What is ERCP?
ERCP is a procedure that allows the physician to diagnose and treat problems on the liver, gall bladder, bile ducts and pancreas.
The procedure combines Upper GI endoscopy and X-rays.
Indications:
ERCP is used when it is suspected that a person's bile or pancreatic ducts may be narrowed or blocked due to tumors/gallstones/inflammation due to trauma or illness/infection/valves in the ducts, that do not open properly.
Complications:Infections/Pancreatitis/Excessive bleeding called hemorrhage/Puncture of the GI tract or ducts/Tissue damage from radiation exposure.
Patients who experience any of the following symptoms after ERCP, should contact their physician immediately:Difficulty in swallowing/Throat, chest or abdominal pain that worsens/Vomiting/Bloody or dark stool/Fever
Nurse's Interventions:
Preprocedure Care:Advise NPO for eight hours prior to the procedure. Smoking and chewing gums are also prohibited during this time. Assess for any allergies and comorbidities like diabetes, heart and lung problems. Obtain information about all the regular medications of the patient and discuss with the physician regarding withholding of any medication if needed (blood thinning medication). Administer sedation before the procedure as prescribed.
Postprocedure Care: After the procedure, the patient is shifted to recovery room for observation. Monitor vital signs and the return of gag reflex. Monitor for signs of perforation or peritonitis. Instruct not to drive or operate machinery for 24 hrs. Advise to report to the hospital immediately if any sign of complications occur.
What is UGE?
Upper Gastrointestinal Endoscopy: This is a procedure that is used to visualize the interior of the esophagus, the stomach and the first part of the small intestine (duodenum).
Indications: Gastritis, Gastroesophageal reflux diseases, Stricture of esophagus, Esophageal varices, Barrett's esophagus, Hiatus hernia, Ulcers, Hematemesis, Suspected upper GI cancers, Collect tissue samples, To remove gastrointestinal polyps, Removal of foreign objects that have been swallowed, Treatment of hematemesis and esophageal varices.
Complications:Risk of puncturing esophagus, stomach, or duodenum, Risk of infection after an endoscopy, Bleeding from after a tissue biopsy, Aspiration pneumonia, Arrhythmia
Nurse's Interventions:
Preprocedure Care: Advise NPO (Nil Per Oral) for 6-12hrs before the test. Administer a local anesthetic (spray or gargle) that provides local anesthesia. In some patients, administer IV Midazolam as prescribed to relieve anxiety just before the procedure. Administer atropine sulfate to reduce secretions as prescribed. The patient is positioned on the left side to facilitate saliva drainage and provide easy access of the endoscopy. Airway patency is monitored during the test and pulse oximetry is used to monitor oxygen saturation, emergency equipment should be readily available. Patients who are taking blood-thinning drugs are advised to stop taking them a few days before surgery.
Postprocedure Care: The patient must be kept NPO until the gag reflex returns (1-2hrs). Monitor for signs of perforation (pain, bleeding, unusual difficulty in swallowing, elevated temperature). Advise bed rest for the sedated patient until alert.
Terminology:
Gastritis- It is the inflammation, irritation or erosion of the lining (mucosa) of the stomach. It can occur suddenly (acute) or gradually (chronic).
Urea Breath Test:
This is a rapid diagnostic test to detect the presence of Helicobacter pylori. This test is based upon the ability of Helicobacter Pylori to convert urea to ammonia to carbon-di-oxide
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