Assessment of gastrointestinal and function of gastrointestinal

• On completion of this chapter, the learner will be able to:

1. Describe the structure and function of the organs of the

gastrointestinal (GI) tract.

2. Describe the mechanical and chemical processes involved in

digesting and absorbing foods and eliminating waste products.

3. Use assessment parameters appropriate for determining the status

of GI function.

4. Describe the appropriate preparation, teaching, and follow- up care

for patients who are undergoing diagnostic testing of the GI tract.
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Overview anatomy of the Gastrointestinal System

• The GI tract = 23- to 26-foot-long (7 m to 7.9 m

• Esophagus
• Is located in the mediastinum anterior to the spine
and posterior to the trachea and heart.
• This hollow muscular tube, 25 cm (10 in) in length,
passes through the diaphragm at an opening
called the diaphragmatic hiatus.
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Stomach

• The remaining portion of the GI tract is located within

the peritoneal cavity.

• Is located in the left upper portion of the abdomen

under the left lobe of the liver and the diaphragm,
overlaying most of the pancreas

• Capacity of approximately 1500 mL

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 Stomach…

• Secretes digestive fluids, and move forward the

partially digested food, or chyme, into the small
intestine.

• Has four anatomic regions: cardia (entrance), fundus,

body, and pylorus (outlet).

• Circular smooth muscle in the wall of the pylorus forms

the pyloric sphincter and controls the opening
between the stomach and the small intestine.
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Gastroesophageal junction(inlet)

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Small intestine

• Is the longest segment 2/3

• It folds back and forth on itself

• Has largest surface area for secretion and absorption

• It has three sections:

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Small intestine…

• The ileum terminates at the ileocecal valve

which
• Controls the flow of digested material and
• Prevents reflux of bacteria into the small intestine.

• Attached to the cecum is the vermiform

appendix, an appendage that has little or no
physiologic function.
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Emptying into the duodenum at the ampulla of Vater is the common bile duct,
which allows for the passage of both bile and pancreatic secretions.

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Large intestine

• Consists of
• Ascending segment

• Transverse segment and COLON

• Descending segment.

• Sigmoid colon,

• Rectum, and anus complete the terminal portion of the large intestine.

• A network of striated muscle that forms both the internal and the
external anal sphincters regulates the anal outlet.

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Blood supply of GIT

• The GI tract receives blood from

• thoracic and abdominal aorta.
• Oxygen and nutrients are supplied to the stomach
by the gastric artery and

• to the intestine by the mesenteric arteries

• 20% of the total cardiac output and increases

significantly after eating.

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• Return blood through portal venous through

• Gastric
• Splenic
• Superior and
• Inferior mesenteric veins
• Once in the liver, the blood is distributed throughout and
collected into the hepatic veins that then terminate in the
inferior vena cava.
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 Innervation of GIT
Parasympathetic
Sympathetic
• Stimulation causes peristalsis
• Exert an inhibitory effect on
and increases secretory
the GI tract
activities.
• Decreasing gastric secretion • Relax sphincter except external
• Decrease motility anus sphincter

• Causing the sphincters and

blood vessels to constrict.
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Function of the Digestive System

• Primary functions of the GI tract are the following:

The breakdown of food particles into the molecular form for
digestion
The absorption into the bloodstream of small nutrient molecules
produced by digestion
The elimination of undigested unabsorbed foodstuffs and other
waste products

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Chewing and Swallowing

• The process of digestion begins with the act of chewing, mixed with
digestive enzymes.

• Eating—or even the sight, smell, or taste of food—can cause reflex

salivation.

• Approximately 1.5 L of saliva is secreted daily

• Water and mucus in the saliva = help lubricate the food.

• Ptyalin or salivary amylase converts starch into dextrin and maltose.

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• Swallowing is a voluntary act regulated =medulla oblongata

• The epiglottis = prevent aspiration of food into the lungs.

• The smooth muscle of the esophagus contracts in a rhythmic

sequence to move bolus.

