-
Upper GI Tract Study
- examination of the upper gGI tract under fluroscopy
- after pt drinks barium sulfate
PRE PROCEDURE: NPO after Midnight
POST PROCEDURE: Laxative may be given
*Monitor stools for passage of Barium
-
Cholecystography
- Detect gallstones
- assess ability of gallbladder to:
- fill
- concentrate
- contract
- empty
- PRE PROCEDURE: Assess for allergies to Fish or Iodine
- contrast given 10-12 Hours prior to test
- NPO after contrast given
- POST PROCEDURE:
- Dysuria, contrast excreted in urine
-
ERCP
- Examination of hepatobiliary system.
- endoscope inserted into esophagus to duodenum
- PRE PROCEDURE:
- NPO for several hours prior
- Sedation
- POST PROCEDURE:
- MONITOR FOR GAG REFLEX
- SIGNS OF PERFORATION
-
Liver Biopsy
- Needle inserted through abdominal wall, to obtain tissue sample.
- PRE PROCEDURE:
- 1. consent
- 2. assess coagulation studies
- 3. Sedative
- 4. SUPINE or LEFT LATERAL
- POST PROCEDURE:
- 1. VS
- 2. assess site for bleeding
- 3. monitor for peritonitis
- 4. bed rest
- 5. PLACE CLIENT ON RIGHT SIDE W/PILLOW
- 6. No heavy lifting
-
Paracentesis
Removal of fluid from abdominal cavity
- PRE PROCEDURE:
- 1. consent
- 2. *Void prior to procedure
- 3. measure ab girth, weight, baseline VS
- 4. Positioned upright at edge of bed, back supported
- POST PROCEDURE
- 1. monitor VS
- 2. Measure fluid collected
- 3. Send fluid to lab
- 4. Dry sterile dressing to site
- 5. measure ab girth, weight
- 6.* monitor for hypovolemia, E-lyte loss
-
Esophageal varices
- Dilated/Tortuous veins in the sub mucosa of esophagus.
- Caused by PORTAL HYPERTENSION
- associated with liver cirrhosis
- high risk for rupture
- Bleeding is an emergency
*Goal to control bleeding
-
Esophageal varices
Assessment
- Hematemesis
- Melena
- Tarry Stools
- Ascites
- Jaundice
- Hepatomegaly
- Splenomegaly
- Dilated abdominal veins
- Hemorrhoids
- Signs of shock
-
Esophageal varices
Implementation
- Monitor VS
- Elevate HOB
- monitor for orthostatic hypotension
- Monitor Lung sounds
- 02 as prescribed/prevent hypoxia
- LOC
- NPO
- IV fluids
- hgb, hct, coagulation factors
- blood transfusion/clotting factors
- NG/Balloon tamponade
-
Esophageal varices
- Iced saline
- Vasopressin
- nitro
-
Sengstaken-Blakemore tube.
- Maintain traction/pressure at 40mmHG
- Scissors at bedside
- Oral Suction, mouth care
- cannot swallow or will aspirate
- Deflate balloon every 12 hrs
-
Endoscopic injection
Sclerotherapy
Injection of sclerosing agent into and around bleeding vessels
- complications:
- chest pain
- pleural effusion
- aspiration pneumonia
- esopahgeal stricutre
- perforation
-
Endoscopic variceal ligation:
- Ligation of the varices with elastic rubber band
- sloughing, followed by superficial uldceration
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