CGRN STUDY GUIDE 2026–2027

Single-use brushes are discarded after each scope. Reusable brushes must be cleaned and high-level disinfected or sterilized after each use. Use brush sizes that fit the channel, and never reuse worn brushes.

Secure them upright in a stand or cart, keep the valve cap on during transport, store them away from heat and flammables, label them as full or empty, and never use oil or grease near oxygen fittings.

In a closed, labeled container or bag, clearly marked as contaminated, and kept separate from clean scopes. They are taken directly to the reprocessing area, avoiding patient and public spaces.

Stored under double lock, counted by two licensed staff at shift change, signed out with a patient-linked record, and wasted with a witness. Discrepancies are reported at once, and diversion warning signs must be reported.

Wear a lead apron and thyroid shield, step back from the source because exposure drops sharply with distance (inverse square law), and use shielding. Hang aprons on racks (do not fold them) and have them inspected regularly for cracks.

Place them in a private room when possible, post clear signs, cohort patients with the same organism if needed, limit transport, and use a mask or cover wounds during transport. Tell the receiving unit of the precautions.

Pad bony areas, keep arms and legs in a neutral position, avoid hanging limbs or pressure on nerves such as the ulnar and peroneal nerves, secure IV lines, use safety straps and check skin afterwards.

They are critical items, so they are cleaned and sterilized, for example by steam, and stored sterile. Single-use accessories are preferred and must never be reprocessed.

Single-use accessories and valves are used once and discarded. They are never cleaned and reused. Reusable valves are reprocessed with the scope following the manufacturer's directions.

In sealed, leak-proof, labeled containers placed in a biohazard bag with a separate pocket for the requisition. Never place paperwork in the bag with the specimen, and keep specimens upright and away from patient areas.

Clean and disinfect them after each patient, use clean linen, cover the patient or wound if needed, and follow isolation precautions for patients on transmission-based precautions.

According to local and facility rules and the SDS. Some disinfectants must be neutralized before they go down a drain, and others are collected as chemical waste. Do not mix chemicals, and label waste containers.

Use enclosed automated reprocessors, lidded basins, local exhaust ventilation and adequate air exchange in the reprocessing room, and carry out air monitoring or exposure badges as the employer's program requires. Staff who develop symptoms should report them.

Recognize early signs of agitation, use de-escalation, keep escape routes open, follow the security call process, report incidents, and never confront an aggressive person alone.

Wipe items such as blood pressure cuffs, pulse oximeter probes, stethoscopes, bed rails, monitors, keyboards and carts with an approved disinfectant, and let them dry.

Contact precautions (and a mask near vomiting), soap and water hand hygiene, prompt cleaning of vomit and stool with a bleach-based disinfectant, and excluding ill staff for at least 48 hours after symptoms stop.

Use curtains and doors, keep voices low, do not leave screens or charts in view, share information only with those who need it, and follow HIPAA policies for photos, specimens and records.

Unused controlled drugs are wasted with a witness and recorded, in the manner the policy describes. Hazardous pharmaceutical waste goes in specially labeled containers, not the sink or regular trash.

With an alcohol-based antiseptic such as chlorhexidine-alcohol, applied with friction and allowed to dry completely before the procedure. A prophylactic antibiotic is given for PEG.

Handle it as little as possible, bag it where it is used, do not shake it or place it on the floor, wear gloves and a gown if there is a risk of soiling, and use leak-proof bags for wet linen.

Use a sporicidal disinfectant (EPA-registered for C. difficile, or a 1:10 bleach solution), clean high-touch surfaces thoroughly, use dedicated equipment and soap-and-water hand hygiene, and observe contact precautions while the patient has diarrhea.

Use sterile water in the bottle and clean tubing, which should be changed or reprocessed according to the manufacturer and at least every 24 hours. Do not top off a bottle that is partly full.

Regulated medical waste (items saturated with blood or other potentially infectious material) goes in red biohazard bags, sharps in sharps containers, pharmaceutical and chemical waste in labeled containers, and general waste in regular trash. Follow local regulations.

Hepatitis B virus can survive on dry surfaces for at least 7 days, and hepatitis C virus for days to weeks. HIV is fragile outside the body. This is why surfaces must be cleaned and disinfected after blood exposure.

Daily or per the facility's schedule: the lock or seal, the defibrillator test, suction and oxygen function, the airway and drug supplies and their expiry dates. All checks are recorded.

With separate dirty and clean zones, one-way flow from contaminated to clean, adequate ventilation, hand hygiene and PPE stations, an eyewash station and separate storage. Clean and soiled equipment must not cross paths.

Hung vertically in a clean, closed, ventilated cabinet, with valves removed and the distal end not touching the floor or other scopes. The maximum hang time before they need reprocessing again follows policy (many allow up to 7 days).

Immediately available where sedation is given, clearly labeled, in a consistent location, and checked for expiry. High-alert drugs are separated, and look-alike or sound-alike drugs are stored apart.

As soon as possible and generally within 1 hour, or as the manufacturer directs. Delays let soil dry and form biofilm, which makes later disinfection less effective.

Gown, mask or respirator, goggles or face shield, then gloves (over the gown cuffs). Perform hand hygiene before starting.

Gloves, goggles or face shield, gown, then mask or respirator last (outside the room for airborne precautions). Perform hand hygiene immediately after removal.

Bacteria such as MRSA, VRE, ESBL producers and CRE that resist several antibiotics. Control includes contact precautions, hand hygiene, environmental cleaning, antibiotic stewardship and screening where the policy requires.

Use a new needle and a new syringe for every injection and every patient, never reuse a syringe even with a new needle, and clean the vial septum with alcohol. Failure to do so has caused hepatitis outbreaks in endoscopy centers.

Before touching a patient, before a clean or aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching the patient's surroundings.

Glutaraldehyde, ortho-phthalaldehyde (OPA) and peracetic acid irritate the eyes, skin and airway, and can cause asthma or skin sensitization. Glutaraldehyde has a ceiling exposure limit of 0.05 ppm. OPA stains skin and mucous membranes gray.

Annual goals to improve patient safety, such as identifying patients correctly, improving staff communication, using medicines safely, using alarms safely, preventing infection, and identifying patient safety risks.

Use grounded three-prong plugs and ground-fault protection, inspect cords and equipment before use, keep fluids away from outlets, never touch equipment with wet hands, and remove and tag defective equipment for biomedical engineering.

Do not exceed the reuse life on the label, label the container with the date opened and expiry, test MEC, and replace the solution if it is cloudy, diluted or past its date.

It standardizes disinfection and rinsing, but manual cleaning must still be done first. The correct connectors must be attached to every channel for each scope model, and the cycle printout must be checked.

CLABSI: hand hygiene, full barrier precautions, chlorhexidine skin prep, best insertion site, and daily review of the need for the line. CAUTI: use catheters only when needed, insert aseptically, keep the system closed, and remove it early.

In the United States, 50 mSv (5 rem) per year to the whole body for workers, and for a declared pregnancy 5 mSv (0.5 rem) to the fetus during gestation, with no more than 0.5 mSv in any month.

RACE: Rescue, Alarm, Contain (close doors), Extinguish or Evacuate. PASS: Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep side to side.

It must be reachable within about 10 seconds, on the same level as the hazard with no obstruction, give a controlled flow for 15 minutes, and be checked regularly (usually weekly). Hold the eyelids open during flushing.

Do not recap used needles, use safety devices, place sharps immediately into a puncture-resistant container, and never fill it more than about three-quarters full. Never pass sharps by hand, and keep the container close to where the sharp is used.

Single-dose vials are used for one patient and discarded. Multi-dose vials are dedicated to one patient when possible and discarded within 28 days of opening. Propofol should be drawn up just before use and discarded within the time on the label (about 6 hours after opening).

Remove all used supplies and linen, dispose of waste, wipe all high-touch surfaces and equipment with an approved disinfectant from clean to dirty areas, allow the wet contact time, and restock before the next patient.

Hand hygiene, PPE based on the risk of exposure, respiratory hygiene and cough etiquette, safe injection practices, sharps safety, safe handling of equipment and linen, and environmental cleaning. They apply to all patients at all times.

A clean room, working suction and oxygen, a functioning scope and light source, the electrosurgical unit and recording system, reversal agents and emergency equipment, supplies for the planned procedure, and a time-out ready to proceed.

Medical clearance, annual fit testing for each user and model, user seal checks every time it is worn, and training. Facial hair that breaks the seal makes the respirator ineffective.

Immerse the scope in fresh enzymatic detergent, brush all accessible channels with the correct-size brush until no debris is seen, flush all channels, clean valves and ports, and wipe the outside. Use new detergent for each scope.

A written exposure control plan reviewed yearly, annual training, free hepatitis B vaccination offered within 10 working days of assignment, free PPE, safer sharps devices, post-exposure evaluation and a sharps injury log.

Labeled containers using standard pictograms, an up-to-date SDS for every chemical, a written program and training for all workers who may be exposed.

Adjust the bed and monitor height, keep the scope controls close to the body, use neutral wrists and a balanced stance, take micro-breaks and rotate tasks, use anti-fatigue mats, and report early pain.