• During esophageal peristalsis, the lower esophageal

sphincter relaxes and permits the bolus of food to enter the
stomach.

• lower esophageal sphincter closes tightly to prevent reflux

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• Peristaltic contractions in the stomach propel the stomach’s
contents toward the pylorus.

• Because large food particles cannot pass through the pyloric

sphincter, they are churned back into the body of the stomach.

• Food remains in the stomach from 30 minutes to several hours,

depending on the volume, osmotic pressure, and chemical
composition of the gastric contents.

• This partially digested food mixed with gastric secretions is

called chyme.
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Gastric secretions and gastric motility influenced

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Small Intestine Function
• Duodenal secretions come from the accessory digestive organs—
• the pancreas,
• liver,
• gallbladder
• the glands in the wall of the intestine itself.

• These secretions contain digestive enzymes: amylase, lipase, and bile.

• Pancreatic secretions have an alkaline pH due to their high concentration of

bicarbonate

• The sphincter of Oddi = bile to intestine

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• Two types of contractions occur regularly in the small intestine:
segmentation contractions and intestinal peristalsis.

• Segmentation contractions produce mixing waves that

move the intestinal contents back and forth in a
shaking motion.
• Intestinal peristalsis propels the contents of the small
intestine toward the colon.
• Both movements are stimulated by the presence of chyme.

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• Chyme stays in the small intestine for 3 to 6 hours

• villi = function to produce digestive enzymes and absorb nutrients.

• Absorption is the primary function of the small intestine.

• fats, proteins, carbohydrates, sodium, and chloride absorb = jejunum.

• Vitamin B12 and bile salts are absorbed in the ileum.

• Mg, Po4-, and K are absorbed throughout the small intestine.

• Ca mainly at stomach

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 Colonic Function

• Within 4 hours after eating, residual waste material passes into right colon
through the ileocecal valve.

• Bacteria helps in the degradation of waste material specially undigested or

unabsorbed proteins and bile salts.

• Two types of colonic secretions are added to the residual material

1. The electrolyte solution is chiefly a bicarbonate solution that acts to neutralize

the end products formed by the colonic bacterial action

2. Whereas the mucus protects the colonic mucosa from the interluminal contents
and provides adherence or the fecal mass.

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• Slow, weak peristalsis takes place at the colon

• Which allow it’s function

• reabsorption of water and electrolytes

• The waste materials reach usually in about 12 hours

but may stay up to 3 days

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Waste Products of Digestion

• Feces consist of undigested foodstuffs, inorganic materials, water,

and bacteria.

• Fecal matter

• 75% fluid and 25% solid material.

• The brown color =breakdown of bile by the intestinal
bacteria.
• Chemicals formed by intestinal bacteria = fecal odor.

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• RBC degradation = hem /globin and propryrine
metabolic proc in the cell biliverdine reeducates

• Propryrine biliverdine bilirubin (not polar, bile

pigment)
by glucoronic transferase by bacteria

• Bilirubin goes to liver bilirubin + glucoronic acid urobilinogen

by bacteria

• Urobilinogen (colorless) GIT stercorbilin (brown for feces)

renal urobilin (yellow )

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• Gases formed contain

• Methane, hydrogen sulfide, and ammonia, among others.

• The GI tract 150 mL gases, which are either

• Absorbed into the portal circulation and detoxified by

the liver or
• Expelled from the rectum as flatus.

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Assessment of the Gastrointestinal System
1. Health History

• A focused GI assessment begins with a complete

history.

• Information about abdominal pain, dyspepsia, gas,

nausea and vomiting, diarrhea, constipation,
fecal incontinence, jaundice, and previous GI
disease is obtained.

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 History
Common Symptoms

• Pain

• major symptom of GI disease.

• The character, duration, pattern, frequency, location,

distribution of referred pain (Fig. 34-3), and time of the
pain vary greatly depending on the underlying cause.

