By Lynn Elsloo RN CGRN

Objectives1. 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.

General PrinciplesEducation of patient prior to examInclude family, if indicated or possibleReview history, discuss preparationsAfter procedure, monitor for adverse effectsProvide discharge instructions, how to obtain

results and give recommended follow-up

Radiographic and Nonradiographic ImagingRadiographic—

Flat and upright plain x-rays films of abdomen and upright chest x-ray (1st test for acute abdominal symptoms)

Contrast medium accentuates tissue density Barium sulfate—orally, rectally or via intestinal

stomaContraindicated with digestive tract

obstruction or perforation

Radiographic and Nonradiographic ImagingReport failure to pass barium within 2-3 daysIodine-based contrast media - IV for viewing

gallbladder, pancreas, spleen and various ducts

Check allergy hx. – Iodine, shellfish/seafood

Radiographic and Nonradiographic ImagingBarium SwallowUpper Gastrointestinal (GI) Series EnteroclysisBarium EnemaCapsule EndoscopyPatency CapsuleMRCP—PTC with CholangiographyAbdominal Ultrasonography

Radiographic and Nonradiographic ImagingOral CholecystographyArteriographyComputerized Tomography (CT)Scintigraphy – Hepatic and BiliaryRadionuclide evaluation of gastric emptyingScintigraphic scanningTIPS (Transjugular intrahepatic

portosystemic shunts)

Secretory StudiesBiliary DrainagePancreatic StimulationGastric analysis24 hour pH monitoringBravo

Blood TestsHemoglobin and hematocritProthrombin levelProthrombin timeActivated partial thomboplastin timeInternational Normalized Ratio (INR)Bleeding TimePlatelet CountSerum albumin-globulin ratioProtein loss

Blood TestsGalactose toleranceGlucose toleranceDisaccharide toleranceSerum d-xyloseSerum cholesterolSerum AST and ALTSerum bilirubinSerum alkaline phosphatase

Blood TestsGamma-glutamyl transferaseSerum amylaseSerum lipaseSerum gastrinHepatitis antigens and antibodiesCarcinoembryonic antigen (CEA)CA-19-9Serum antibodiesCeliac screening panel

UrinalysisUrine BilirubinUrine urobilinogenSchilling Test

Fecal analysisFecal uroblinogenOccult BloodFecal FatFecal chymotrypsinProtein lossFecal organisms.

MiscellaneousHydrogen Breath TestHelicobactor Pylori Test

Urea Breath TestCarbon-13 Blood TestH. Pylori Stool Antigen

Review Questions1. The usual position of the patient during a

barium swallow:a. Standing positionb. Sitting positionc. Prone positiond. Supine position

Review Questions2. Which of the following is true about the

TIPS procedure?a. TIPS is an invasive radiological procedureb. TIPS is performed under fluoroscopic

guidance.c. TIPS are effective in lowering portal pressured. All of the above

Review Questions3. Patient Teaching prior to capsule endoscopy

should include which of the following:a. NPO after midnightb. Iron tablets should be avoided one week prior

to testc. MRIs must be avoided until confirmed

excretion of the capsuled. Abdominal pain, nausea, or vomiting require

calling their physician.e. All of the above

Review Questions4. The three-dimensional image produced by

CT is based on:a. Differences in tissue densityb. The differential transmission of sound waves

by different tissues.c. The differential uptake of radioactive isotopesd. Visualization of radiopaque structures

Review Questions5. For gastric analysis, gastric acid secretions

are stimulated by the injection of:a. Secretinb. Metoclopramide (Reglan)c. Glucosed. Pentagastrin (Peptavlon)

Review Questions6. An increase in platelet levels could indicate:

a. Cancerb. SLEc. Cirrhosisd. Crohn’s disease

Review Questions7. Extremely high levels of ALT are indicative

of:a. Viral or alcohol-induced hepatitisb. Biliary obstructionc. Hepatocellular injuryd. Hepatic metastasis

Review Questions8. The Schilling Test is used to evaluate:

a. Disaccharide toleranceb. Vitamin B12 absorptionc. Immunity to hepatitisd. Bilirubin levels