A 16-section document for each hazardous chemical that lists hazards, first aid, spill response, handling, storage, exposure limits and disposal. Staff must be able to find an SDS quickly for every chemical in the unit.

Staff become desensitized to frequent alarms and may miss critical ones. Set alarm limits to fit the patient, check electrodes and probes, respond to every alarm, and follow the facility's policy on alarm management.

A program that ensures antibiotics are used only when needed, at the right dose, for the right duration and with the right choice. Nurses support it by obtaining cultures before antibiotics and questioning unneeded or prolonged therapy.

Practices that keep sterile items and sites free of microorganisms: perform hand hygiene, use sterile gloves and a sterile field, avoid touching sterile items, and discard any item that may be contaminated.

Wipe the insertion tube with a damp cloth or sponge with enzymatic detergent, suction detergent solution through the channels, flush the air/water channel, and detach the scope from the light source, keeping soil from drying.

A process that kills all microorganisms except large numbers of bacterial spores. It is the minimum standard for semi-critical items such as endoscopes.

Testing the disinfectant with a test strip to make sure it is strong enough to disinfect. It is done at the frequency set by the manufacturer and policy (often each day of use) and recorded. A failed test means the solution is discarded.

Use lateral transfer devices, slide sheets, ceiling lifts and gait belts rather than manual lifting, get enough staff, and assess the patient first. NIOSH suggests 35 pounds (16 kg) as the maximum for manual patient handling.

Checks such as microbiologic cultures of scope channels, ATP tests, visual inspection with a borescope, and audits of practice and logs. They help detect failures before patients are harmed.

Prions resist standard disinfection and sterilization. Standard endoscopy has very low risk, but facilities need a policy for patients with known or suspected prion disease, which may include special handling or removing the instruments from service.

Bedside pre-cleaning, transport to the reprocessing room, leak testing, manual cleaning, rinsing, high-level disinfection (manual or automated), final rinse, drying, and storage.

Follow the unit plan, protect sedated and unstable patients, bring emergency medications and portable monitoring if possible, move patients away from danger by the safest means, keep track of every patient and tell the incident commander when the area is clear.

To find holes or damage in the scope's sheath that would let fluid reach internal parts. If the scope fails, do not immerse it, and send it for repair according to policy.

To find system causes of errors, near misses and sentinel events, not to blame individuals. Staff report promptly and honestly in a just-culture setting, and the team reviews and changes the process to prevent a repeat.

A system that sets the level of reprocessing by the risk of the item. Critical items enter sterile tissue and need sterilization. Semi-critical items touch mucous membranes (endoscopes) and need at least high-level disinfection. Non-critical items touch intact skin and need cleaning or low-level disinfection.

The time the surface must stay visibly wet with the product for it to kill the organisms listed on the label. Wiping it dry sooner makes it less effective.

Patient identifier, scope model and serial number, procedure date and time, the person who reprocessed it, the AER or cycle details, and disinfectant test results. This allows tracing if a problem is found.

Repaired and loaner scopes must be inspected and fully reprocessed before they are used on a patient, since they may arrive contaminated or untested.

Outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) linked to ERCP scopes led to FDA safety communications. They showed that following the manufacturer's instructions exactly is essential, and that enhanced reprocessing may be needed.

Nitrile or butyl gloves (latex is not protective), a fluid-resistant gown, eye protection or a face shield, and a respirator if vapors exceed limits or there is no adequate ventilation. Keep containers closed and use only in a well-ventilated area.

Strict hand hygiene, a private room where possible, no sick visitors or staff, avoiding fresh flowers and raw foods per policy, and prompt reporting of fever. An absolute neutrophil count below 500 puts the patient at high risk.

Upper endoscopy and intubation can create aerosols, so staff follow facility policy, usually an N95 respirator, eye protection, a gown and gloves. The patient wears a mask until the procedure and the room is cleaned according to air-change time.

Wash the wound with soap and water or flush the mucous membranes with water, report it immediately, and go for evaluation. Post-exposure prophylaxis for HIV should start as soon as possible, ideally within 2 hours, and the source patient is tested per policy.

That it has been reprocessed and is within its hang time, the insertion tube is free of damage, angulation works, valves are in place, air, water and suction work, and the image and light are clear.

Remove it from use, reprocess it correctly, notify the supervisor and infection prevention team, review which patients were exposed, and follow policy for risk assessment and patient notification and reporting.

Heat (ignition source), fuel and an oxidizer (oxygen). Electrocautery, argon plasma coagulation and lasers are ignition sources, so use the lowest effective settings, keep oxygen flow low, and know the fire response plan.

Sterile water or filtered water (such as 0.2 micron) is preferred. Tap water may contain organisms like Pseudomonas, so if it is used it must be followed by an alcohol flush and thorough drying.

For infections that stay in the air, such as tuberculosis, measles and varicella. Place the patient in an airborne infection isolation (negative pressure) room, and wear a fit-tested N95 respirator. Elective endoscopy is postponed if active TB is suspected.

For organisms spread by touch, such as MRSA, VRE, CRE, C. difficile and scabies. Use a gown and gloves on entering the room, a private room if possible, and dedicated or disinfected equipment.

For infections spread by large respiratory droplets, such as influenza and pertussis. Use a surgical mask within about 2 meters (6 feet) of the patient, and a mask on the patient during transport.

When hands are visibly soiled, after contact with patients with C. difficile or norovirus (alcohol is less effective against spores and norovirus), and after using the toilet. Alcohol rub of 60 to 95% is used otherwise, for about 20 seconds.

At the collar outside the lead apron. A pregnant worker who has declared her pregnancy wears a second badge under the apron at waist level to monitor the fetal dose.

Glutaraldehyde, ortho-phthalaldehyde (OPA) and peracetic acid are common. Contact time depends on the product and temperature (for example, about 12 minutes for OPA at room temperature and 20 minutes or more for glutaraldehyde). Always follow the manufacturer's instructions.

Under the medical device reporting rules, a user facility must report a device-related death to the FDA and the manufacturer within 10 working days, and a serious injury to the manufacturer. Voluntary reports can be made through MedWatch.

Hepatitis B vaccination with a check of anti-HBs (10 mIU/mL or higher), annual influenza vaccine, current COVID-19 and Tdap vaccines, and tuberculosis screening as the employer requires.

The Society of Gastroenterology Nurses and Associates (SGNA), AAMI (ST91), the CDC, ASGE, the FDA and the equipment manufacturers' instructions for use. Local and state regulations also apply.

They have a complex elevator mechanism at the tip that is hard to clean, so organisms can remain after standard HLD. Enhanced measures include extra cleaning, repeated HLD, sterilization with ethylene oxide, surveillance cultures and disposable-end designs.

To remove detergent and debris, which would reduce the effect of the disinfectant. Rinse all channels and the outside with clean water and purge them with air.

Bacteria in poorly prepared bowel produce hydrogen and methane, which can ignite. Use an adequate bowel prep (not mannitol, which is fermented to explosive gas), consider CO2 insufflation, and aspirate gas if the prep is poor.

Reprocessing is a complex procedure with many steps, so staff should be trained, shown to be competent initially and at least annually, and given written procedures that match the manufacturers' instructions for use.

Water systems can grow Legionella and other organisms. A water management program, regular flushing of unused outlets and monitoring reduce the risk, which is especially important for immunocompromised patients.

Moisture lets bacteria grow in the channels. Flush with 70% isopropyl alcohol and then dry with filtered, forced air until the channels are dry.

With cyanoacrylate (glue) injection, or with balloon-occluded retrograde transvenous obliteration (BRTO) or TIPS. Band ligation is less effective for gastric varices.

Schedule them early in the day, give instructions about insulin and oral agents while fasting, check blood glucose before the procedure, and treat low blood sugar quickly.

Follow fasting rules, use suction, position the patient on the left side, keep the head slightly elevated for patients at risk, and use airway protection for high-risk patients. Watch for cough, desaturation and fever afterward.

A rubber band is placed over a varix or hemorrhoid pulled into a cap on the scope, cutting off its blood supply. It is the first-line endoscopic treatment for esophageal variceal bleeding.

The stomach is divided into a small upper pouch that is joined to a limb of jejunum (the Roux limb), and the rest of the stomach and duodenum continue as the biliopancreatic limb. Standard ERCP is difficult because the ampulla is hard to reach.

Ia spurting and Ib oozing bleeding and IIa visible vessel are high-risk and are treated endoscopically. IIb adherent clot may be removed and treated. IIc flat spot and III clean base are low risk and need no endoscopic therapy.

Clean the skin with soap and water daily, keep the site dry, and leave the external bolster about 1 cm loose so the skin is not pressed. After the tract has formed, rotate the tube daily. Report redness, drainage, pain or leakage.

The endoscope shows the stomach lit through the abdominal wall (transillumination) and a finger indents the stomach wall. A needle and guidewire are passed through the skin, and the feeding tube is pulled down through the mouth and out through the abdominal wall. A single dose of prophylactic antibiotic is given beforehand.

It is usually continued, even for high-risk procedures. Other antithrombotics are held or adjusted according to the procedure's bleeding risk and the patient's clotting risk, as directed by the provider.

A drug-induced depression of consciousness in which the patient responds purposefully to verbal commands or light touch, keeps an open airway and breathes adequately without help.

