CBC
complete blood count
--helps diagnose anemia, infections (low H&H is a safety risk)
anemia
a GI bleed is the most common cause of _____________ in adults
however....
a GI bleed in a male could mean colorectal cancer..
prothrombin time
is a good indicator that the liver isn't functioning
--measures the rate at which prothrombin is converted to thrombin
--process depends on vit K---associated clotting factors
liver
severe or acute ____________dz leads to elevated prothrombin time--> bad coag!!!
safety risk....bleeding risk!!!
calcium
absorbed in the GI tract
may detect malabsorption
seizures
low sodium levels can cause confusion and _______________
potassium
vomitting & diarrhea may cause depletion of sodium & ________________
AST
ALT
what are the 2 common liver function tests?
failure
ammonia levels up == liver ______________--> coma
ammonia
is normally used to rebuild amino acids or is converted to urea for excretion
amylase
lipase
elevations of what two lab levels is indicative of pancreatitis?
necrosis
amylase & lipase are not elevated in the presence of extensive pancreatic _______________ d/t destruction of the pancreatic cells
CA 19-9
cancer marker for pancreas & other cancers but not 100% specific
CEA
cancer marker ---somewhere in the body (breast)...can be used to dx cancer, just not the type of cancer
can also be used to stage
if test levels decrease...cancer is going away
--robyn
amylase
urobilinogen
what are 2 urine lab tests used in GI?
fecal occult blood
looking for hidden blood in the stool
NSAIDs can cause a false-postive fecal occult blood test, NEED TO BE OFF OF IT FOR A WEEK TO 10 DAYS
should not be performed when there is hemorrhoidal bleeding
hemoccult II
traditional stool test
--hold coumadin, NSAIDs X 7 days prior
--hold red meats, raw fruits, veggies, vit c rich foods X 72hrs (hold horseradish too--robyn)
FIT (fecal immunochemical test)
more expensive stool test
however...
drugs and food do not influence testing
ERCP (endoscopic retrograde cholangiopancreatography)
--allows
visualization
of the common bile duct and pancreatic ducts
--allows
removal of gallstones
--allows placement of
stents
--allows for
biopsies
gag
boardlike
care--> post ERCP:
--ensure that the patient's ________reflex has returned before giving foods, fluids
--monitor for complications at home
--cholangitis
--perforation (rigid, _______________ abdomen that is tender)
--sepsis
--
pancreatitis
EGD (esophagogastroduodenoscopy)
allows visualization of the esophagus, gastric and duodenal mucosa through a lighted endoscope.
--can collect secretions & tissue samples and allows pictures to be taken
*NPO X 8hrs prior
*Requires sedation (versed)
*monitor O2
*mouth guard to prevent biting scope
*left lateral position--best view
*atropine for secretions if needed
PILL CAM ESO
seven photos per second and transmits to a wireless storage device.
--only for the esophagus and can become lodged rather than pass and have to be removed surgically or endoscopically
*visualize entire bowel
*improve evaluation of small bowel
*8 lead sensors applied, held in place with abdominal binder
*test lasts 8hrs
*NPO except water for 8-10 hrs prior
*can eat after 4 hrs
colonscopy
*gold standard for colorectal cancer screening and surveillance & monitoring of pts with previous colon cancer/polyps
*allows for tissue biopsies & removal of polyps
*pt to lay on left side with knees to chest
*eval of pts with diarrhea of unknown origin, occult bleeding/anemia, other bowel dz
*only useful if pt is sedated
*can not be done if suspected perforation (broad like abd), severe diverticulitis or fulminant colitis
*pts with prosthetic heart valves--> prophylactic abx
flexible sigmoidoscopy
examination using a fiberoptic endoscope to visualize the sigmoid colon (about 16-20 inches from the anus)
*no sedation required
*low residue diet 1-2 days prior
*clear liquid diet & laxative day before
*NPO after midnight
*cleansing enema the morning of
*left side with right leg bent
*no recovery time
gastric analysis
measures hydrochloric acid and pepsin content for eval of aggressive gastric and duodenal disorders
basal gastric secretion
gastric acid stimulation
what are the 2 types of gastric analysis?
basal gastric secretion
*NPO X 12 hrs including--> alcohol, tobacco, drugs that affect gastric secretion (PPI...etc)
*NG tube is inserted and gastric contents are aspirated Q 15mins X 1hr
gastric acid stimulation test
*NG left in place
*drug is given to stimulate gastric secretion
*contents are aspirated Q 15 min X 1hr
*depressed levels suggest--> gastric cancer
*increased levels suggest--> zollinger-ellison and duodenal ulcers