• Other factors such as may directly affect this pain.

meals, rest, activity, and defecation patterns

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 History… symptoms…

Dyspepsia

• upper abdominal discomfort associated with eating (commonly

called indigestion)

• symptoms such as pain, discomfort, fullness, bloating

(distend), early satiety (complete satisfaction), heartburn, or
regurgitation

• Typically, fatty foods

• Salads(sellata Amharic) and coarse vegetables as well as

highly seasoned foods haymanot Z.
Cont.…

• Intestinal Gas

• Belching (expulsion of gas from the stomach through

the mouth) or

• flatulence (expulsion of gas from the rectum).

• often complain of bloating, distention, or feeling “full

of gas” with excessive flatulence as a symptom of food
intolerance, in/complete obstruction, bacterial over
grow. haymanot Z.
Nausea and Vomiting

• Vague. may result from

(1) visceral afferent stimulation (ie, dysmotility,

peritoneal irritation, infections, hepatobiliary or
pancreatic disorders, mechanical obstruction);

(2) CNS disorders (ICP, infections, psychogenic) or

(3) irritation of the chemoreceptor trigger zone from

radiation therapy, systemic disorders, and antitumor
chemotherapy medications.
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Change in Bowel Habits and Stool Characteristics

• Changes in bowel habits may signal dysfunction or

disease.

• Diarrhea, an abnormal increase in the frequency

and liquidity of the stool or in daily stool weight or
volume,
• Constipation, a decrease in the frequency of
stool, or stools that are hard, dry, and of smaller
volume than normal
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• Blood in the stool

• If blood is shed from upper GI tract, it produces a

tarry-black color (melena), whereas blood entering
the lower portion of the GI tract or passing rapidly
through it will appear bright or dark red.

• Lower rectal or anal bleeding is suspected if there is

streaking of blood on the surface of the stool or if
blood is noted on toilet tissue.
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 Other common abnormalities in stool characteristics
include:

• Bulky, greasy, foamy stools that are foul in odor and

may or may not float

• Light-gray or clay-colored stool, caused by a

decrease or absence of conjugated bilirubin

• Stool with mucous threads or pus

• Small, dry, rock-hard masses occasionally streaked

with blood

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Past Health, Family, and Social History

• asks normal brushing and flossing routine; frequency of

dental visits; awareness of any lesions or irritated areas in the
mouth, tongue, or throat;

• Daily food intake; use of alcohol and tobacco,

• psychosocial, spiritual, or cultural factors

• Past and current medication use

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Physical Assessment

• requires a good source of light, full exposure of the

abdomen, warm hands with short fingernails, and a
comfortable, relaxed patient with an empty bladder.

• Oral Cavity Inspection and Palpation

• Dentures should be removed to allow good
visualization of the entire oral cavity.
• The lips should be moist, pink, smooth, and
symmetric.
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• Gums and Tongue
• inflammation, bleeding, retraction, and
discoloration, odor of the breath is also noted.
• The dorsum of the tongue is inspected for texture,
color,& lesions.
• CN12
• “ah”; this indicates an intact vagus nerve (10th
cranial nerve). haymanot Z.
Abdominal Inspection, Auscultation, Palpation,&Percussion

• The patient lies supine with

knees flexed slightly

• Tympani

• dullness is heard over organs

and solid masses.

• Testing for rebound tenderness

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Rectal Inspection and Palpation

• The final part of the examination = rectum, perianal region, and

anus.

• Positions of rectal examination = knee-chest, left lateral with hips

and knees flexed,
• Encouraged to focus on deep breathing and visualization of a
pleasant setting during the brief examination.
• Lubricated index finger inserted into the anal canal
• Inspection for lumps, rashes, inflammation, excoriation, tears,
scars
• Rectal prolapse, polyps, and internal
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 1. Serum Laboratory Studies

• Serum laboratory studies, including but not limited to

• CBC
• complete metabolic panel
• partial thromboplastin time,
• triglycerides,
• liver function tests,
• amylase, and lipase.
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• Alpha-fetoprotein = sensitivity for liver cancer.

