Assessment of The Gastrointestinal System

Also Read

• ANPH: The Gastrointestinal Tract
  • Functions of the GIT
  • Four Tissue Layers of the GIT (Mucosa, Submucosa, Muscularis Externa, Serosa)
  • Blood Supply of the GIT
  • The Oral Cavity
  • The Esophagus (UES, LES)
  • The Stomach (Cardium, Fundus, Body/Corpus, Curvatures, Pylorus)
  • Phases of Gastric Secretion (Cephalic, Gastric, Intestinal)
  • The Small Intestine (Duodenum, Jejunum, Ileum)
  • The Large Intestine (Cecum, Ascending, Transverse, Descending, Sigmoid)
  • The Pancreas
  • The Liver
  • The Gallbladder
  • Digestion Processes
• B314:

  GIT Changes in Older Adults

  Physiologic changes occur as individuals age, especially at the age of 65 and older. Overall changes of the digestive system involved in aging include:

  1. Oral Cavity and Pharynx: difficulty chewing and swallowing
     • Injury, loss, or decay of teeth
     • Atrophy of taste buds
     • Saliva production and enzyme content (ptyalin, amylase) are decreased
  2. Esophagus: reflux and heartburn
     • Decreased motility and slower emptying
     • Weakened gag reflex
     • Decreased resting pressure of the lower esophageal sphincter.
  3. Stomach: food intolerances, malabsorption, decreased Vitamin B₁₂ absorption
     • Degeneration and atrophy of gastric mucosal surfaces with decreased HCl production.
     • Decreased secretion of gastric acids and most digestive enzymes
     • Decreased gastric motility and emptying
  4. Small Intestine: decreased motility and transit time; resultant indigestion and constipation.
     • Atrophy of muscle and mucosal surfaces.
     • Thinning of villi and epithelial cells.
  5. Large Intestine: decreased motility and transit time; resultant indigestion and constipation, decreased absorption of nutrients (dextrose, fats, calcium, iron), fecal incontinence.
     • Decreased mucus secretion (by the Goblet cells)
     • Decreased elasticity of rectal walls (lower capacity)
     • Decreased tone of internal anal sphincter
     • Slower and duller nerve impulses in the rectal area

  Link to original

• MSRLE: Assessment of the Abdomen

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Patient History

• Demographic Data: age, gender, culture, occupation
• Family History and Genetic Risk
• Medical History: Previous GI Disorders, Abdominal Surgeries, and Medications     - Aspirin and NSAIDs may cause PUD and GI Bleeding.     - Laxatives and Enemas may cause dependence, leading to constipation.
• Travel History
• Dietary History
• Socioeconomic Status
• Current Health Problem: a common complaint is pain.
• PQRST Guide Questions
  • Preceiptating or Palliative: what causes or relieves the presenting symptoms?
  • Quality or Quantity: How severe are the symptoms? How does it look, feel, or sound?
  • Region or Radiation: where is pain found? Does the pain spread or radiate anywhere?
  • Severity Scale: how bad is the pain on a scale from 1 to 10?
  • Timing: when was the onset, what is the duration, and how often does pain occur?
• GI Health Habits: toothbrushing, flossing, and dental visit frequency; awareness of lesions or irritated areas in the mouth, tongue, or throat; recent history of sore throat, bloody sputum, discomfort from certain foods, daily food intake, alcohol and tobacco use (including smokeless chewing tobacco, take note of type, amount, length of use, and if applicable, date of discontinuation), denture or partial plate use, medical history, previous diagnostic studies, treatments, surgeries, current nutritional status (via history, laboratory tests; complete metabolic panel including liver function studies, triglyceride, iron studies, and CBC), changes in appetite or eating patterns, unexplained weight gain or weight loss over the past year, and other questions about psychosocial, spiritual, or cultural factors that may be affecting the patient.

Health History

Obtain data on the most common symptoms of gastrointestinal disorders: abdominal pain, dyspepia (indigestion), gas, nausea and vomiting, diarrhea or constipation, fecal incontinence, jaundice, and other previous GI diseases (Weber & Kelley, 2018).