Rectal indomethacin or diclofenac (100 mg) given just before or after ERCP, aggressive hydration with lactated Ringer's solution, and prophylactic pancreatic duct stents in high-risk patients.

Each of three colon segments (right, transverse, left) is scored 0 to 3, for a total of 0 to 9. A score of 2 or more in every segment indicates adequate preparation.

Usually left lateral (Sims) at the start. The position may change to supine or right lateral to help pass the scope, and abdominal pressure may be applied.

Left lateral decubitus, with the head slightly flexed and a bite block in place. Dentures are removed beforehand.

Usually prone or semi-prone, with the head turned to the side. Staff wear lead aprons, thyroid shields and dosimeters, and apply ALARA principles: minimize time, increase distance and use shielding.

Celiac disease: at least 4 biopsies from the distal duodenum plus 1 or 2 from the duodenal bulb. Eosinophilic esophagitis: at least 6 biopsies from at least two levels of the esophagus.

At the bedside or in the room, in the presence of the patient, with two patient identifiers, the source site, the date and the type of specimen. Check the label against the requisition and tell the provider the results of the check.

Billroth I joins the stomach to the duodenum (gastroduodenostomy). Billroth II joins the stomach to the jejunum (gastrojejunostomy) and closes the duodenal stump. Complications include dumping and afferent loop syndrome.

Chromoendoscopy sprays dyes such as indigo carmine or methylene blue to highlight the mucosal pattern. Narrow-band imaging uses filtered light to highlight blood vessels and surface patterns. Both help find and characterize lesions in Barrett's esophagus, IBD and polyps.

Mechanical closure of bleeding vessels, closure of perforations and defects after polypectomy, and anchoring of stents. They close tissue without thermal injury.

Relief of malignant strictures causing dysphagia or obstruction, and sealing of fistulas and leaks. They can migrate, so patients are told to report pain, vomiting or return of symptoms.

I: healthy. II: mild systemic disease. III: severe systemic disease. IV: severe disease that is a constant threat to life. V: moribund and not expected to survive without the procedure. VI: brain-dead organ donor.

Dysphagia, upper GI bleeding, persistent dyspepsia, refractory GERD, iron-deficiency anemia, screening for Barrett's esophagus or varices, foreign body removal and abnormal imaging.

Colorectal cancer screening and polyp surveillance, lower GI bleeding, iron-deficiency anemia, a change in bowel habits, abnormal imaging, and assessment or surveillance of inflammatory bowel disease.

Clear liquids are allowed until 2 hours before, a light meal until 6 hours before, and a fatty meal until 8 hours before. Follow the facility's policy.

Very rapid onset and recovery, deep sedation, and a risk of hypotension and respiratory depression. There is no reversal agent, so it requires a trained provider dedicated to airway monitoring.

Indications: a need for enteral feeding longer than about 4 weeks in patients who cannot swallow safely, such as stroke, neurologic disease or head and neck cancer. Contraindications: uncorrected coagulopathy, no transillumination, ascites, peritonitis and lack of a safe access route.

Place the return electrode (grounding pad) on a clean, dry, muscular area close to the site, remove metal jewelry, check the skin under the pad afterward, keep fluids away from the unit, and know that cut mode and coagulation mode have different effects.

Minimal (anxiolysis), moderate (conscious sedation), deep sedation and general anesthesia. Deeper levels mean less responsiveness, more risk to the airway and breathing, and greater monitoring needs.

Pancreatitis (the most common), bleeding after sphincterotomy, perforation (including retroperitoneal), cholangitis, and sedation-related events.

The control section (angulation dials, suction and air/water valves, working channel port), the insertion tube, the bending section, and the distal tip, which holds the lens, light, air/water nozzle and working channel opening.

Large polyps, thick stalks, anticoagulants and electrocautery. Bleeding can occur immediately or be delayed by up to 2 weeks. Patients should report heavy rectal bleeding or clots.

Perforation, bleeding and aspiration. Chest pain, fever or subcutaneous emphysema after dilation need urgent assessment.

Severe or worsening abdominal or chest pain, fever, tachycardia, a rigid abdomen, subcutaneous emphysema (crepitus), and free air on imaging. Keep the patient NPO, start IV fluids and antibiotics, and notify the provider at once.

Slow or shallow breathing, snoring or airway obstruction, falling oxygen saturation, and unresponsiveness. Stimulate the patient, open the airway with a jaw thrust, give oxygen, support breathing with a bag-valve-mask, and give reversal agents as ordered.

Awake and oriented, stable vital signs, intact protective reflexes, able to sit, pain and nausea controlled, written instructions reviewed, and a responsible adult escort. No driving, alcohol or important decisions for 24 hours.

Hypoxia, hypoventilation, arrhythmias, hypotension and vasovagal reactions. Most are related to sedation and underlying disease, so monitoring and preparedness are essential.

Splenic injury (capsular tear or rupture). It is rare but can cause hypotension and abdominal pain, so notify the provider promptly.

Wire-guided bougies (Savary-Gilliard) and through-the-scope balloon dilators. With bougies, no more than three successive dilators of increasing size should be passed after the first resistance is felt in one session.

Pressing the air/water valve partway delivers air, and pressing it fully flushes water over the lens. The suction valve removes fluid and air through the working channel. The up/down and left/right dials bend the tip.

The rectum, sigmoid colon and part of the descending colon, to about 60 cm. It needs a limited bowel prep, often enemas, and is usually done without deep sedation.

As Low As Reasonably Achievable. Reduce exposure by using the least fluoroscopy time, staying as far from the source as possible, and wearing shielding and a dosimeter.

10% neutral buffered formalin, using about 10 times the volume of the tissue. The container must be tightly closed and labeled.

It irritates the eyes, skin and airway and is a carcinogen. Use gloves, eye protection and ventilation, keep containers sealed, know the location of eyewash stations and the spill plan, and follow the safety data sheet.

Massive colonic dilation without a mechanical blockage, usually in hospitalized or post-operative patients. A cecal diameter over 12 cm raises the risk of perforation. Treatment includes neostigmine (with cardiac monitoring and atropine ready) and colonoscopic decompression.

Non-contact thermal coagulation using ionized argon gas. It is used for superficial bleeding lesions such as angiodysplasia, gastric antral vascular ectasia and tumor bleeding. Gas can distend the bowel, so suction or venting may be needed.

The internal bumper of a PEG moves into the stomach wall because the external bolster is too tight. Signs: the tube cannot be pushed in or rotated, feeds meet resistance, and pain or leakage occurs. Prevent it by leaving slack and rotating the tube.

Direct visualization of the bile duct using a small scope, usually passed through the duodenoscope (for example SpyGlass). It is used for indeterminate strictures and difficult stones.

Injection of sterile ink into the submucosa near a lesion so it can be found later by a surgeon or at follow-up colonoscopy. A saline bleb is created first to confirm the correct layer.

An endoscope with an ultrasound transducer at its tip that images the layers of the GI wall and nearby organs such as the pancreas, bile duct and lymph nodes. It is used for staging cancers and evaluating submucosal and pancreatic lesions.

Endoscopic examination of the small bowel beyond the reach of a standard scope. Push enteroscopy reaches the proximal jejunum, and balloon-assisted (single or double) enteroscopy can reach much of the small bowel. It is used for obscure bleeding, tumors and Crohn's disease.

Endoscopic retrograde cholangiopancreatography. A side-viewing duodenoscope is passed to the ampulla and contrast is injected into the bile and pancreatic ducts under fluoroscopy. Today it is mainly therapeutic.

A needle is passed through the scope under ultrasound view to sample a mass or lymph node. Coagulation status is checked beforehand, and risks include bleeding, infection and pancreatitis.

A topical mineral powder sprayed through a catheter that becomes adherent and forms a barrier over actively bleeding tissue. It is used for diffuse or hard-to-reach bleeding and sometimes as a bridge to other therapy.

Persistent or recurrent bleeding after a normal EGD and colonoscopy. The small bowel is then evaluated, usually first with capsule endoscopy and then with enteroscopy or imaging.

A tunnel is made through the esophageal submucosa and the muscle of the lower esophageal sphincter is cut, treating achalasia. Reflux after the procedure is common and may need a PPI.

Abdominal pain, fever and raised white cells hours to days after electrocautery, caused by a burn through the wall without perforation. It is treated with rest, fluids, antibiotics and observation.

Inflammation of an ileal pouch constructed after colectomy for ulcerative colitis. Symptoms are increased stool frequency, urgency, cramping and sometimes bleeding. Pouchoscopy confirms the diagnosis, and antibiotics such as ciprofloxacin or metronidazole are used.

Thermal destruction of Barrett's esophagus with dysplasia, usually after removing any visible nodules. Common effects are chest pain and sore swallowing, and strictures can develop.

Bending the scope tip back on itself inside the stomach so the examiner can see the cardia and fundus from below. It is skipped or done carefully when there is a risk, such as a large varix or a recent surgical repair.

At least 25% for screening patients aged 45 and older (about 30% in men and 20% in women, in older benchmarks). It measures the quality of the examination.

Cold forceps take a tissue sample by simple pinching. Hot forceps carry an electrical current that coagulates the site while removing the tissue, so they need a return electrode.