• carcinoembryonic antigen (CEA) and cancer

antigen (CA) 19-9 = have sensitivity for colorectal
cancer, and

• CEA is a protein that is normally not detected in

the blood; therefore, when detected, it indicates that
cancer is present, but not what type of cancer is
present.
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• CA 19-9 levels are elevated in most patients with
advanced pancreatic cancer, but they may also be
elevated in other conditions such as
• Colorectal, lung, and gallbladder cancers;
gallstones; pancreatitis; cystic fibrosis; and liver
disease.

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 2. Stool Tests

• inspecting the specimen for

• Consistency, color, and occult (not visible) blood.

• Additional studies, including

 Fecal urobilinogen, fecal fat,

 nitrogen,

 Clostridium difficile, fecal leukocytes,

 Parasites pathogens,

 Food residues, and other substances, require laboratory evaluation.

 Fecal occult blood testing (FOBT) = early cancer detection programs.

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• In addition, red meats, aspirin, NAID should be
avoided for 72 hours prior to the study

• Also, ingestion of vitamin C from supplements or

foods can cause a false-negative result.

• The stool DNA test does not require any dietary or

medication restrictions and can detect neoplasia
anywhere in the colon.

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 3. Hydrogen Breath Tests

• The hydrogen breath test was developed to evaluate

carbohydrate absorption, in addition to aiding 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 (on contact of galactose with fermenting
bacteria) and absorbed into the blood.
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Urea breath tests detect Helicobacter pylori

• After the patient ingests a capsule of carbon-labeled urea, a

breath sample is obtained 10 to 20 minutes later.

• Because H. pylori metabolizes urea rapidly, the labeled carbon is

absorbed quickly; it can then be measured as carbon dioxide
in the expired breath to determine whether H. pylori is present.

• The patient is instructed to avoid antibiotics or loperamide for

1 month; sucralfate and omeprazole for 1 week; and
cimetidine, famotidine , and ranitidine for 24 hours before the
test.
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4. Abdominal Ultrasonography

• Is a noninvasive diagnostic technique

• Useful in the detection of an enlarged gallbladder or pancreas,

the presence of gallstones, an enlarged ovary, an ectopic
pregnancy, or appendicitis.

• diagnosing acute colonic diverticulitis.

• Gas and fluid in the abdomen or air in the lungs also prevents
transmission of ultrasound.

• It cannot be used to examine structures that lie behind bony

tissue because bone prevents sound waves from traveling into
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 Endoscopic ultrasonography (EUS)

• providing direct imaging of a target area.

• To evaluate submucosal lesions, specifically their
location and depth of penetration.
• Intestinal gas, bone, and thick layers of adipose
tissue, which hamper conventional ultrasonography,
are not problems when EUS is used.

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 Nursing Interventions

• NPO for 8 to 12 hours before the test to decrease the

amount of gas in the bowel.

• If gallbladder studies are being performed, the patient should

eat a fat free meal the evening before the test.

• If barium studies are to be performed, they should be

scheduled after ultrasonography; otherwise, the barium could
interfere with the transmission of the sound waves.

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5. DNA Testing

• for certain GI disorders (eg, gastric cancer, lactose

deficiency, inflammatory bowel disease, colon
cancer) (Chart 34-2).

• In some cases, DNA testing allows clinicians to

prevent (or minimize) disease, by intervening before
its onset, and to improve therapy

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Imaging Studies

1) invasive and

2) noninvasive imaging studies

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 Images …

• Including
• X-ray and contrast studies,
• Computed tomography (CT), three-dimensional CT,
• Magnetic resonance imaging (MRI),
• Positron emission tomography (PET),
• Scintigraphy (radionuclide imaging), and
• Virtual colonoscopy, are available today.
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Upper Gastrointestinal Tract Study

• By using contrast agent.

• A radiopaque liquid (eg, barium sulfate) is commonly used

• To detect anatomic or functional disorders of the

upper GI organs or sphincters.

