Stool for Lipids

Stool for Lipids DEFINITIONA quantitative test performed on stool collected over a 72-hour period that confirms the presence of steatorrhea.

NURSING RESPONSIBILITIESinstruct the client to abstain from alcohol and to consume a high fat diet (100 g daily) for 3 days before the test and during the collection period. drugs that may affect test results, such as mineral oil, potassium chloride, and neomycin, should be withheld.collect the stool in a non-wax container and keep it refrigerated.

FINDINGSNormal Findings: 2-6 g/24 hr (normal diet)Abnormal Findings: steatorrhea (increased values) can result from intestinal malabsorption or pancreatic insufficiency.

Gastric AnalysisDEFINITIONThis is performed to measure secretions of hydrochloric acid (HCL) and pepsin in the stomach.To aid in the diagnosis of:Duodenal ulcerZollinger-Ellison syndromeGastric carcinomaPernicious anemia

Gastric analysis consists of:The basal cell secretion testGastric acid stimulation test

Pre-procedure Care

The client is NPO for 12 hours before the test.Do not administer drugs that interfere with gastric acid levels, such as cholinergics, histamine blockers, or antacids. If a client requires coronary vasodilator therapy, change the oral form to an ointment or sublingual preparation during the procedure.

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PROCEDUREFor the Basal cell secretion test:A nasogastric tube is inserted and attached to a suction.Stomach contents are collected every 15 minutes for 1 hour.Label specimens with time, volume, and a client identification.

Specimens are analyzed.If abnormal gastric secretion is suggested, a gastric acid stimulation test is performed.

Gastric acid stimulation testMeasures the amount of gastric acid for 1 hour after subcutaneous injection of a drug that stimulates its secretion (pentagastrin and bentazole)If results are abnormal, radiographic studies or endoscopy may be done to determine the cause.

Results:A markedly increased level of gastric secretion may indicate Zollinger-Ellison syndromeModerately increased level suggests duodenal ulcer.Decreased levels may indicate gastric ulcer or carcinoma.

Post procedure careIf the nasogastric tube is left in place, attach it to low intermittent suction.Record the amount and color of the drainage.

H. PyloriDEFINITIONHelicobacter pylori- a bacterium that can cause gastritis and peptic ulcer disease.Stomach contents are examined for the presence of H. Pylori using the Exfoliative Cytologic Analysis. It is a study of cells that have sloughed off from a tissue. The examination is performed to distinguish benign from malignant lesions.

PROCEDUREObtain a written consent if required.Keep the client NPO before the procedure.A nasogastric tube is palced and cells are obtained by saline lavage through the tube.Specific areas of the GI tract are lavaged, and cells are collected and sent to the laboratory for analysis.Afterward, the client rests and may resume eating.

Urea Breath test- detect the presence of H. Pylori, the bacteria that can live in the mucosal lining of the stomach and cause peptic ulcer disease, because H. Pylori produces large quantities of the enzyme urease. 13C- & 14C-urea breath tests offer excellent diagnostic yield.

Procedure:Patients ingest a solution containing 13c- or 14c- labeled urea and an exhaled breath is sampled for isotope labeled CO2 released by intragastric H. Pylori urease activity.The patient is to avoid antibiotics or loperamide for 1 month before the test; sucralfate and omeprazole for 1 week before the test, and cimetidine, famotidine, ranitidine, and nizatidine for 24 hours before urea breath testingH. Pylori also can be detected by assessing serum antibody levels. Hydrogen Breath TestingDEFINITIONUsed to evaluate carbohydrate absorption. it is also used to aid in the diagnosis of bacterial overgrowth in the intestine and short bowel syndrome. this test determines the amount of hydrogen expelled in the breath after it has been produced in the colon and absorbed in the blood.

Procedure:The client must take a dose of xylose ( a sugar normally completely absorbed in the intestine).Within the next few hours, large amounts of hydrogen in the breath would reveal the disease condition is present.

III. Radiologic Exams

Scout film/ Flat Plate Abdomen

DEFINITIONAn x-ray (radiograph) of the abdominal organs. Can help identify:Tumors Obstructionsabnormal gas or fluid collections strictures

Also used to assess positioning of indwelling devices such as ureteric stents and nasogastric tubesThe client may be required to lie flat or sit in the upright position for the x-ray.

Upper GI series/ Barium SwallowDEFINITIONRadiologic visualization of the esophagus, stomach, duodenum, and jejunum.It can aid in the detection of strictures, ulcers, tumors, polyps, hiatal hernias, or motility problems.Pre-procedure:The client cannot have food or fluids for 6-8 hours before the test.Instruct the client about the procedure and about the barium preparation.It may be necessary to drink up to 16 ounces of barium for the procedure. Barium has a thick consistency and a chalky taste.

Procedure:The client drinks a radiopaque contrast medium (barium) while standing in front of a fluoroscopy tube.The client may also be asked to assume other positions, such as lying on the x-ray table and turning left to right.

Post procedureA laxative is given to help expel the barium and to prevent fecal impaction.Asses the abdomen for distention, and observe the stool to determine whether the barium has been eliminated. Initially the stool is white, but it should return to its normal brown color within 72 hours. A distended abdomen and constipation may indicate barium impaction.Clients with ostomies should be closedly monitored for retained barium.

Barium Enema/ Lower GI Series

DEFINITIONPerformed to visualize the position, movements and filling of colon.Helps to detect tumors, diverticula, stenoses, obstructions, inflammation, ulcerative colitis, and polyps.

Indications:History of altered bowel habitsLower abdominal painPassage of blood, mucus, or pus in the stools

Pre- procedure A low residue or clear liquid diet for 2 days before the test to reduce feces volume.The client usually receives a potent laxative and an oral liquid preparation for cleaning the bowel the day before the test and has nothing by mouth after midnight.

The morning of the examination, a suppository or cleansing enema may be administered. If the client has active bleeding or an ileostomy, different bowel preparations may be needed.If ultrasonography, abdominal scan, or colonoscopy is also indicated, it should be performed first because barium interferes with these tests.The procedure is uncomfortable and takes 60-90 minutes.

ProcedureBarium sulfate (single contrast technique) or barium sulfate and air (double contrast technique) are instilled rectally.Administered for the radiographic examination (with or without fluoroscopy) of the large intestine.

Post procedureA laxative or cleansing enema is often given after the test to empty the large bowel. Stools are white for 24-72 hours after the examination.

Encourage the client to increase liquid intake to prevent fecal impaction.Instruct the client to report any pain, bloating, absence of stool, or bleeding.Complication: Barium impaction- if the lbarium is not evacuated.

CT-ScanDEFINITIONUsed to identify masses, such as neoplasm, cysts, local inflammatory lesions, and abscesses of the liver, pancreas, and pelvic areas.Also aids in evaluating local tumor spread, especially if barium studies suggests tumor growth beyond the bowel wall.Procedure:The client receives nothing by mouth for 6-12 hours before the procedureAsses for any allergies to iodineInformed consent is given.

The client is placed supine on the examination table and asked to lie still and hold his breath when instructed.Tell the client to expect diuresis from the dye, and encourage drinking plenty of fluids to flush the dye and prevent nephrotoxicity.