe the passage of the enema into the large intestines. The patient is asked to retain the enema while the radiographs of the intestines are being taken. After the desired procedure is done the patient is asked to expel the barium enema and another fluid given to see if there are any pouches of barium in the intestines.

After the procedure

Retained barium enema is difficulty to expel therefore the patient is given oil retention enema or laxatives to completely expel the barium.

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CONTRAINDICATIONS

Barium swallow or meal test is not suitable for pregnant women or people with some conditions of the digestive tract, including suspected perforation (a hole in the gut wall) or obstruction (blockage).

Radiology

is a medical specialty in which imaging technology is examined and used to identify, diagnose and treat diseases.

 

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PARACENTESIS ABNOMINIS

It is a surgical

puncture

of a cavity for the aspiration of fluid which involves insertion of a

trocar

through a small incision and into the

peritoneal

cavity

to remove

ascitic

fluids or inject a therapeutic agent.

This is most often done to remove excess fluid in a patient with

cirrhosis

of the liver and it is also called

abdominocentesis

and

peritoneocentesis

.

Before the procedure the patient is instructed to empty the bladder to reduce the danger of accidental puncture of the bladder.

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The skin below the umbilicus and overlying the rectus muscle is cleansed with an antiseptic. A local anesthetic is used to anesthetize the skin and underlying tissues at the site of insertion of the trocar.

During the procedure the patient may be placed in a sitting position with the feet resting on a foot stool or on the floor. As the fluid is being withdrawn the patient is observed for symptoms of fainting or shock.

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CHOLECYSTOGRAPHY

This is a procedure used to visualize the

gallbladder

by administering, by mouth, a radiopaque contrast agent that is excreted by the liver.

This excreted material will collect in the gallbladder, where reabsorption of water concentrates the excreted contrast.

Since only 10% of gallstones are radiopaque, the remaining 90% will appear as translucent on an opaque background in an abdominal x-ray. This technique should not be confused with

cystography

, which is imaging of the

urinary bladder

.

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ULTRA-SOUND SCANNING

Ultra-sound scanning is a diagnostic

imaging

technique used for visualizing subcutaneous body structures including

tendons

,

muscles

, joints, vessels and internal organs for possible pathology or

lesions

.

The ultra sound waves used in hospitals has the frequency of 3.5-5mHz for soft tissues.

Obstetric

sonography

is commonly used during

pregnancy

and is widely recognized by the public.

It is possible to perform both

diagnosis

and therapeutic procedures, using ultrasound to guide interventional procedures (for instance

biopsies

or drainage of fluid collections).

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Procedure

A lubricant is applied to the skin of the area to be examined and this act as a conductor for the sound waves.

Then a transducer is pointed at the desired area of the body and moved back and front.

A transducer is a device that transmits ultra-sonic waves the height of the sound waves as well as the time required, the height of the sound waves to be reflected from the body and displayed on the oscilloscope screen, thus the sound waves are reflected differently from different structures.

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OBSTETRIC ULTRA SOUND

Purpose

To evaluate fetus during pregnancy

Indication

To determines fetal age

Diagnose pregnancy

To determine fetal position

To identify the placenta

To detect fetal deaths and determine congenital abnormalities.

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PATIENT PREPARATION

Give patient 3-4 glasses of water and should not urinate until the test is

done.The

water is to extend the bladder making it easier to visualize the pregnancy.

Advantages of ultra sound

It involves no radiation so it’s safe for both the patient and the technician.

It takes little time.

It requires little patient’s preparations.

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GLUCOSE TEST

Starch and glucose are digested and absorbed in the small intestines and appear in blood as glucose. Islets of Langerhans in the pancreas produce insulin to lower the level of blood glucose by increasing the storage of glucose as glycogen in the liver and muscles

.

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Tests for glucose in blood and urine

Urinalysis-

Used for testing sugar in urine by use of multi-sticks.

Glucose tolerance test

-It is a test used to assess the rate at which glucose is being eliminated or used up in the blood.

Fasting blood sugar-

This is when blood is taken from the patient before taking breakfast to assess the amount of blood glucose levels.