1. Pain may be a major and frequent symptom of GI disease. This pain may be affected by meals, rest, activity, and defecation patterns. Character, duration, pattern, frequency, location, time, and distribution of referred pain can vary depending on the underlying cause.
2. Dyspepia, commonly called “indigestion”, is the most common symptom of GI dysfunction (partly due to its broad definition). It may refer to pain, discomfort, fullness, bloating, early satiety, belching, heartburn, or regurgitation.
   • 25% of Americans experience dyspepia annually.
   • 20% of Americans experience GERD, increasing with age and sometimes with dyspepia.
   • Typically, fats cause the most dyspepia due to their slow gastric emptying.
3. Intestinal Gas may result in belching or flatulence. Patients often complain of bloating, distention, or feeling “full of gas” with excessive flatulence as a symptom of food intolerance or gallbladder disease.
4. Nausea is a vague, uncomfortable sensation of sickness or “queasiness” that might be followed by vomiting, and may be an early sign of a pathologic process. It may be triggered by odors, activity, medications, or food intake.
   • Often caused by distention of the upper intestinal tract or duodenum.
5. Vomiting is the forceful emptying of the stomach and intestinal contents through the mouth. The emesis or vomitus may vary in color and content. It may contain undigested food, blood (hematemesis), bilous gastric juices, etc.
   • Acute, bright-red/coffee-ground vomiting is characteristic of a Mallory-Weiss Tear e.g. a laceration in the mucosal lining of the gastroesophageal junction, and indicates upper GI bleeding.
   • Causes for nausea and vomiting (N&V) are many. These may include: visceral pain; motion or motion sickness; anxiety; several types of intestinal, vagal, or sympathetic input (including side effects of medications); and torsion or trauma of the ovaries, testes, uterus, bladder or kidney.
   • Initiation of vomiting includes pathways through medication therapy, metabolic abnormalities (chemoreceptor trigger zone), ingested toxins, chemotherapy, radiation therapy (vagal and splanchnic receptors), inner ear disorders, motion sickness (vestibular center), and anticipatory emesis (cerebral cortex).
6. Bowel Habit Changes may signal colonic dysfunction or disease.
   • Diarrhea is the abnormal increase in the frequency and liquidity of stool or daily stool weight or volume.
     • Commonly occurs when waste products move rapidly through the intestine, resulting in inadequate forming and absorption of water content.
     • Typically associated with abdominal pain, cramping, and N&V.
   • Constipation is the abnormal decrease in the frequency of defecation, hardness, dryness, and/or being smaller in volume of stool than normal.
     • Typically associated with anal discomfort and rectal bleeding, commonly the reason individuals seek health care referrals.
7. Stool Characteristics may also signal colonic dysfunction or disease.
   • Color is normally light to dark brown. Specific diseases and certain foods or medications may change color.
     • Green: leafy green vegetables, spinach, and kale
     • Red: beets, red gelatin, tomato soup, food coloring. Bright-red indicates lower gastrointestinal bleeding, and dark-red may indicate upper gastrointestinal bleeding.
     • Black: bismuth, iron, black licorice; upper GI bleeding (tarry-black).
     • Light Gray/Clay-colored: decrease of conjugated bilirubin
     • Milky White: from barium, typically from barium enemas or intake for imaging
   • Bulky, greasy, foamy stools that are foul in odor and may or may not float
   • Stool with mucus threads or pus that may be visible upon gross inspection
   • Small, dry, rock-hard masses occasionally streaked with blood
   • Loose, watery stools that may or may not be streaked with blood

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Physical Assessment

Also assess client nutritional Status and anthropomorphic measurement

1. Oral Cavity Inspection and Palpation

Site	Assessment	Finding
Lips	Inspection: moisture, hydration, color, texture, symmetry, ulcerations/fissures	Moist, pink, smooth, and symmetric
Gums	Inspection: inflammation, bleeding, retraction, discoloration	-
Breath	Odor	-
Oral Cavity	Inspection (Tongue Blade): color and lesions	-
Stensen Duct (Parotid Gland)	Inspection: visibility, color	Small red dot in the buccal mucosa next to upper molars
Tongue	Protrude the tongue and move it laterally	Size, symmetry and strength; integrity of the hypoglossal nerve
Dorsal Tongue	Inspection: texture, color, lesions	Thin white coat, large, vallate papillae in a V formation on the distal portion of the dorsum of the tongue
Ventral tongue	Touch the roof of the mouth with the tip of the tongue	No lesions or abnormalities
Ventral tongue	-	Common site for oral cancer. Assess location, size, color, and pain of lesions.
Pharynx (Tonsils, uvula, posterior pharynx)	Visualization: depress tongue with tongue blade	Color, Symmetry, Evidence of Exudate, Ulceration, Enlargement
Hard Palate	Color and shape	-
Uvula and Soft Palate	Inspection: open mouth, deep breath, and say “ah”	Rises symmetrically; integrity of the vagus nerve