To risk-stratify patients with upper GI bleeding using blood urea nitrogen, hemoglobin, blood pressure, pulse and other findings. A score of 0 to 1 identifies patients at very low risk who may be managed as outpatients.

It predicts how difficult the airway may be to manage by how much of the throat is visible with the mouth open. Classes III and IV suggest a higher risk of a difficult airway during sedation.

Resuscitate carefully, give a vasoactive drug such as octreotide, give antibiotic prophylaxis (for example ceftriaxone), and perform band ligation within 12 hours. Balloon tamponade and TIPS are rescue options.

At least 6 minutes after reaching the cecum, because careful inspection during withdrawal improves polyp detection.

To continuously observe the patient's airway, breathing, circulation and responsiveness, to recognize problems early, and to assist with rescue. The nurse should have no other tasks that interrupt monitoring.

Four-quadrant biopsies every 2 cm along the length of the Barrett's segment (every 1 cm if dysplasia is known), plus targeted biopsies of any visible lesions.

It happens with Zenker's diverticulum and blind intubation. Signs include neck pain, crepitus and fever, and it needs urgent evaluation.

Five biopsies: two from the antrum, one from the incisura angularis and two from the body of the stomach. Samples are separated into labeled containers by site.

The lumen that carries suction and accessories such as forceps, snares and needles to the tip. Standard channels are about 2.8 mm wide, and therapeutic scopes have larger channels of about 3.7 mm or more.

The squamocolumnar junction in the lower esophagus, where pale squamous lining meets salmon-pink gastric-type lining. A Z-line above the diaphragmatic pinch may indicate a hiatal hernia or Barrett's esophagus.

Changing the patient's position, applying abdominal pressure, using CO2 insufflation or water exchange, and keeping the scope loops straight. The nurse should watch the patient's face and vital signs for pain.

The gag reflex is lost, so the patient must not eat or drink until it returns (usually 30 to 60 minutes). Benzocaine spray can rarely cause methemoglobinemia, which shows as cyanosis not corrected by oxygen.

Do it only when the indication is strong, preferably in the second trimester, with the lowest effective sedation, left lateral positioning, and fetal assessment as ordered.

Cover the stoma and call the provider at once, because the tract can close within hours. If the tube comes out in the first 4 weeks, the tract is not mature and it must not be reinserted blindly because of the risk of placing it in the peritoneum.

Level of consciousness, heart rhythm, blood pressure (at least every 5 minutes), respiratory rate, oxygen saturation, and end-tidal CO2 (capnography) where available.

A saline-filled balloon is placed in the stomach to promote weight loss. Nausea, vomiting and cramping are common in the first days. The balloon is removed by endoscopy at about 6 months, and it comes with diet and lifestyle support.

Allergies, current medicines (especially anticoagulants, antiplatelets and diabetes medicines), comorbidities, previous sedation or anesthesia problems, time of last oral intake, an escort home, and any implanted devices.

Electrical current may interfere with the device. Use bipolar or short bursts, place the return pad so the current does not cross the chest, monitor the rhythm, and follow the provider's and device clinic's instructions.

Sphincterotomy, stone extraction with balloon or basket, mechanical or laser lithotripsy, biliary or pancreatic stent placement, dilation of strictures and sampling of strictures.

Immediately before the procedure begins (before sedation is started), with the team verifying patient identity, procedure, consent, allergies, equipment and any special needs. It prevents wrong-patient and wrong-procedure errors.

Cold snare polypectomy (no current) is preferred for small polyps under 10 mm. Hot snare (electrocautery) is used for larger or pedunculated polyps, with a lower risk of immediate bleeding in some cases but a higher risk of burn injury.

For PEG placement, for patients with cirrhosis and GI bleeding, for ERCP when the bile duct cannot be fully drained, and for EUS-guided needle biopsy of cystic lesions. It is not routine for most other procedures.

For culture, flow cytometry or special tests, as directed by the laboratory. Fresh specimens go to the laboratory promptly, in saline or the medium specified. Never use formalin for cultures.

Before any sedation is given, while the patient can understand and decide. Consent must be signed and in the chart before the procedure starts.

Urgently, ideally within 6 hours and no later than 24 hours, because the risk of ulceration and perforation rises with time. The airway must be protected.

Within 24 hours after the patient has been resuscitated. For suspected variceal bleeding, endoscopy is done within 12 hours.

Flumazenil reverses benzodiazepines (it may cause seizures in chronic users). Naloxone reverses opioids.

Head tilt-chin lift or jaw thrust, suction, an oral or nasal airway, and bag-valve-mask ventilation. Call for help early.

Oral sodium phosphate preparations, because of the risk of electrolyte shifts and acute phosphate nephropathy. Polyethylene glycol (PEG) solutions are the safer choice.

Heater probes and bipolar (multipolar) probes. They coagulate the vessel by pressing on it and applying heat or current.

Rat-tooth and alligator forceps, snares, Roth nets, baskets, and retrieval overtubes or protective hoods to protect the airway and esophagus.

Midazolam (a benzodiazepine) for sedation and amnesia, combined with fentanyl or meperidine (opioids) for analgesia.

Suction, oxygen, bag-valve-mask, airway adjuncts, a crash cart with defibrillator, and the reversal agents flumazenil and naloxone.

High risk: polypectomy, sphincterotomy, endoscopic mucosal resection, variceal therapy, PEG placement and dilation. Low risk: diagnostic endoscopy with biopsy and biliary stent placement without sphincterotomy.

The appendiceal orifice, the ileocecal valve, and the triradiate (Mercedes-Benz) fold. The terminal ileum may also be entered through the ileocecal valve.

Those with chronic constipation, opioid use, diabetes, neurologic disease, prior poor preparation, or previous colon surgery. They may need extended prep, additional laxatives or a lower-residue diet beforehand.

Endoscopic mucosal resection (EMR) in which the lesion is lifted with a submucosal injection and removed with a snare, often in pieces. Endoscopic submucosal dissection (ESD) removes large lesions en bloc.

Severe or increasing abdominal pain, fever, repeated vomiting, chest pain, difficulty swallowing, black stools or more than a little rectal bleeding, and a rigid, swollen abdomen.

The esophagus, stomach and duodenum (to the second part). The stomach is also viewed in retroflexion to see the cardia and fundus.

Button batteries and magnets (when more than one), sharp or pointed objects, and anything causing airway compromise or complete esophageal obstruction. Esophageal button batteries should be removed as soon as possible, ideally within 2 hours.

To protect the endoscope from the patient's teeth and to protect the patient's teeth and mouth from injury.

Taking half the prep the evening before and half on the morning of the procedure gives better cleansing, especially of the right colon, and improves polyp detection.

Saline, often with methylene blue or indigo carmine dye, lifts the lesion off the muscle layer. This creates a cushion that lowers the risk of perforation and shows the plane of resection.

To protect the airway and esophagus while sharp or large objects are removed or when the scope must pass repeatedly. It also allows easy re-entry of the scope.

It detects hypoventilation and apnea earlier than pulse oximetry, especially when the patient is receiving supplemental oxygen, which can keep saturation normal while breathing slows.

Carbon dioxide is absorbed from the bowel much faster than air, so it causes less bloating and abdominal pain after the procedure, especially after long procedures.

Injection of epinephrine (1:10,000) around a bleeding ulcer causes vasoconstriction and tamponade. It should be combined with a second method, such as clips or thermal therapy, rather than used alone.

Flumazenil and naloxone wear off sooner than many sedatives, so the patient can become sedated again after the reversal effect ends.

Check the balloon water volume weekly with sterile water as instructed, rotate the tube, keep the skin clean and dry, and replace according to the manufacturer. After a replacement, confirm correct placement before feeding.

After an overnight fast, the patient drinks lactose or glucose and breath is sampled at intervals. A rise of 20 parts per million or more over baseline within about 90 minutes suggests lactose intolerance or small intestinal bacterial overgrowth. Smoking, exercise, recent antibiotics and a high-fiber meal the evening before can alter results.

Lactulose traps ammonia in the colon and is titrated to 2 to 3 soft stools a day. Rifaximin, a gut-acting antibiotic, is added to prevent recurrence. Monitor stool output, fluids and electrolytes.

Propranolol, nadolol and carvedilol lower portal pressure and help prevent variceal bleeding. Check pulse and blood pressure before each dose, and hold and report for a very low heart rate, hypotension (for example systolic below 90), or kidney injury.

Right at the start of each meal or snack, swallowed whole and not crushed or chewed. If the patient cannot swallow capsules, the beads can be sprinkled on a small amount of acidic soft food such as applesauce. Dose is based on lipase units and the fat content of the meal.

A barium swallow (esophagram) images the esophageal anatomy and shows strictures, hiatal hernia and achalasia. A modified barium swallow is a video study done with a speech-language pathologist to evaluate oropharyngeal swallowing and aspiration.

A Menghini needle takes the sample by suction (aspiration). A Tru-Cut needle cuts a core of tissue with a notch and sheath mechanism. The needle gauge and technique are chosen by the operator.

It blocks the alpha-4 beta-7 integrin, which keeps inflammatory cells from entering the gut. It is gut-selective with a lower systemic infection risk, and it is given by IV infusion at weeks 0, 2 and 6, then every 8 weeks, or by subcutaneous injection.

