1. By Lynn Elsloo RN CGRN

2. Objectives 1. Describe two radiographic and two non-radiographic studies including indications and contraindications and patient care instructions. 2. List three diagnostic tests that analyze either blood, urine and feces.

3. General Principles Education of patient prior to exam Include family, if indicated or possible Review history, discuss preparations After procedure, monitor for adverse effects Provide discharge instructions, how to obtain results and give recommended follow-up

4. Radiographic and Nonradiographic Imaging Radiographic— Flat and upright plain x-rays films of abdomen and upright chest x-ray (1 st test for acute abdominal symptoms) Contrast medium accentuates tissue density Barium sulfate—orally, rectally or via intestinal stoma Contraindicated with digestive tract obstruction or perforation

5. Radiographic and Nonradiographic Imaging Report failure to pass barium within 2-3 days Iodine-based contrast media - IV for viewing gallbladder, pancreas, spleen and various ducts Check allergy hx. – Iodine, shellfish/seafood

6. Radiographic and Nonradiographic Imaging Barium Swallow Upper Gastrointestinal (GI) Series Enteroclysis Barium Enema Capsule Endoscopy Patency Capsule MRCP—PTC with Cholangiography Abdominal Ultrasonography

7. Radiographic and Nonradiographic Imaging Oral Cholecystography Arteriography Computerized Tomography (CT) Scintigraphy – Hepatic and Biliary Radionuclide evaluation of gastric emptying Scintigraphic scanning TIPS (Transjugular intrahepatic portosystemic shunts)

8. Secretory Studies Biliary Drainage Pancreatic Stimulation Gastric analysis 24 hour pH monitoring Bravo

9. Blood Tests Hemoglobin and hematocrit Prothrombin level Prothrombin time Activated partial thomboplastin time International Normalized Ratio (INR) Bleeding Time Platelet Count Serum albumin-globulin ratio Protein loss

10. Blood Tests Galactose tolerance Glucose tolerance Disaccharide tolerance Serum d-xylose Serum cholesterol Serum AST and ALT Serum bilirubin Serum alkaline phosphatase

11. Blood Tests Gamma-glutamyl transferase Serum amylase Serum lipase Serum gastrin Hepatitis antigens and antibodies Carcinoembryonic antigen (CEA) CA-19-9 Serum antibodies Celiac screening panel

12. Urinalysis Urine Bilirubin Urine urobilinogen Schilling Test

13. Fecal analysis Fecal uroblinogen Occult Blood Fecal Fat Fecal chymotrypsin Protein loss Fecal organisms.

14. Miscellaneous Hydrogen Breath Test Helicobactor Pylori Test Urea Breath Test Carbon-13 Blood Test H. Pylori Stool Antigen

15. Review Questions 1. The usual position of the patient during a barium swallow: a. Standing position b. Sitting position c. Prone position d. Supine position

16. Review Questions 2.Which of the following is true about the TIPS procedure? a. TIPS is an invasive radiological procedure b. TIPS is performed under fluoroscopic guidance. c. TIPS are effective in lowering portal pressure d. All of the above

17. Review Questions 3.Patient Teaching prior to capsule endoscopy should include which of the following: a. NPO after midnight b. Iron tablets should be avoided one week prior to test c. MRIs must be avoided until confirmed excretion of the capsule d. Abdominal pain, nausea, or vomiting require calling their physician. e. All of the above

18. Review Questions 4.The three-dimensional image produced by CT is based on: a. Differences in tissue density b. The differential transmission of sound waves by different tissues. c. The differential uptake of radioactive isotopes d. Visualization of radiopaque structures

19. Review Questions 5.For gastric analysis, gastric acid secretions are stimulated by the injection of: a. Secretin b. Metoclopramide (Reglan) c. Glucose d. Pentagastrin (Peptavlon)

20. Review Questions 6.An increase in platelet levels could indicate: a. Cancer b. SLE c. Cirrhosis d. Crohn’s disease

21. Review Questions 7.Extremely high levels of ALT are indicative of: a. Viral or alcohol-induced hepatitis b. Biliary obstruction c. Hepatocellular injury d. Hepatic metastasis

22. Review Questions 8.The Schilling Test is used to evaluate: a. Disaccharide tolerance b. Vitamin B12 absorption c. Immunity to hepatitis d. Bilirubin levels