2. Abdominal Assessment: lie the patient supine with knees flexed slightly for inspection, auscultation, percussion, and palpation of the abdomen. For documentation, the abdomen may be divided into four or nine regions.
   1. Inspection: Note changes of the skin, nodules, lesions (important), scarring, discoloration, inflammation, bruising, or striae, contour (flat, rounded, scaphoid), symmetry, bulging, distention, peristaltic waves.
   2. Auscultation: done prior to percussion and palpation as those may alter sounds. Determine character, location, and frequency of bowel sounds. Also identify vascular sounds.
      • Use the diaphragm of the stethoscope to identify clicks and gurgles (usual bowel sounds). These occur irregularly and range from 5 to 30 sounds per minute. Listen for at least 5 minutes, with at least one minute in each quadrant to confirm the absence of bowel sounds.
      • Use the bell of the stethoscope to identify bruits in the aortic, renal, iliac, and femoral arteries. Friction rubs are notes over the liver and spleen during respiration. Borborygmus is a long gurgle (“stomach growling”).
      • Normal, Hyperactive, or Hypoactive
   3. Percussion: assess the size and density of the abdominal organs; detect air-filled, fluid-filled, or solid masses. It may be done independently or concurrently with palpation as it may validate palpation findings. Percuss all quadrants for tympani (high pitched) or dullness.
      • Tympanic sounds are head over air-filled organs (stomach and small intestines).
      • Dullness is heard over organs and solid masses.
      • Deep palpation should be used for masses, and light palpation is appropriate for areas of tenderness and muscle resistance. Most examiners do not examine for rebound tenderness due to discomfort inflicted.
3. Rectal Inspection and Palpation: evaluation of the terminal portions of the GI tract, the rectum, the perianal region, and anus. The anal canal is approximately 2.4 to 4 cm in length and opens to the perineum. Concentric rings of muscle, the internal and external sphincters, normally keep the anal canal securely closed. Gloves, water-soluble lubrication, a penlight, and drapes are necessary for the evaluation. This is a mandatory part of every thorough examination. For women, this may be part of a gynecologic examination. Encourage the patient to visualize pleasant scenery and focus on deep breathing.
   • Positioning may include knee-chest, left lateral with hips and knees flexed, or standing with hips flexed and upper body supported by the examination table.
   • External: lumps, rashes, inflammation, excoriation, tears, scars, pilonidal dimpling, and tufts of hair at the pilonidal area (above the anus, near the tailbone). The discovery of tenderness, inflammation, or both should alert the examiner to the possibility of a pilonidal cyst (cyst containing hair and pus), perianal abscess, or an anorectal fistula or fissure.
   • Internal: the patient’s buttocks are carefully spread until the patient has relaxed the external sphincter control. Ask the patient to bear down, and inspect for fistulas, fissures, rectal prolapse, polyps, and internal hemorrhoids. Insert a gloved, lubricated index finger and ask the patient to bear down. The tone of the sphincter and any nodules or irregularities of the anal ring is noted.

Abdominal Assessment

Also Read: Abdominal Assessment Procedure

• Have the client void, lie supine with knees bent, and keep the arms at the side. This should relax the abdominal muscles.
• IAPePa (as opposed to the usual IPaPeA): Inspection, Percussion, Palpation, Auscultation     - Leave the reported areas with pain as the last areas to check, as pain causes involuntary abdominal tension, impeding on the assessment.     - Observe for signs of pain: grimacing     - Starting from the RUQ, clockwise around each quadrant
• Cullen’s Sign: ecchymosis (bruising) around the umbilicus is indicative of intra-abdominal bleeding.
• Abdominal movements indicate intestinal obstruction (hyperperistalsis). These are rarely seen upon inspection.

Auscultation

• High-pitched Gurgles: movement of air and fluid; q5-15s; 5-30 sounds/min.
  • Hyperactive: 30 sounds in 1 minute.
  • Hypoactive: 1-2 sounds in 2 minutes. Diminished or absent gurgling may be observed after abdominal surgery, with peritonitis, or a paralytic ileus.
  • Absent: no sounds in 3 to 5 minutes.
• Borborygmus: loud gurgling sounds due to hypermotility of the bowel e.g. in gastroenteritis, diarrhea, or complete intestinal obstruction.
• Bruit: “swooshing sounds” that indicate an aneurysm (AAA), especially if heard over the abdominal aorta. Avoid percussion or palpation if observed; rupturing the aneurysm is life-threatening.