The patient lies in the left lateral (Sims) position with knees bent. After explanation, a lubricated finger or anoscope is used to assess sphincter tone, masses, hemorrhoids, blood and fissures.

Fasting for 6 to 8 hours so the gallbladder is full and there is less bowel gas. It shows gallstones, ductal dilation, liver texture and ascites.

Fasting for about 6 hours and withholding drugs that affect motility, such as prokinetics, nitrates, calcium channel blockers and sedatives, as the provider directs. A thin catheter is passed through the nose and the patient takes about 10 small sips of water on request.

Consent is obtained, INR and platelet count are checked (many centers need an INR of about 1.5 or less and platelets of 50,000 or more), anticoagulants are held as directed, the patient is NPO, and vital signs are recorded as a baseline.

Keep the dressing clean and dry, secure the tube, flush as ordered, record the amount and color of bile, and report fever, chills, leakage, bleeding, a dislodged tube or a sudden drop in output.

Test only unformed stool from patients with at least 3 loose stools in 24 hours, using toxin, antigen and PCR tests. Do not repeat the test within a week or as a test of cure. Use contact precautions and wash hands with soap and water.

The patient eats a radiolabeled meal, such as an egg sandwich, and images are taken at 0, 1, 2 and 4 hours. Retention of more than 10% at 4 hours is delayed emptying. Opioids and prokinetics are held, and blood glucose is checked in diabetics.

By X-ray, which is the gold standard before first use. Aspirate pH of 5.5 or less supports gastric placement. Listening for air over the stomach is not reliable.

A band is placed on the hemorrhoid at least 2 cm above the dentate line, where there is no pain sensation. Risks are pain, vasovagal reactions, urinary retention, bleeding as the tissue sloughs 7 to 10 days later, and rarely pelvic sepsis (fever and severe pain need urgent care).

It forms a protective coat on ulcers in an acid environment. It is taken on an empty stomach, and other oral drugs are given at least 2 hours apart because it binds them. It can cause constipation and contains aluminum, a concern in kidney failure.

A baseline breath sample is taken, the patient drinks a solution of labeled urea, and another sample is taken about 15 to 30 minutes later. H. pylori converts urea to labeled CO2, which shows in the second sample.

Put on PPE and follow the facility's spill kit instructions. Absorb a body fluid spill, clean and disinfect with an approved agent, and dispose of it as regulated waste. For a formalin spill, ventilate, use the chemical spill kit, evacuate and call for help if the spill is large, and report it.

Inoculate the fluid into blood culture bottles at the bedside, which raises the chance of growing bacteria in suspected spontaneous bacterial peritonitis. Send other tubes for cell count, albumin and any further tests as ordered.

30 to 60 minutes before the first meal of the day, swallowed whole. Long-term use is linked with low vitamin B12 and magnesium, fractures, C. difficile and other enteric infections, so the lowest effective dose is used.

Percutaneous (the usual route), transjugular (for coagulopathy or ascites, through the hepatic vein), and EUS-guided or laparoscopic approaches. The choice depends on clotting status, ascites and the reason for biopsy.

Mild to moderate ulcerative colitis, by mouth or as rectal suppositories, enemas or foam for distal disease. Sulfasalazine can cause folate deficiency and a sulfa allergy. Kidney function is monitored with mesalamine.

Oral small molecules such as tofacitinib and upadacitinib that block inflammatory signaling in ulcerative colitis. They carry warnings for serious infection, malignancy, cardiovascular events and blood clots, and require lipid checks and vaccination planning, including shingles.

Indications: obscure GI bleeding, suspected small bowel Crohn's disease, tumors and polyposis. Preparation: clear liquids the day before, fasting for 10 to 12 hours, and sometimes a bowel prep and simethicone. The capsule's images are recorded by a data recorder worn for about 8 hours.

Bulk-forming (psyllium), osmotic (polyethylene glycol, lactulose), stimulant (bisacodyl, senna), stool softener (docusate) and secretagogues (linaclotide, lubiprostone). Bulk-forming agents need plenty of fluid, and stimulant laxatives are not for long-term use.

Serious infections, reactivation of tuberculosis and hepatitis B, lymphoma and skin cancer, demyelinating disease and worsening of heart failure. Live vaccines must be avoided during treatment.

Dosing is typically 5 mg/kg at weeks 0, 2 and 6, then every 8 weeks. Infuse over at least 2 hours, check vital signs, give premedication if ordered, and watch for infusion reactions such as fever, chills, rash, dyspnea and hypotension for 1 to 2 hours afterward.

Steroids induce remission in flares but are not used for long-term maintenance because of side effects. Budesonide has high first-pass metabolism, so it causes fewer systemic effects. Tapering is needed, and bone health and infection risk are monitored.

It is hyperosmolar, so aspiration can cause pulmonary edema, and it can draw fluid into the bowel. It is used when a leak or perforation is suspected and sometimes in small bowel obstruction.

Ondansetron can prolong the QT interval. Metoclopramide has a boxed warning for tardive dyskinesia, should be used for no more than 12 weeks and is avoided in bowel obstruction, hemorrhage or perforation. Promethazine causes sedation and is irritating to veins.

They remove gastric contents and air. A Salem sump has a vent (blue pigtail) that must stay open and above the stomach level, and is connected to low intermittent suction. A Levin tube is single-lumen and also uses low intermittent suction.

A radiotracer is injected and its path is followed through the liver, bile ducts and gallbladder. Failure of the gallbladder to fill suggests acute cholecystitis, and a low ejection fraction after CCK (below about 35%) suggests gallbladder dysfunction. The patient fasts for 4 to 6 hours, and opioids can interfere.

Resting and squeeze pressures of the anal sphincters, rectal sensation, and coordination during evacuation. It is used for fecal incontinence, chronic constipation and dyssynergic defecation, and when the rectoanal inhibitory reflex is absent it suggests Hirschsprung disease.

A neutrophil count of 250 per mm3 or more diagnoses spontaneous bacterial peritonitis. A serum-ascites albumin gradient (SAAG) of 1.1 g/dL or more means portal hypertension, such as in cirrhosis.

Pressures and coordination of the esophagus and lower esophageal sphincter during swallows. It diagnoses motility disorders such as achalasia, absent contractility, distal esophageal spasm and ineffective motility, and is done before anti-reflux surgery.

It detects non-acid and gas reflux as well as acid reflux, and measures whether a reflux event goes up the esophagus. It is often done on PPI therapy in patients whose symptoms continue.

Portal pressure measured through a hepatic vein catheter. A normal value is 1 to 5 mmHg, 10 mmHg or more indicates clinically significant portal hypertension, and 12 mmHg or more is linked with variceal bleeding.

Liver stiffness in kilopascals, which estimates fibrosis. The patient fasts for about 3 hours, and ascites or marked obesity can limit accuracy.

A stent placed by interventional radiology between a hepatic vein and the portal vein to lower portal pressure. It treats refractory ascites and recurrent variceal bleeding. The main complications are hepatic encephalopathy and shunt stenosis, and it is avoided in heart failure.

A probe or wireless capsule records esophageal acid exposure for 24 to 96 hours while the patient follows normal activities and keeps a diary of symptoms, meals and position. To test for GERD off treatment, a PPI is stopped about 7 days before.

The patient drinks barium and X-rays follow it through the stomach and small bowel to show ulcers, strictures and Crohn's disease. Afterward the patient should drink fluids, expect pale stools, and report constipation.

Training with sensors and visual feedback to coordinate the abdominal and pelvic floor muscles so the sphincter relaxes during straining. It is the first-line treatment for dyssynergic defecation.

Imaging of the small bowel after the patient drinks a large volume (about 1 to 1.5 liters) of neutral oral contrast, with IV contrast. It shows inflammation, strictures and fistulas in Crohn's disease. Check kidney function and contrast allergy history first.

Magnetic resonance cholangiopancreatography shows the bile and pancreatic ducts without radiation or contrast. Screen for pacemakers, metal implants, claustrophobia and the ability to hold still.

A somatostatin analog that lowers portal pressure and is used in variceal bleeding, and for diarrhea from some tumors. Side effects are bradycardia, high or low blood sugar and gallstones.

A rectal balloon filled with about 50 mL of water is expelled in private. Failure to pass it within about 1 to 2 minutes supports dyssynergic defecation.

Capsule retention behind a stricture, which is more likely in Crohn's disease or previous small bowel surgery. A patency capsule, which dissolves, can test whether a stricture exists before the video capsule is swallowed.

Position the patient on the right side for 1 to 2 hours, take vital signs frequently, and keep the patient on bed rest for 4 to 6 hours. Watch for bleeding, shock, severe pain, right shoulder pain and breathlessness, which can signal bleeding or pneumothorax.

Obtain consent, ask the patient to void, record weight, abdominal girth and vital signs, position the patient semi-recumbent, assist with a sterile procedure, and afterward monitor vital signs, the puncture site for leaking and the patient for hypotension.

Correct patient (two identifiers), correct procedure and site, signed consent, allergies, correct equipment, and lab results such as INR and platelets. All team members stop and agree before the procedure begins.

The airway should be secured by intubation before placement. Keep scissors at the bedside to cut the tube and deflate the balloons immediately if the airway is obstructed. Check balloon pressures, monitor for aspiration and use it only for a short time, usually no more than 24 hours.

