DIAGNOSTIC TESTS I.

LABORATORY TESTS Laboratory tests for GI disorders include stool testing for blood (Hemoccult), other stool tests, and a variety of blood tests, such as hematocrit and hemoglobin for monitoring GI bleeding. A. Hemoccult Guaiac Tests (Hemoccult) Commercially available guaiac-impregnated slides or wipes present a simple, inexpensive, and aesthetically acceptable method of testing feces for blood. Nursing and Patient Care Considerations Advise patient as to the test preparation procedure. For 3 days before the test and during the stool collection period: Diet should have a high-fiber content. Avoid red meat in the diet. Avoid foods with a high peroxidase content, such as turnips, cauliflower, broccoli, horseradish, and melon. Avoid iron preparations, iodides, bromides, aspirin, NSAIDs, or vitamin C supplements greater than 250 mg/day. Avoid enemas or laxatives before the stool specimen collection. NURSING ALERT Certain protocols may specify to avoid aspirin and NSAIDs for at least 1 week before Hemoccult testing to prevent bleeding. Vitamin C (ascorbic acid) can cause a false-negative reading. Procedure A wooden applicator is used to apply a stool specimen to the slide, or a special wipe is used and placed in the packet. Three stool samples are taken because of the possibility of intermittent bleeding and false-negative results. Slides (or wipes) applied inside a packet can be brought or mailed to the health care provider or laboratory. When hydrogen peroxide (denatured alcohol-stabilizing mixture) is added to samples, any blood cells present liberate their hemoglobin, and a bluish ring appears on the electrophoretic paper. Read precisely at 30 seconds. A single positive test is an indication for further diagnostic evaluation for GI lesions. Falsepositive results occur in about 10% of tests. Test may become false-negative in 10% of specimens tested 4 or more days after streaking on paper. Community and Home Care Considerations Nonadherence to the diet/medication restrictions can cause false-positive or false-negative

readings. The stool must not be contaminated with urine or toilet tissue. The stool guaiac specimen packets do not require refrigeration. Stool specimen packets should be submitted for laboratory testing within 6 days. B. Stool Specimen The stool is examined for its amount, consistency, and color. Normal color varies from light to dark brown, but various foods and medications may affect stool color. Special tests may be made for fecal urobilinogen, fat nitrogen, food residue, and other substances. Fecal leukocytes are tested by Wrights stain, and stool cultures are obtained to identify bacteria, virus, or ova and parasites. Nursing and Patient Care Considerations Use a tongue blade to place a small amount of stool in a disposable waxed container. Save a sample of fecal material if unusual in appearance, contains worms or blood, blood streaked, unusual color, or excess mucus; show to health care provider. Specimens for parasitology must be collected in vials containing special preservatives. For accurate specimen results, the vials must be sent to the laboratory as soon as possible. The vials should be refrigerated if unable to submit quickly to the laboratory. Send specimens to be examined for parasites to the laboratory immediately so the parasites may be observed under microscope while viable, fresh, and warm. Test for occult blood or to confirm grossly visible melena or bloodHemoccult guaiac test. Consider that barium, bismuth, mineral oil, and antibiotics may alter the results. C. Hydrogen Breath Test The hydrogen breath test is used to evaluate carbohydrate absorption. A radioactive substance is ingested, and, after a certain time period, exhaled gases are measured. The test measures the amount of hydrogen produced in the colon, absorbed in the blood, and then exhaled in the breath. This test is used as a diagnostic test for short bowel syndrome, lactose intolerance, and bacterial overgrowth of the intestine (blind loop syndrome, Crohns disease, distal ileal disease). Nursing and Patient Care Considerations The patient should be nothing-by-mouth (NPO) for 12 hours before the procedure. The patient should not smoke after midnight before the test. Antibiotics and laxative/enemas should not be used for 1 week before the test. These

products may alter the laboratory results. Appropriate diet instructions should be given before discharge if the test is positive. D. Helicobacter pylori Testing Laboratory tests for H. pylori include a serum immunoglobulin G antibody test and an H. pylori breath test. A positive antibody test may not differentiate between active and inactive disease. A negative test can be interpreted to mean no antibodies or antibodies present at a lower level than detectable. Nursing and Patient Care Considerations Symptomatic patients and patients with an active or past history of ulcer disease should be tested for H. pylori. Endoscopy may be necessary for patients with symptoms of weight loss, anemia, occult blood loss, and patients older than age 50. It is recommended that negative H. pylori test results in a patient with ulcer-related complications be confirmed by a second test. Contact laboratory for the type of serologic test being performed for H. pylori and the appropriate tube for blood. Due to the potential for false-negative H. pylori breath test, preparation includes stopping treatment 2 weeks before testing. False-positive results from H. pylori breath testing may be caused by achlorhydria or urease production associated with other GI disorders.