Percussion

This method is used to determine and estimate the size of solid organs such as the liver and the spleen, the presence of masses, of fluids, and of air.

• Tympanic: high-pitched, loud musical sound of an air-filled space.
• Dull: medium-pitched, softer, thud-like sound over a solid organ.

Palpation

This method (light and deep) is used to determine the size and location of abdominal organs and assess the presence of masses or tenderness (pain).

• Blumberg’s Sign: rebound tenderness; pain felt when pressure from fingers pressing perpendicular to the abdomen is removed. Found in appendicitis,.

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Diagnostic Examination

Diagnostic studies can confirm, rule out, stage, or diagnose various disease states, including cancer. Time should be allotted after diagnosis with the patient in addition to offering information resources.

• Preparation for many studies include a clear-liquid or low-residue diet, fasting, ingestion of a liquid bowel preparation, the use of laxatives or enemas, and ingestion or injection of a contrast agent or radiopaque dye. In older patients or those with comorbidities, this may lead to fluid and electrolyte imbalance.
• General nursing interventions for GI diagnostic evaluation: establish the need for information, provide education to patients and families on the diagnostic test, pre- and post-procedure restrictions and care, helping the patient cope with discomfort and alleviate anxiety, inform the primary provider of known medical conditions or abnormal laboratory values that may affect the procedure, and assess for adequate hydration before, during, and immediately after the procedure (also provide education about the maintenance of hydration).

Blood Tests

• Complete blood count (CBC): GI bleeding may result in acute or chronic anemia.
• Prothrombin Time (PT): Liver damage will prolong an individual’s PT due to its role in the production of coagulation factors.
• Serum Electrolytes: GI malabsorption, excessive vomiting, and excessive diarrhea may all result in electrolyte imbalance.
• Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT): these are liver function tests. AST and ALT levels are raised in chronic alcoholics and patients with viral hepatitis.
• Serum Amylase & Lipase: the best indicator of acute pancreatitis if elevated within 1 to 5 days.
• Bilirubin Levels: evaluation of liver and biliary tract functioning.
• Serum Ammonia: evaluation of hepatic function. Ammonia is used to rebuild amino acids or is converted to urea and excreted.

Urine Tests

• Urine Amylase: increased in acute pancreatitis. This may remain high even after serum levels return to normal.
• Urobilinogen: indicative of hepatic and biliary obstruction.

Stool Tests

• Fecal Occult Blood Test: test for GI bleeding.
• Parasitic Infection
• Fecal Fats (steatorrhea): malabsorption.

Plain Abdominal X-Ray

• Also referred to as a KUB (Kidney, Ureter, Bladder) X-Ray or a Scout Film; a Flat Plate of the Abdomen. Used for detection of masses, tumors, structures, or obstructions. There are no special preparations required for this test.

Upright Abdominal X-Ray

• The standing position will allow the radiologist to see if there are any blockages or perforations in your digestive tract.
• Erect abdominal X-rays are used to look for fluid levels in obstruction or ileus. Air may be seen under the diaphragm in an erect film if the bowel has been perforated, although a CXR is more usual to look for that sign.

Barium Swallow Test

• A special type of imaging test that uses barium and X-rays to create accurate images of the upper gastrointestinal tract (back of mouth, pharynx, esophagus). Barium coats the walls of the alimentary organs and allows for better visualization of their size and shape, as well as how the patient performs deglutition. Barium is only used for GIT imaging. It does not cause any harm.
• This may be part of the upper GI series, which visualizes the esophagus, stomach, and duodenum. Fluoroscopy is often used during a barium swallow test.
• Used for heartburn, gastric reflux, and problems with eating, drinking, or swallowing. It may show ulcers, abnormal growths, blockages, and narrowing.

Procedure

1. NPO a few hours before the test. Even medication may be withheld prior to the test. Some hospitals also recommend not chewing gum, eating mints, or smoking cigarettes the midnight before the test.
2. Takes ~60 minutes at the x-ray department of the hospital. Changing into a gown is required.
3. The patient then drinks the barium liquid. It is often chalky but may have added flavoring.
4. The patient then lies on a tilting table, but may stand up on some other parts of the exam to facilitate barium flow and imaging. An injection may be used to relax the stomach.
   • This injection may be skipped if the patient has glaucoma or heart problems.
5. This is performed on an outpatient basis, and results are usually available within 1 to 2 weeks.