TPMT or NUDT15 status before starting, then regular CBC and liver tests because of bone marrow suppression and hepatotoxicity. Benefit takes 2 to 3 months, and long-term use slightly raises lymphoma and skin cancer risk.

No MRI for 30 days. The capsule falls off in about 1 to 2 weeks and passes in the stool. Use the recorder as instructed, press the button for symptoms, and record meals and lying down.

They lower acid output by blocking histamine receptors. They act faster but more weakly than PPIs, and the dose is reduced in kidney impairment. Confusion can occur in older patients.

Do not have an MRI until the capsule has passed. Avoid strong magnets, follow the diet instructions, return the recorder, and report abdominal pain, vomiting or bloating. Passage is confirmed by seeing it in the toilet or by X-ray.

It is given weekly (not daily), folic acid is prescribed, regular blood tests check liver and blood counts, alcohol is avoided, and it must not be used in pregnancy because it causes birth defects.

When perforation or leak is suspected, since barium in the peritoneum or mediastinum causes severe inflammation. A water-soluble contrast agent is used instead. Barium can also worsen obstruction and constipation.

For acute cholecystitis in patients too ill for surgery. A drain is placed through the liver wall into the gallbladder. Care includes drain site care, monitoring output and watching for bile leak and infection.

In bloody diarrhea, suspected C. difficile or infectious colitis, and severe inflammatory colitis, because slowing the bowel can lead to toxic megacolon.

Anti-tumor necrosis factor (anti-TNF) agents. Before starting, patients are screened for tuberculosis (skin or interferon-gamma release assay), hepatitis B, and active infection, and live vaccines are updated.

Ustekinumab blocks IL-12 and IL-23. Risankizumab, mirikizumab and guselkumab block IL-23. They are used in Crohn's disease and ulcerative colitis, often with an IV induction and subcutaneous maintenance.

Fecal elastase (below 200 mcg/g suggests insufficiency, below 100 mcg/g severe) and the 72-hour fecal fat test (over 7 g of fat per day is abnormal), done while the patient eats a high-fat diet.

Removing more than about 5 liters can cause circulatory collapse and kidney injury. Albumin (about 6 to 8 g per liter removed) helps maintain blood volume.

Around 2.5 to 3 mg/dL. Look first at the sclerae, under the tongue and on the skin in natural light.

Grade I: bleed but do not prolapse. Grade II: prolapse and reduce on their own. Grade III: prolapse and need manual reduction. Grade IV: prolapsed and cannot be reduced.

Hepatitis A and E: fecal-oral. Hepatitis B, C and D: blood and body fluids. Hepatitis B and C can become chronic. Vaccines exist for A and B, but not for C.

Crohn's disease can affect any part of the GI tract from mouth to anus, with skip lesions, transmural inflammation, strictures and fistulas. Ulcerative colitis affects only the colon, starts in the rectum, is continuous and mucosal, and causes bloody diarrhea.

HBsAg means current infection. Anti-HBs alone means immunity from vaccination. Anti-HBs with anti-HBc means recovery from natural infection. Anti-HBc IgM suggests acute infection.

Gastric ulcer pain tends to worsen soon after eating. Duodenal ulcer pain often eases with food and returns 2 to 3 hours later or wakes the patient at night.

With direct-acting antiviral tablets for about 8 to 12 weeks. More than 95% of patients are cured, shown by sustained virologic response 12 weeks after treatment.

With validated tools such as the Malnutrition Universal Screening Tool (MUST), Nutritional Risk Screening 2002, or Subjective Global Assessment, together with weight change and intake. Albumin is not a reliable marker of acute nutrition because it is affected by inflammation.

A drop in systolic blood pressure of 20 mmHg or more, or in diastolic pressure of 10 mmHg or more, within 3 minutes of standing.

About 25 cm (10 inches). It is a muscular tube that moves food from the pharynx to the stomach by peristalsis, with an upper and a lower esophageal sphincter.

At least 5 minutes in each quadrant. Normal sounds are irregular clicks and gurgles, about 5 to 30 per minute.

Use plain language and short sentences, avoid jargon, aim for about a 6th-grade reading level, use pictures and large print, and give the most important points first.

Documents such as a living will and a durable power of attorney for health care that state a patient's wishes if they cannot speak for themselves. The Patient Self-Determination Act requires facilities to ask patients about them.

Charcot's triad (acute cholangitis): fever, right upper quadrant pain and jaundice. Reynolds' pentad adds hypotension and altered mental status, and signals severe cholangitis needing urgent drainage.

Arthritis, uveitis, erythema nodosum, pyoderma gangrenosum, aphthous mouth ulcers, and primary sclerosing cholangitis.

Cullen's sign is bruising around the umbilicus. Grey Turner's sign is bruising on the flanks. Both suggest retroperitoneal bleeding, such as in severe acute pancreatitis.

Enlarged submucosal veins of the esophagus caused by portal hypertension in cirrhosis. They can rupture and bleed massively. Prevention uses non-selective beta blockers or endoscopic band ligation.

The islets of Langerhans release insulin (beta cells) and glucagon (alpha cells) to regulate blood glucose.

Amylase digests carbohydrates, lipase digests fats, and proteases (trypsin, chymotrypsin) digest proteins. Bicarbonate neutralizes stomach acid in the duodenum.

A tear in the anal canal causing sharp pain with defecation and a little bright red blood. Treatment is fiber, fluids, sitz baths and a topical nitroglycerin or diltiazem ointment.

General Nursing Care; Gastroenterological Procedures; Patient Care Interventions; and Environmental Safety, Infection Prevention and Control. Prep sites report weights of about 21%, 35%, 25% and 19%, so confirm the current weights in the certification handbook.

Cardia, fundus, body, and pylorus (the antrum plus the pyloric sphincter).

Bile production, metabolism of carbohydrates, fats and proteins, detoxification of drugs and ammonia, synthesis of albumin and clotting factors, and storage of glycogen, vitamins and iron.

Causes: chronic hepatitis B or C, alcohol, and metabolic dysfunction-associated steatotic liver disease. Complications: ascites, esophageal varices, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome and liver cancer.

It absorbs water and electrolytes, forms and stores stool, and houses the gut microbiota.

Cecum, ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon, sigmoid colon, rectum, anal canal.

Timely, accurate, objective, complete and legible entries. Record what you saw and did, not opinions. Label late entries as such and never alter or erase a previous entry.

Early aggressive intravenous fluids, pain control, early oral or enteral nutrition when tolerated, and treatment of the cause (for example, removing an obstructing gallstone).

Recurrent abdominal pain at least 1 day a week in the last 3 months that is linked to two or more of: defecation, a change in stool frequency, or a change in stool form. Symptoms began at least 6 months before diagnosis.

Severe bleeding, toxic megacolon, perforation and colorectal cancer. Long-standing extensive colitis needs regular surveillance colonoscopy.

1: separate hard lumps. 2: lumpy sausage. 3: sausage with cracks. 4: smooth soft snake. 5: soft blobs. 6: fluffy mushy pieces. 7: watery. Types 1 and 2 suggest constipation, 3 and 4 are normal, and 5 to 7 lean toward diarrhea.

Colicky abdominal pain, vomiting, distension, and failure to pass stool or gas. Early bowel sounds may be high-pitched and tinkling, and later they are absent. Care includes NPO status, IV fluids and nasogastric decompression.

Severe abdominal pain, a rigid board-like abdomen, guarding, rebound tenderness, fever, tachycardia and absent bowel sounds. It is a surgical emergency.

Ask a clinical question, search for the best evidence, appraise it, apply it together with clinical expertise and patient preferences, and evaluate the result.

Assessment, Diagnosis, Planning, Implementation, Evaluation (ADPIE).

Duodenum, jejunum, ileum.

Gallstones and heavy alcohol use. Other causes include hypertriglyceridemia, medications and ERCP.

Helicobacter pylori infection and the use of NSAIDs, including aspirin.

Heartburn and regurgitation, often after meals or when lying down. Other signs are chronic cough, hoarseness, throat clearing and dysphagia. Chest pain should always be assessed for cardiac causes.

About 12 to 16 g/dL for women and 14 to 18 g/dL for men. Ranges vary by laboratory, and a bleeding patient's hemoglobin may not fall until fluids equilibrate.

Tissue transglutaminase IgA antibody (tTG-IgA). The patient must still be eating gluten, or the result can be falsely negative.

Hypoactive or absent: ileus, peritonitis, post-operative state, opioids. Hyperactive: gastroenteritis, early bowel obstruction, diarrhea, bleeding in the bowel.

Cholestasis or bile duct obstruction. GGT confirms that a raised ALP comes from the liver and biliary tract.

Hepatocellular injury, such as hepatitis or fatty liver. ALT is more specific to the liver than AST.

Specific, Measurable, Achievable, Relevant, Time-bound. For example, 'the patient will state three signs of bleeding before discharge'.

Intestinal inflammation. A high level suggests inflammatory bowel disease rather than irritable bowel syndrome.

It stimulates parietal cells to secrete hydrochloric acid and increases gastric motility.

Patient or population, Intervention, Comparison, Outcome. It is a format for writing a focused clinical question.