• ulcers, varices, tumors, regional enteritis,

• The procedure may be extended to examine the

duodenum and small bowel (small bowel follow
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1. Computed Tomography

• many inflammatory conditions in the colon, such as

• Appendicitis, diverticulitis, regional enteritis, and
ulcerative colitis, as well as
• diseases of the liver, spleen, kidney, pancreas, and
pelvic organs, and structural abnormalities of the
abdominal wall.

• test depends on the presence of fat, this diagnostic

tool is not useful for very thin
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Nursing Interventions

• CT with or without oral or intravenous (IV) contrast, but the

enhancement of the study is greater with use of a contrast
agent.

• Any allergies to contrast agents, iodine the patient’s current

serum creatinine level; and urine human chorionic gonadotropin
(HCG) must be determined before administration of a contrast
agent.

• Patients allergic to the contrast agent may be premedicated with

IV prednisone 24 hours, 12 hours, and 1 hour before the scan.
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• In addition, renal protective measures include the
administration of IV sodium bicarbonate 1 hour
before and 6 hours after IV contrast and oral
acetylcysteine (Mucomyst) before or after the
study.

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2. Magnetic Resonance Imaging

• This noninvasive technique uses magnetic fields

and radio waves to produce images of the area
being studied.

• The use of oral contrast agents to enhance the

image soft tissues as well as blood vessels,
abscesses, fistulas, neoplasms, and other
sources of bleeding.
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• MRIs are not totally safe for all people.

• Any ferromagnetic objects (metals that contain iron)

• include jewelry, pacemakers, dental implants,
paperclips, pens, keys, IV poles, clips on patient
gowns, and oxygen tanks

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• MRI is contraindicated for patients with
• permanent pacemakers,
• artificial heart valves and defibrillators, implanted
insulin pumps, or implanted transcutaneous
electrical nerve stimulation devices, because the
magnetic field could cause malfunction.
• aneurysm clips, intraocular metallic fragments

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 Nursing Interventions

• NPO status 6 to 8 hours before the study and removal of all jewelry
and other metals.

• The patient and family are informed that the study may take 60 to
90 minutes; during this time, the technician will instruct the patient
to take deep breaths at specific intervals.

• MRI machine will make a knocking sound during the procedure.

• Patients may choose to wear a headset and listen to music
during the procedure.

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3. Positron Emission Tomography

• PET scans produce images of the body by detecting the

radiation emitted from radioactive substances.

• The radioactive substances are injected into the body

by IV and are usually tagged with a radioactive atom, such
as. carbon-11, fluorine-18, oxygen-15, or nitrogen-13

• The scanner essentially “captures” where the radioactive

substances are in the body, transmits information.

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4. Scintigraphy

• A sample of blood is removed, mixed with a

radioactive substance, and reinjected to pt.

• Tagging of red blood cells and leukocytes by injection

of a radionuclide is performed to define areas of
inflammation, abscess, blood loss, or neoplasm.

• Tagged red cell studies = source of internal bleeding

when other studies negative
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• During gastric emptying studies, the liquid and solid
components of a meal (typically scrambled eggs) are
tagged with radionuclide markers.

• After ingestion of the meal, the patient is positioned

under a scintiscanner, which measures the rate of
passage of the radioactive substance from the stomach.
• gastric motility, diabetic gastroparesis, and
dumping syndrome.
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 5. Endoscopic Procedures

• Endoscopic procedures include

• fibroscopy/esophagogastroduodenoscopy (EGD),
• small bowel enteroscopy,
• colonoscopy,
• sigmoidoscopy,
• proctoscopy, anoscopy, and
• endoscopy through an ostomy.

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Upper Gastrointestinal Fibroscopy /
Esophagogastroduodenoscopy

• Fibroscopy of the upper GI tract allows direct visualization of the

esophageal, gastric, and duodenal mucosa through a lighted
endoscope (gastroscope) (Fig. 34-5).