Upper GI Series and Small Bowel Series

• X-ray of the Upper GI structures from the oral pharynx to the duodenojejunal junction. Used for the detection of esophageal (with a barium swallow), gastric, or duodenal disorders and function.
• Up to the ileocecal junction with a small bowel follow-through (SBFT)
• The barium preparation is traced by fluoroscopy through the esophagus and stomach.

Client Preparation

• 8 hours NPO before the procedure. Withhold opioid analgesics and anticholinergics 24 hours before the test, as these decrease motility.
• The client must drink ~16 ounces of barium preparation.

Post-procedure Considerations

• Plenty of fluids should be given to eliminate ingested barium.
• Mild laxatives or stool softeners can be given.
• Advise clients that stool may be chalky white for 1 to 2 days as barium is excreted.

Lower GI Series (Barium Enema)

• Radiographic visualization of the large intestine with a barium enema. It often complements lower gastrointestinal endoscopy. Two forms may be used: single contrast (only uses barium) and double contrast (uses barium and air). Double contrast barium enemas are often more successful and common.
• This detects bowel obstructions due to the twisting of the colon upon itself (volvulus), lower GI bleeding, altered bowel habits or abdominal pain, and screens for polyps, or colorectal cancer.
• Contraindication: suspected colon perforation or fistula. This may cause cardiac arrest if barium enters venous circulation, acute colitis/diverticulosis, recent polypectomy or colonic biopsy, old age (>70 y.o.), and pregnancy.

Client Preparation

• All preparations are related to reducing fecal content of the colon for the procedure.
• Clear liquid diet 12 to 24 hours before the procedure to reduce fecal matter in the bowel.
• NPO the night before the procedure.
• Potent laxatives or a cleansing enema is performed the evening before the test.

Procedure

1. The patient is cannulated. IV antispasmodics (e.g. hyoscine butytbromide) may be used for comfort.
2. Positioning: left lateral position on an x-ray table.
3. Perform a digital rectal examination, followed by the insertion of a (lubricated) rectal catheter. The catheter should have two connectors, one for passing barium, and one for insufflating air.
4. Positioning: prone
5. Pass the barium slowly through a giving set into the catheter. Fast passing may cause discomfort and stimulate defecation. X-ray screening begins once the barium is being passed.
   • Stopped once the rectum has been filled, and barium moves along the colon. Positioning of the patient may be changed by the radiologist to aid in filling.
   • Once the barium reaches splenic fixture, they return to the prone position and air is insufflated. As air enters, the colon inflates and the mucosa becomes clearer in imaging.
   • Screening continues until the cecum (via imaging of the appendix or the small intestines) is identified. Final photos are taken in various positions to obtain complete views.
6. Empty the rectum and remove the catheter. The patient may still pass barium for several hours after the procedure.

Post-procedure Considerations

• Complications:
  • Major: colonic perforation, hemorrhaging, oversedation, cardiac arrhythmias
  • Minor: constipation, abdominal discomfort, rectal bleeding, and flatus.
• Advise the client to drink plenty of water (to eliminate barium)
• Mild laxatives or stool softeners can be given.
• Chalky white stool may persist for 1 to 3 days until all barium is expelled.

Percutaneous Transhepatic Cholangiography (PTC)

• Iodinated dye (contrast medium) is instilled via a percutaneous needle through the liver into the intrahepatic ducts with x-ray guidance. This is now an uncommon diagnostic procedure. The needle is inserted into the left hepatic ducts, so the patient is placed on the right side.
• Observe for bleeding, hematoma, ecchymosis, or bile leakage.

Computed Tomography (CT) Scan

• A non-invasive cross-sectional x-ray visualization detecting tissue densities and abnormalities in the abdomen and the structures in it. It can be performed with or without a contrast medium. As usual, check for seafood or iodine allergies.
• No particular follow-up care is required unless sedatives were used. Monitor VS until the client is fully awake.

Endoscopy

• Direct visualization of the GIT by means of a flexible fiberoptic endoscope. This is often used to evaluate bleeding, ulceration, inflammation, masses, tumors, and cancerous lesions.

Esophagogastroduodenoscopy (EGD)

• Upper endoscopy; a visual examination of the upper GI tract: the esophagus, stomach, and duodenum. This may also include a biopsy.

Client Preparation

• Medications used: Midazolam HCl (sedative), Meperedine (Demerol) (sedative), Fentanyl, Atropine (reduces secretions and vagal responses), Local Anesthetics (inactivates gag reflex and facilitates passage of tube).