Peritoneal irritation (peritonitis). Pain is worse when the examiner's hand is quickly released than when it is pressed.

It is released from the duodenum in response to acid and stimulates the pancreas to secrete bicarbonate-rich fluid.

Human globin from hidden blood in stool. It needs no dietary restriction and is used for colorectal cancer screening.

Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing.

Recurrent upper abdominal pain, steatorrhea and weight loss from enzyme deficiency, and diabetes. Treatment includes pancreatic enzyme replacement taken with meals.

A diet limited in fiber and foods that leave bulk in the colon, such as whole grains, raw vegetables, nuts and seeds. It is used before some bowel procedures and during flares of conditions such as diverticulitis or strictures.

Failure of the lower esophageal sphincter to relax, with loss of peristalsis. It causes dysphagia to solids and liquids and regurgitation. A barium swallow shows a 'bird's beak'. Treatment is pneumatic dilation, Heller myotomy or peroral endoscopic myotomy (POEM).

A flapping tremor of the outstretched, dorsiflexed hands. It suggests hepatic encephalopathy.

Replacement of the normal squamous lining of the lower esophagus with intestinal-type columnar cells, caused by chronic reflux. It raises the risk of esophageal adenocarcinoma, so patients need surveillance endoscopy.

Dilated veins radiating from the umbilicus across the abdominal wall. It signals portal hypertension.

An autoimmune reaction to gluten (wheat, barley and rye) that damages the villi of the small bowel. Treatment is a strict lifelong gluten-free diet. Dermatitis herpetiformis is its skin form.

Rapid emptying of stomach contents into the small bowel after gastric surgery, causing cramps, sweating, dizziness and diarrhea. Teach small, frequent, low-sugar meals, drinking fluids between meals and lying down after eating.

A chronic, allergen-driven inflammation of the esophagus. It causes dysphagia and food impaction and is diagnosed by biopsy showing at least 15 eosinophils per high-power field. Treatment includes PPIs, topical swallowed steroids and food elimination diets.

An inherited APC gene disorder with hundreds to thousands of colon polyps and a near-certain cancer risk. A prophylactic colectomy is usually advised.

Delayed gastric emptying without a mechanical obstruction, commonly due to diabetes. Management includes small, frequent, low-fat, low-fiber meals, glucose control, and prokinetics such as metoclopramide.

Bright red blood passed from the rectum. It usually comes from the lower GI tract, but a brisk upper GI bleed can also cause it.

Lactase deficiency causes bloating, gas and diarrhea after dairy products. A hydrogen breath test or a trial of lactose avoidance supports the diagnosis.

An inherited mismatch-repair gene disorder (hereditary nonpolyposis colorectal cancer) that raises the risk of colorectal, endometrial and other cancers. Colonoscopy is started early, around age 20 to 25, and repeated every 1 to 2 years.

Black, tarry, foul-smelling stool. It usually means upper GI bleeding, because blood has been digested on its way through the gut.

Fat accumulation in the liver in people with metabolic risk factors such as obesity, diabetes or high lipids, without heavy alcohol use. It was formerly called NAFLD. Weight loss of 7 to 10% improves liver health.

Pain or a stop in breathing when the examiner presses under the right costal margin while the patient inhales. It suggests acute cholecystitis.

The opening in the second part of the duodenum where the common bile duct and the main pancreatic duct enter. The sphincter of Oddi controls flow through it.

Periumbilical pain that moves to the right lower quadrant, with anorexia, nausea and low-grade fever. Keep the patient NPO, give analgesia as ordered, and do not apply heat to the abdomen.

Inspection, auscultation, percussion, palpation. Auscultation comes before percussion and palpation.

Diverticulosis is the presence of colonic pouches, often without symptoms. Diverticulitis is inflammation or infection of the pouches, with left lower quadrant pain, fever and raised white cells.

Hematemesis is vomiting of bright red blood from active, rapid bleeding. Coffee-ground emesis is dark vomit from blood that has been partly digested by stomach acid.

It sits between the ileum and the cecum, controls flow of contents into the colon and limits backflow of colon contents into the small intestine.

It keeps gastric contents from refluxing into the esophagus. It relaxes with swallowing to let food pass into the stomach.

If the gut works, use it. Enteral feeding is preferred because it protects the gut lining and has fewer complications. Parenteral nutrition is used when the gut cannot be used.

Adenomatous polyps are premalignant and are removed. Hyperplastic polyps in the distal colon are usually benign. The surveillance interval depends on the size, number and type found.

Ask the patient to explain in their own words what you taught, such as 'show me how you will take this medicine'. It checks understanding without blaming the patient and is repeated until the information is correct.

Total bilirubin is about 0.1 to 1.2 mg/dL. A high conjugated bilirubin suggests obstruction of bile flow or liver cell dysfunction.

A 14-day course of combination therapy, commonly bismuth quadruple therapy (a PPI, bismuth, tetracycline and metronidazole). Eradication is confirmed with a non-serologic test at least 4 weeks after treatment.

A gastrin-secreting tumor (gastrinoma) that drives extreme acid output. It causes severe, recurrent or multiple ulcers, often with diarrhea. A very high fasting serum gastrin supports the diagnosis.

Raise the head of the bed, avoid lying down for 2 to 3 hours after meals, eat smaller meals, lose weight if overweight, stop smoking, and avoid personal triggers such as fatty food, caffeine, alcohol and chocolate.

Proton pump inhibitors for 2 weeks, and antibiotics and bismuth for 4 weeks, to avoid a false-negative result.

Use a qualified medical interpreter, in person or by phone or video. Do not rely on family members, especially children, to interpret clinical information.

Tachycardia, low blood pressure, orthostatic changes, cool clammy skin, low urine output, weak pulse, anxiety or confusion, and falling hemoglobin.

They may present with vague or atypical symptoms, take many medicines, and are more sensitive to sedatives. They need careful fall and fluid status monitoring and extra time for education.

About 6 to 8 weeks after recovery, to rule out cancer. It is avoided during the acute episode because of the risk of perforation.

At age 45. Options include a colonoscopy every 10 years if normal, an annual FIT, or other tests recommended by guidelines. Earlier or more frequent screening applies to higher-risk patients.

In the terminal ileum. Ileal disease or resection can cause fat malabsorption and B12 deficiency.

Bile is stored and concentrated in the gallbladder. Cholecystokinin (CCK) makes the gallbladder contract and the sphincter of Oddi relax, so bile enters the duodenum to emulsify fats.

In the duodenum and proximal jejunum. Duodenal disease, such as celiac disease, can cause iron deficiency.

One third of the way from the right anterior superior iliac spine to the umbilicus. Tenderness suggests appendicitis.

GI bleeding, unintended weight loss, iron-deficiency anemia, nocturnal symptoms, progressive dysphagia, a family history of colon cancer or IBD, and new symptoms after age 50.

Cholecystokinin (CCK), released from the duodenum when fats and proteins arrive.

Systematic reviews and meta-analyses of randomized controlled trials. Expert opinion and case reports are at the bottom.

Serum ammonia. Treatment aims to lower ammonia production and absorption, for example with lactulose and rifaximin.

Serum lipase (more specific) and amylase, usually more than three times the upper limit of normal, along with typical pain and imaging findings.

Albumin and the INR (prothrombin time). Low albumin and a prolonged INR indicate poor synthetic function in advanced liver disease.

RUQ: liver, gallbladder, head of pancreas. LUQ: stomach, spleen, tail of pancreas. RLQ: cecum, appendix. LLQ: sigmoid colon.

Parietal cells secrete HCl and intrinsic factor. Chief cells secrete pepsinogen. G cells (in the antrum) secrete gastrin. Mucous cells secrete protective mucus.

The provider performing the procedure obtains it. It covers the nature of the procedure, risks, benefits, alternatives, and the right to refuse. The nurse witnesses the signature and verifies that the patient understands and agrees voluntarily.

The dye can look like blood or coat the colon wall and be mistaken for it, which can hide or imitate findings. Clear, light-colored liquids are allowed.

It binds vitamin B12 so that B12 can be absorbed in the terminal ileum. Without it, B12 deficiency and pernicious anemia can develop.

Percussion and palpation can change bowel motility and alter the bowel sounds, so listening first gives a true picture.

Warfarin: vitamin K plus 4-factor prothrombin complex concentrate. Dabigatran: idarucizumab. Factor Xa inhibitors such as rivaroxaban and apixaban: andexanet alfa or prothrombin complex concentrate per protocol. Heparin: protamine.

Assess fall risk, offer help to the toilet frequently, keep the call light and a clear path, use non-slip footwear and bed or chair alarms as needed, and have patients sit up slowly after sedation.

Reduce or avoid lactose-containing products, try lactose-free milk or lactase enzyme tablets, and make sure they get enough calcium and vitamin D from other foods. Many people tolerate small amounts, such as hard cheese and yogurt.

Use a risk scale such as the Braden scale, reposition at least every 2 hours, keep skin clean and dry, manage incontinence, relieve pressure on heels, and make sure nutrition and hydration are adequate.

Class I: under 15% blood loss. Class II: 15 to 30%, with tachycardia. Class III: 30 to 40%, with hypotension and confusion. Class IV: over 40%, with severe shock.