• directly to a video processor, converting the electronic signals into

pictures

• EGD is valuable when esophageal, gastric, or duodenal disorders

or inflammatory, neoplastic, or infectious processes are suspected.

• To evaluate esophageal and gastric motility and to collect specimens

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Endoscopic Procedures…

• The side-viewing flexible scopes used to visualize

• Common bile duct
• Pancreatic and hepatic ducts through the ampulla of
Vater in the duodenum.
• Evaluating jaundice, pancreatitis, pancreatic tumors,
common bile duct stones, and biliary tract disease.

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Endoscopic Procedures…

• Upper GI fibroscopy also can be a therapeutic

procedure when combined with other procedures.
• To remove common bile duct stones, dilate strictures,
and treat gastric bleeding and esophageal varices.
• Laser-compatible scopes = be used to provide laser
therapy for upper GI neoplasms.

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Figure 34-5 Patient undergoing gastroscopy.

• The patient may experience nausea, gagging,

or choking.
• Finger oximeters are used to monitor oxygen
saturation, and supplemental oxygen if
needed.
• The patient wears a mouth guard to keep
from biting the scope.

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Nursing Interventions before upper GIT endoscope

• NPO for 8 hours prior to the examination.

• Midazolam (Versed), a sedative & relieves anxiety during the

procedure,

• Atropine = reduce secretions, and

• Glucagon = to relax smooth muscle.

• Left lateral position to facilitate clearance of pulmonary

secretions

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Fiberoptic Colonoscopy

• Direct visual inspection of the large intestine (anus,

rectum, sigmoid, transcending and ascending colon)
is possible by means of a flexible fiberoptic
colonoscope (Fig. 34-6).

• Still and video recordings can be used to document

the procedure and findings

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Colonoscopy…

• Used commonly as a diagnostic aid and screening device.

Used for cancer screening (chart 34-3)

Tissue biopsies, and polyps can be removed and evaluated.
To detect diarrhea of unknown cause, occult bleeding, Anemia;
The extent of inflammatory or other bowel disease.
Treat areas of bleeding or stricture.
Bowel decompression
Removal and diagnosis of colonic neoplasms.

• NB. Patient is lying on the left side with the legs drawn up toward the
chest. haymanot Z.
Material may use
Special snare and cautery through the colonoscope.
Use of bipolar and unipolar coagulators
Use of heater probes, and
 Injections of sclerosing agents or vasoconstrictors
are all possible during this procedure.
Biopsy forceps or a cytology brush

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Nursing Interventions…
• Clear liquid diet starting at noon the day before the procedure
like juices .

• Then the patient ingests the lavage solution PO interval of 3

to 4 hr.
• If the patient cannot swallow use NG

• Patients with a colostomy can receive this same bowel

preparation.

• The use of lavage solutions is contraindicated in patients

with intestinal obstructionhaymanot
or inflammatory
Z. bowel disease.
Nursing Interventions…

• A sodium phosphate tablet can be used for colon cleansing prior to

colonoscopy.

• With the use of lavage solutions, bowel cleansing is fast (4hr will take

• Dosing consists of 32 tablets:

• 20 tablets (4 tablets every 15 minutes with 8 ounces of any clear liquid
(water, any clear carbonated beverage, or juice) on the evening prior to
the examination, and
• 12 tablets (taken in the same manner) on the morning of the examination

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Nursing Interventions…

• Colonoscopy cannot be performed if there is a

acute sever diverticulitis, infection, obstruction,
colitis

• Patients with prosthetic heart valves or a history

of endocarditis require prophylactic antibiotics
before the procedure.

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 Anoscopy, Proctoscopy, and Sigmoidoscopy

Endoscopic examination of the anus, rectum, and

sigmoid and descending colon

• Flexible sigmoidoscope

• rigid sigmoidoscope.

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 Nursing Interventions

• warm tap water or Fleet’s enema until returns are clear.

• Dietary restrictions usually are not necessary, and

sedation usually is not required.