Procedure

1. The test lasts from approximately 30 to 60 minutes.
2. Monitoring for breathing, heart rate, blood pressure, and oxygen levels are set up.
3. IV medication for relaxation is given. Analgesia and induced amnesia should occur for the procedure.
4. Local anesthetics may be used for the throat to prevent coughing or gagging.
5. A mouth guard is used to protect the teeth and scope. Dentures are removed before the procedure begins.
6. Positioning: left lateral position
7. Insertion of the endoscope to the esophagus, stomach, and duodenum.
8. Air is introduced through the scope in order to facilitate visual inspection.
9. Biopsies may be performed.
10. Treatments (therapeutic esophagogastroduodenoscopy) may be done such as stretching or widening a narrowed area of the esophagus.
11. NPO until gag reflex returns.

Post-procedure Considerations

• Complications: colonic perforation, hemorrhaging, oversedation, cardiac arrythmias, abdominal discomfort, rectal bleeding, and flatus.
• Monitor VS q30m until sedation wears off. Put side rails up to prevent falls.
• NPO until gag reflex returns (often in 1 to 2 hours) to avoid aspiration.
• WOF: Signs of Perforation (Pain, Bleeding, Fever)

Endoscopic Retrograde Cholangiopancreatography (ERCP)

• Visual and radiographic examination of the liver, gallbladder, bile ducts, and pancreas to identify cause & location of obstruction. After the cannula is inserted into the common bile duct radio-opaque dye is inserted followed by x-ray examination.
• For removal of gallstones, a small incision (papillotomy) may be made at the ampulla of Vater (hepatopancreatic duct).
• The same preparations apply as for an EGD.

Colonoscopy

• Examination of the large bowel (colon). It is used to identify causes of chronic diarrhea, sources of bleeding, tissue biopsies, or to remove polyps.

Client Preparation

• Liquid diet for 12 to 24 hours before the procedure
• NPO for 6 to 8 hours before the procedure
• Laxatives, Suppositories, Cleansing Enemas to clean the bowel the night before the procedure.
• Sedation, preparation of Atropine Sulfate to prevent vasovagal responses from causing bradycardia.

Post-procedure Considerations

• Monitor VS q15m until the patient is stable. Keep the side rails up (prevent from falls) and observe for signs of perforation (bleeding, fever, pain).

Proctosigmoidoscopy

• Examination of the rectum and sigmoid colon. Either a rigid or a flexible scope may be used.
• Screens for colon cancer, GI bleeding, diagnosis or monitoring of inflammatory bowel disease.

Client Preparation

• Liquid diet for at least 24 hours before the procedure
• Laxatives the evening before, and cleansing enema the morning before the procedure.
• Positioning: left-side lying in the knee-chest position.
• No sedation is required because of the shallow depth.

Post-procedure Considerations

• Inform the client that mild gas pain and flatulence may be experienced because of air introduced by the procedure.
• If a biopsy was involved, slight bleeding may be observed. However, excessive bleeding should be immediately reported.

Gastroscopy

• A thin, flexible tube with a camera and light (endoscope) is used to look within the esophagus, stomach, and duodenum. This procedure is also referred to as an upper gastrointestinal endoscopy.
• Used to investigate dysphagia, persistent abdominal pain; to diagnose (diagnostic gastroscopy) stomach ulcers, GERD; or to treat (therapeutic gastroscopy) bleeding ulcers, esophageal obstruction, non-cancerous growths (polyps), or small cancerous tumors.

Procedure

1. Therapeutic forms may last longer, but a gastroscopy generally takes ~15 minutes or less to perform in an outpatient setting.
2. A local anesthetic spray (or sedative, if preferred) numbs the throat.
3. The endoscope is inserted, with the patient being asked to swallow the first segment. It is then guided further down the esophagus and into the stomach.
4. Pain should be minimal or absent, but discomfort and unpleasantness may still occur.

Complications

1. Reaction to sedatives (affected breathing, heart rate, blood pressure)
2. Internal bleeding
3. Tearing of the lining of the esophagus, stomach, or duodenum.

Gastric Analysis

• Measures the hydrochloric acid and pepsin content of the stomach in order to determine aggressive gastric and duodenal disorders (Zollinger-Ellison Syndrome)

Ultrasound

• Sound waves are passed through the body via a transducer, in which the “echoes” of the sound waves are recorded as images for analysis. It is commonly used to image soft tissue such as the liver, spleen, the pancreas, and gallbladder (biliary system).
• A full bladder is required for some forms of this procedure because a full bladder will move organs out of the way, as well as because the sound waves travel better through fluids than through air.