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Ulcer, plaque on lips or mouth

Assessment (Sore or Lesionn)
Abnormalities
Etiology = Carcinoma, viral infection

Cheilosis
(Softening, fissuring, and cracking of lips at angles of mouth)

Etiology = Riboflavin deficiency

Cheilitis
(inflammation of lips (usually lower) with fissuring, scaling, crusting)

Smooth Tongue
(Red, slick appearance)

Etiology = Cobalamin deficiency

Mouth Leukoplakia
(Thickened, white patches)

Etiology = Premalignant lesion

Pyorrhea
(Recessed gingivae, purulent pockets)

Etiology = Periodintis

Herpes Simplex
(benign vesicular lesion)

Etiology = Herpes Virus

Candidiasis
(white, curdlike lesions surrounded by erythematous mucosa)

Etiology = Candida Albicans

Glossitis
(Reddened, ulcerated, swollen tongue)

Etiology = Exposure to streptococci, irritation, injury, Vitamin B defiency,

anemia
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Acute marginal gingivitis

(Friable, edematous, painful, bleeding gingivae)

Etiology = Irritation from ill-fitting dentures, calcium deposits on teeth,

food impaction

Esophagus & Dysphagia

Stomach (Difficulty swallowing)

Etiology = Cancer of esophagus

Hematemesis
(Vomiting of blood)

Etiology = Esophageal varices, bleeding peptic ulcer

Pyrosis
(Heartburn, burning in epigastric or substernal area)

Etiology = Hiatal Hernia, Esophagitis, incompetent LES

Dyspepsia
(Burning or Indigestion)

Etiology = Peptic ulcer disease, gallbladder disease

Odynophagia
(painful swallowing)

Etiology = Cancer of esophagus, esophagitis

Eructation
(Belching)

Etiology = Gallbladder disease

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Abdomen Distention
(Excessive gas accumulation, enlarged abdomen, generalized tympany)

Etiology = Obstruction Paralytic ileus

Ascites
(Accumulated fluid within abdominal cavity, eversion of umbilicus
(usually)

Etiology = Peritoneal inflammation, heart failure, metastic carcinoma,

cirrhosis

Rebound Tenderness
(Sudden pain when fingers withdrawn quickly)

Etiology = Peritoneal inflammation, appendicitis

Hepatomegaly
(Enlargement of liver)

Etiology = Metastatic Carcinoma, hepatitis, venous congestion

Splenomegaly
(Enlarged spleen)

Etiology = Chronic leukemia, hemolytic states, portal hypertension, some

infections)

Hernia
(Bulge or nodule on abdomen, usually from straining)

Etiology = Inguinal (in inguinal canal), Femoral, umbilical or incisional

(defect in muscles after surgery)

Rectum & Anus Tenesmus

(painful and ineffective straining at stool. Sense of incomplete evacuation)

Etiology = Inflammatory bowel disease, IBS, diarrhea secondary to GI

infection (food poisoning)

Steatorrhea
(Fatty, frothu, foul-smelling stool)

Etiology = Chronic Pancreatitis, Biliary obstruction, malabsorption

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Diagnostic Studies

Upper Structural abnormalities of esophagus, stomach and duodenum

gastrointestinal
(GI) or barium Before: Drink contrast medium and assume various positions on x-ray
swallow table. Keep patient NPO for at least 8 hours. Avoid smoking after midnight

After: Contrast media impaction, stool may be white for up to 72 hours

Lower GI or Used to detect presence of tumors, diverticula and polyps

barium enema
Before: Enema until clear evening before procedure. NPO for 8 hours.
Explain that cramping and urge to defecate may occur during procedure.

After: Observe stool for passage of contrast medium. Stool may be white
for up to 72 hours.

Cholangiography Used to determine filling of hepatic and biliary ducts

(Percutaneous
transhepatic PTC) Before: Assess patients medications. Keep patient NPO 8-12 hours before
test. Initiate prophylactic IV antibiotics 1 hr prior.

After: Observe for signs of hemorrhage, bile leakage, and infection.

