DIAGNOSTIC PROCEDURES
UPPER LIMIT YPES
a. WITHOUT TUBE (tubeless gastric analysis)
- using DIAGNEX BLUE (specimen: urine);
if urine colors turns BLUE, therefore (+) HCL Acid; if urine (-) blue color, therefore (-) HCL Acid
- if (-) HCL Acid at stomach (achlorhydia), therefore Gastric CA;
- if Increase HCL Acid – therefore ZOLLINGER-ELLISON SYNDROME – (+) Gastric Tumor b. WITH TUBE – with the use of NGT then aspirate
ULTRASONOGRAPHY
- upper abdl USG to detect abnormalities in the upper abdl area w/ includes biliary tree and Upper GI;
- painless;
- gel at abdomen and pt is NPO
LIVER BIOPSY
- aspiration of sample tissue from the liver to detect: Hepatic CA and Cirrhosis; - ALERT: Check for Bleeding Time (N – 1-9 mins) and
Clotting Time (N – 10-12 mins) – because liver is highly vascular organ
- WHEN NEDDLE IS INSERTED tell pt to:
Inhale then Exhale then Hold Breath – to stabilize liver position - Position after : R side-lying position
- Things to report: s/s of SHOCK – inc PR, dec BP Check v/s
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)
- to visualize common bile duct and pancreatic duct; - invasive – (+) consent;
- NPO – tube insertion;
- Tell pt that tere will be feeling of soreness a wk after the procedure
COLONOSCOPY
- visualization of colon to detect: inflammatory bowel condition Chron’s Dses Diverticulitis Hemmorhoids Tumor Polyps - (+) Consent - NPO b4
- clear liquid diet – 2days b4 the procedure
position: Lateral or side lying position or L Lateral Sims
VI. ENDOCRINE
GLUCOSE TOLERANCE TEST
- to provide measure of bld sugar level at blood; - Inform pt to have high CHO diet 2 days b4 the test; - Instruct NPO a day b4 the test (npo post midnoc); - Inc sugar level, therefore Diabetes
ACTH STIMULATION TEST
- to detect presence of Addison’s Dses - specimen: blood
- pt is given dose of ACTH (not nore than 40ug/dl)
- if still dec despite ACTH administration, therefore Adrenal Insufficiency – Addison’s Dses
DEXAMETHASONE SUPRESSION TEST
- to detect endogenous depression – depression resulting thru endocrine disorder
- pt is given dexa then 24hr urine specimen is collected;
- a dose of dexa will suppress the release of adrenal hormones;
- if despite dexa administration still increase adrenal hormones, therefore pt is suffering depression
17 KETOSTEROID & 170 HCS
Addison’s – dec secretion of ketones Cushing’s – ince secretion of ketones Specimen: 24 hr urine
VANILLYLMANDELIC ACID TEST – VMA Test - bi-product of CATHECHOLAMINE Metabolism
epinephrine norepinephrine
inc if there is TUMOR (pheocromocytoma) of Adrenal Medulla
N 2-7 mg/dl / 24hrs – if inc, therefore tumor
AVOID: vanilla containing food 3 days b4 test – ice cream, coffee, chocolates
R A I U
- pt is given iodine 131 then after 24hr followed by a thyroid scan - inc indicates hyperthyroidism, dec hypothyroidism
- AVOID: iodine rich-food (sea foods, sea shells, sea weeds) 7-10 days b4 and to include
other diagnostic procedures that uses contrast medium (“NO” - angiogram test). – bec it may yield to false (-) result.
SULKOWITCH’S TEST
- detect amount of calcium excreted at urine;
- if to test for hypercalcemia and hyperthyroidism - gather specimen b4 meals; - to test for hypocalcemia and hypothyroidism – gather after meals
VII. R E NA L
URINALYSIS
- examine the gross characteristic of the urine urine amount : 30-60ml/hr
color : clear, amber s. gravity : 1.010 – 1.025
abnormality: lower than 1.005 – diabetic insipidus higher than 1.030 – diabetic mellitus (+) glucose – infection, DM
(+) CHON - PIH, kidney dses. Urine maybe refrigerated if waiting to be examined.
CULTURE & SENSITIVITY
- to detect infection
K U B IVP
- xray of the kidneys, ureter and bladder - xray of the kidneys, ureter and bladder - NO SPECIAL PREPARATION NEEDED - uses contrast medium/ dye
- assess for allergy, then inc. oral fld intake after - benadryl or epinephrine at bedside for allergic rxn - NPO POST MIDNOC, cleansing enema in AM
CYSTOSCOPY
- visualization of urinary bladder - after : monitor I & O;
- note for s/s of bleeding
RENAL BIOPSY
- aspiration of tissues at kidney for biopsy to detect: a. malignancy/ Ca
b. malignant HPN c. kidney disorder - note for s/s of bleeding
CYSTOURETROGRAM
- to check the patency of the ureter and bladder; - monitor I & O
CYSTOMETROGRAM
- to evaluate the sensory and motor funx of bladder;
- to check if bladder respond to distention after installation of flds; - monitor I & O
VIII. MUSCULO-SKELETAL
ELECTROMYOGRAPHY
- to detect electrical activity of the muscle; - (+) consent;
- to alternately contract and release the muscle as needle is inserted - HOLD muscle relaxant b4 the test
ARTHROCENTESIS
- aspiration of fluids at synovial space to detect abnormalities; - check for order of analgesic;
ARTHROSCOPY
- visualization of joints
- KEEP TORNIQUET, ICE PACK and ANALGESIC at bedside
BONE SCAN
- detect rate of bone destruction or bone resorption for pt w/ osteoporosis; - lie still during the procedure;
- PAINLESS AND NON INVASIVE
IX. MISCELLANEOUS
BONE MARROW BIOPSY
- to check abnormalities at the b. marrow (eg. Leukemia) - site : ILEAC REST
- (+) consent
- assess for bleeding
- sand bag at bedside (post procedure) – for emergency use
SCHILLING’S TEST
- specimen: 24hr urine
- test for VIT B12 deficiency; - for pt w/ PERNICIOUS ANEMEIA;
- pt is given oral VIT B12 then urine is collected, then NOTE for RATE of EXCRETION of VIT B12 (N – less than 40%);
eg. If 100mg Vit b was taken – 60mg shld retain at stomach and 40mg will be excreted.
URINE UROBILINOGEN
to detect HEMOLYTIC DSES
WITHOLD ALL MEDS – 24hrs b4 the test
BENCE-JONES PROTEIN
detect presence of MULTIPLE MYELOMA (malignancy of plasma cells);
RELEASED by destroyed or damage bones
ROMBERG’S TEST
check FUNX of CEREBELLUM;
stand erect, close eyes, and observe for inability to maintain posture (if pt is Swaying, therefore TUMOR at cerebellum)
ERYTHROCYTE FRAGILITY TEST
solution (RBC Lifespan: 120 days)
if lifespan of RBC >120 days, therefore HEMOLYTIC ANEMIA (EX. SICKLE CELL)
HETEROPHIL ANTIBODY TEST
- detect presence of IgM w/c is related to Epstein Virus infection
Epstein Virus Infection – causative agent of infectious mononucleousis (“kissing dses”)
mgt: AVOID SHARING of utensils and glass
LYMES DSES SEROLOGY
- detect presence of BORRELIA BURGDORFERI – causative agent of lyme’s dses.
Treatment: tetracycline