• During the procedure, the nurse monitors vital signs,

skin color and temperature, pain tolerance, and vagal
response.

• monitors rectal bleeding and signs of intestinal

perforation haymanot Z.
Small Bowel Enteroscopy

• Including capsule endoscopy and double balloon endoscopy.

• wireless miniature camera, a light source, and an

image transmission system.
• The capsule is 3.7 g in weight

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Double-balloon enteroscopy

• diagnostic and therapeutic interventions.

• inflating & deflating the balloons, causes telescoping

of the small intestine onto the over tube.

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Endoscopy Through Ostomy

Useful for visualizing a segment of the small or

large intestine and

To evaluate the anastomosis

To visualize and treat bleeding in a segment of the

bowel.

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Manometry and Electrophysiologic Studies

• Are methods for evaluating patients with GI motility disorders.

• Measures changes in intraluminal pressures and the coordination

of muscle activity in the GI tract then;
• Pressures transmitted to a computer analyzer.

• Is used to detect motility disorders of the esophagus and the upper

and lower esophageal sphincter.

• To diagnosis achalasia, diffuse esophageal spasm, scleroderma, and

other esophageal motor disorders.

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Nursing intervention

 NPO for 8 to 12 hours before the test.

Medications = effect on motility (eg, calcium channel blockers,

anticholinergic agents, sedatives) are withheld for 24 to 48 hours.

A pressure-sensitive catheter is inserted through the nose and is

connected to a transducer and a video recorder

• Phospho-Soda or a saline cleansing enema is administered 1 hour

before the test, and positioning = prone or the lateral position.

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Gastric Analysis, Gastric Acid Stimulation Test, and
pH Monitoring

• Indicate

• Information about the secretory activity of the

gastric mucosa
• The presence or degree of gastric retention in pt
pyloric or duodenal obstruction.
• Diagnosing Zollinger-Ellison syndrome, or
atrophic gastritis.

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 Gastric analysis

NPO for 8 to 12 hr before • gastric secretion inhibitors drugs withheld for 24 to

procedure 48 hours before the test

• Smoking is not allowed/ • Insert NG tube less than 50cm

b.c incre gastric secretion/ with 45*

• Aspirate the content and take sample

every 15 minutes for next hr.

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Gastric analysis may indicate HCL acid secretion problem
• Pernicious anemia—secrete no acid under basal conditions or after
stimulation.

• Severe chronic atrophic gastritis or gastric cancer—secrete little or

no acid.

• gastric ulcer—secrete some acid.

• Duodenal ulcers—usually secrete an excess amount of acid.

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Gastric acid stimulation test (GAST)

Usually is performed in conjunction with gastric analysis.

Histamine or pentagastrin=subcutaneously to stimulate gastric
secretions.

This injection may produce a flushed feeling.

The nurse monitors hypotension.
Gastric specimens = after the injection every 15 minutes for 1 hour.
Then see the change volume and pH, and cytology study.

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Laparoscopy (Peritoneoscopy)

• With the tremendous advances in minimally invasive surgery,

diagnostic laparoscopy is efficient, cost-effective, and useful in
the diagnosis of GI disease.

• After a pneumoperitoneum (injecting CO2 into the peritoneal

cavity to separate the intestines from the pelvic organs) is
created, a small incision is made lateral to the umbilicus,
allowing for the insertion of the fiberoptic laparoscope.

haymanot Z.
 Laparoscopy…
Advantage
• Less costive
• After visualization of a
problem, excision (eg, removal
of the gallbladder) can then
be performed
• In addition of visualization
biopsy can be taken
• To detect growth,
inflammatory process, organ
diseases, obstruction..
haymanot Z.
Disadvantage
• Need CO2
• Invasive procedure because of this it has
not become an important diagnostic
modality (MRI, CT more better)
• usually requires general anesthesia and
sometimes requires that the stomach
and bowel be decompressed.
• Required Gas (usually carbon dioxide) is
blow in into the peritoneal cavity to
create a working space for visualization.