Maintain bed rest for 6 hr

Surgical *Contrast medium injected into common bile duct during surgery on
Cholangiogram/ biliary structures
Magnetic *MRI technology to obtain images of biliary and pancreatic ducts
resonance
cholangiopancreat Contraindications: Pregnancy, presence of metal implants (pacemaker)
ography (MRCP)

Ultrasound Noninvasive procedure to show size and configuration of an organ

Abdominal Detects abdominal masses (tumors, cysts) gallstones, biliary and liver
Ultrasound disease

Before: NPO 8-12 hours. Air or gas can reduce quality of images
Food intake can cause gallbladder contraction
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Endoscopic Detects and stages esophageal, gastric, rectal, biliary, and pancreatic
Ultrasound (EUS) tumors abnormalities

Ultrasound Assesses level of liver fibriosis. Used to monitor chronic liver disease
Elastography
(Fibroscan) Before: Pt needs to lie in dorsal decubitus position with right arm in
extreme abduction

Nuclear imaging Shows size, shape, and position of organ. Functional disorders and
scans structural defects may be identified.
(scintigraphy)
Before: Tell patient that the substance only contains little radioactivity
and poses no danger. Schedule no more than one radionuclide test a day.
Pt needs to lie flat during scanning

Gastric emptying Used to diagnose delayed gastric emptying (gastroparesis)

breath test (GEBT)
Before: NPO after midnight. Test takes 4 hr

Computed Detects biliary tract, liver, and pancreatic disorders

Tomography (CT)
scan Before: Determine sensitivity to iodine or shellfish if contrast material is
used.

Magnetic Used to detect hepatobiliary disease, hepatic lesions, and sources of GI

Resonance bleeding and stage colorectal cancer
Imaging (MRI)
Before: Contraindications, pregnancy and metal implants (pacemaker)

Detects intestine and colon diseases, including polyps, cancer,

Virtual diverticulosis, and lower GI bleeding
Colonoscopy
Before: Bowel preparation similar to colonoscopy

Defecography Detects pelvic floor abnormalities

Before: Keep pt NPO for 2 hr. Two enemas are 2 hr and 15 mins apart.
Oral barium is given 1 hr before
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Esophagogastrodu Detects inflammation, ulcerations, tumors, varices or Mallory Weiss tears

odenoscopy
Before: Keep pt NPO for 8 hr. Make sure consent is signed. Local
anesthesia on throat.
After: Keep NPO until gag reflex returns. Gently tickle back of throat to
determine reflex. Temperature spike is a sign of perforation

Colonoscopy Used to diagnose IBD, polyps, tumors and diverticulosis and dilate
strictures. Allows for biopsy and removal of polyps without laparotomy

Before: Evening before procedure patient drinks 2L of oral polyethylene

glycol (PEG) lavage solution. The second 2 L dose 4-6 hr before procedure
Pt will be in side lying position
After: Abdominal cramps may be present. Observe for rectal bleeding and
perforation

Used to visualize small intestine and diagnose diseases such as Crohns

Video capsule disease, small bowel tumors, small bowel injury due to NSAIDs, celiac
endoscopy (VCE) disease, malabsorption syndrome and identify source of GI bleeding

Before: pt fast overnight. Bowel preparation similar to colonoscopy. Video

capsule swallowed, and clear liquids resumed after 2 hr and food
medications after 4 hr
During: 8 hr after pt returns to have monitoring device removed. Patency
capsule might be used first to detect strictures (HIGH RISK)
After: Peristalsis causes passage of the disposable capsule with a bowel
movement

Sigmoidoscopy Used to detect tumors, polyps, inflammatory and infectious diseases,

fissures, hemorrhoids
Before: Explain to patient knee-chest position and need to take deep
breaths during insertion of scope. Encourage pt to relax and let abdomen
go limp
After: Observe for rectal bleeding after polypectomy or biopsy

Can be used to retrieve a gallstone from distal common bile duct, dilate
Endoscopic strictures, biopsy and diagnose pseudocysts
retrograde
cholangiopancreat Before: Keep pt NPO 8 hr before. Ensure consent is signed. Sedation
ography (ERCP) immediately before and during surgery
After: Check for signs of perforation or infection. Pancreatitis is most
common complication. Check for return gag reflex
Visualize peritoneal cavity and contents with laparoscope
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Double-puncture permits better visualization of abdominal cavity,

Laparoscopy especially liver. Biopsy specimen can be obtained
(peritoneoscopy)
Before: Keep pt NPO 8 hr. Ensure bladder and bowels are empty
After: Check for complications of bleeding and bowel perforation

Liver biopsy Often done with ultrasound or CT guidance

Before: Check pt coagulation status (prothrombin time, clotting or

bleeding time). Pt blood type is crossmatched. Explain need to hold breath
after expiration when needle is inserted. Ensure consent has been signed
After: Vital signs q15min x 2, q30min x 4, q1hr x 4. Keep pt on right side
for minimum of 2 hr to splint puncture site. Keep flat in bed for 12-14 hr.
Complications: bile peritonitis, shock, pneumothorax

Fecal Analysis Before: diet free of red meat for 24-48 hr before occult blood test
During: Check stools for blood