Reorient the patient, keep a regular sleep-wake pattern, provide glasses, hearing aids and mobility, treat pain and dehydration, and avoid drugs from the Beers list, such as benzodiazepines, anticholinergics and meperidine.

An ileostomy usually sits in the right lower abdomen and drains liquid to pasty stool that contains digestive enzymes and irritates skin. A colostomy drains more formed stool, with consistency depending on the part of the colon used.

Choose a consistent time each day, usually 20 to 30 minutes after a meal when the gastrocolic reflex is strongest, give privacy, use a footstool or squatting position, and combine it with fluids, fiber and activity.

Do not induce vomiting or give neutralizing agents. Keep the patient NPO, protect the airway, give IV fluids and pain control, call poison control, and arrange early endoscopy (usually within 12 to 48 hours) to grade the injury.

Flush gently with warm water using a push-pull motion, and a pancreatic enzyme and bicarbonate mixture if ordered. Never force a stylet or wire into the tube. Carbonated drinks and juices are not recommended.

Ask if the person can speak, then give abdominal thrusts (Heimlich maneuver) until the object is expelled or the person becomes unresponsive, at which point CPR begins.

With aPTT or anti-Xa levels at set intervals and dose changes per protocol, along with platelet counts for heparin-induced thrombocytopenia and signs of bleeding. Use a pump and an independent double check for rate and dose.

With N-acetylcysteine, ideally within 8 hours of ingestion. A serum level is plotted on a nomogram at 4 or more hours after a single ingestion to judge the risk of liver injury.

A rapid decline in liver function with an INR of 1.5 or higher and hepatic encephalopathy in a patient with no prior liver disease and illness of less than 26 weeks. Causes include acetaminophen, viral hepatitis and drug reactions.

The CIWA-Ar scale scores symptoms such as tremor, sweating, anxiety, agitation and hallucinations, and drives benzodiazepine dosing. In liver disease, lorazepam or oxazepam is preferred, and thiamine is given before glucose.

Position the patient in the left lateral (Sims) position, lubricate the tube, insert it 7 to 10 cm (3 to 4 inches) gently, with the solution warmed to about 40.5 degrees Celsius (105 degrees Fahrenheit) and the container 30 to 45 cm (12 to 18 inches) above the rectum. Ask the patient to hold the fluid for 5 to 10 minutes if possible.

Gather supplies, remove the old pouch gently, clean the skin with water, dry it, measure the stoma, cut the barrier opening about 3 mm (1/8 inch) larger than the stoma, and apply it firmly. Change it every 3 to 7 days and empty the pouch when it is one-third to one-half full.

Raise the head of the bed to at least 30 to 45 degrees during feeding and for an hour after bolus feeds, verify tube position, use a slow rate for intolerance, and stop the feeding and notify the provider if there is vomiting, distension, coughing or respiratory distress.

West Haven grade 1: mild confusion, sleep changes. Grade 2: lethargy, disorientation, asterixis. Grade 3: somnolence but arousable, marked confusion. Grade 4: coma. Look for triggers such as bleeding, infection, constipation, sedatives and electrolyte problems.

Check glucose (below 70 mg/dL). If alert, give 15 g of fast-acting carbohydrate and recheck in 15 minutes, repeating if needed. If the patient cannot swallow or is NPO, give IV dextrose or IM glucagon as ordered.

Stop sedative infusions, lay the patient flat or raise the legs, give oxygen, give an IV fluid bolus as ordered, recheck vital signs, and give a vasopressor if ordered. Look for other causes such as bleeding or arrhythmia.

Usually the basal insulin is continued at a reduced dose and mealtime insulin is held, with glucose checks every 4 to 6 hours and correction doses per orders. Schedule diabetic patients early and tell the provider about low or high readings.

With symptom control: antiemetics, analgesics, octreotide and corticosteroids to reduce secretions and edema, NG tube or venting gastrostomy for relief, and clear discussion of goals of care. Surgery is only for selected patients.

Start a stimulant plus an osmotic laxative at the same time as the opioid and keep up fluids. Peripherally acting mu-opioid receptor antagonists such as methylnaltrexone and naloxegol are used if laxatives fail, but they are avoided in bowel obstruction.

Use the correct barrier size, avoid leaks, clean with plain water, and use barrier rings, paste or powder as needed. Treat redness, rash or fungal infection promptly, and avoid harsh soaps or too much adhesive remover.

Cholestyramine (separate from other drugs by at least 4 hours) is first-line, followed by rifampin, naltrexone or sertraline. Keep nails short, use cool compresses and moisturizers and avoid hot baths.

Slowly, over at least 60 minutes (no faster than 1 g per hour). Rapid infusion causes flushing, itching and low blood pressure (red man syndrome), which is treated by stopping the infusion and giving an antihistamine.

Open-system formula is generally limited to 8 hours (and powder-reconstituted products to less), while closed prefilled systems may hang for 24 to 48 hours according to the manufacturer. Label bags with the time, and wash hands before handling.

With about 30 mL of water (or as ordered) before and after each feeding and medication and every 4 hours during continuous feeding, with about 15 mL between medications. Give each medicine separately, use liquid forms when possible, and do not crush extended-release products.

Slowly, to about 25 to 30 g a day for adults, with extra fluids. Adding fiber too fast causes gas and bloating, and too little fluid can worsen constipation.

A liquid or soft diet for 24 hours or more, a PPI or sucralfate for post-banding ulcers, avoiding NSAIDs, and reporting black stools, vomiting blood or severe chest pain. Bleeding from banding ulcers can occur 1 to 2 weeks later.

Sit fully upright (90 degrees) for meals and for 30 to 60 minutes afterward, give small bites and sips, supervise meals, use a chin tuck if advised, avoid distraction, and give oral care.

Sorbitol-containing liquid medicines, antibiotics, C. difficile, contaminated or hung-too-long formula, too fast a rate, and cold formula. Look for the cause before stopping feeds, and check hydration.

Drugs with a high risk of serious harm if misused, such as insulin, opioids, heparin and other anticoagulants, concentrated potassium and procedural sedatives. Use independent double checks, smart pumps and standard concentrations.

Call for help and an AED, start chest compressions at 100 to 120 per minute and at least 5 cm (2 inches) deep, allow full recoil, and give 30 compressions to 2 breaths. Use the AED as soon as it arrives and keep interruptions short.

Lower risk of ulcers, reflux, GI and other cancers, and Crohn's flares and complications. Offer counseling, nicotine replacement and other medicines, and support at every visit.

Catheter-related bloodstream infection, hyperglycemia, refeeding syndrome, liver injury, fluid overload, line occlusion, air embolism and pneumothorax at insertion. Fever or chills in a PN patient need urgent evaluation.

Adequate calories and protein (about 1.2 to 1.5 g/kg a day, with no protein restriction for encephalopathy), a late-evening snack, sodium restriction of about 2 g a day if ascites is present, no alcohol, and no raw shellfish.

Normal saline (0.9% sodium chloride) is isotonic and can cause hyperchloremic acidosis in large volumes. Lactated Ringer's contains potassium, calcium and lactate and is a balanced fluid. Dextrose solutions provide calories and free water.

Verbal and written instructions in plain language, teach-back, an updated medication list, warning signs to report, diet and activity limits, follow-up appointments and pending results, and a number to call. Include the escort or caregiver.

Severe abdominal pain out of proportion to the physical findings, often in older patients with atrial fibrillation or vascular disease, with vomiting, bloody stool and a rising lactate. It needs urgent CT angiography and surgical or vascular treatment.

Projectile non-bilious vomiting in an infant of 2 to 8 weeks who is hungry after vomiting, with an olive-shaped mass in the abdomen. Labs show low chloride and potassium with metabolic alkalosis. Fluid correction precedes surgery.

Sudden crampy abdominal pain and bloody diarrhea, usually in older patients with low blood flow, and often in the watershed areas such as the splenic flexure and rectosigmoid. Most cases settle with fluids and bowel rest.

Secure the airway if needed, place two large-bore IV lines, send type and screen or crossmatch, draw labs, give crystalloid and blood as ordered, give oxygen, monitor vital signs and urine output, and keep the patient NPO. A restrictive transfusion target of hemoglobin 7 g/dL is common (8 for heart disease).

Weight-based dosing, a smaller airway, higher risk of rapid desaturation, appropriately sized equipment, parental presence for comfort, fasting rules and monitoring by staff trained in pediatric resuscitation.

Blood glucose every 6 hours at first, daily weights, fluid intake and output, electrolytes, magnesium, phosphate, liver tests and triglycerides. Do not stop PN suddenly, because rebound hypoglycemia can occur, so taper or hang 10% dextrose if it must be stopped.

Take immunosuppressants such as tacrolimus exactly on time with level monitoring and avoid grapefruit, prevent infection, avoid sick contacts, and report fever, jaundice, pain over the graft, dark urine, or rising liver tests, which may signal rejection or infection.

Early mobilization, early oral feeding, multimodal pain control with fewer opioids, avoiding fluid overload, and removing drains and catheters early. Watch for ileus and anastomotic leak (fever, tachycardia and abdominal pain around days 3 to 7).

Measure lactate, take blood cultures before antibiotics, give broad-spectrum antibiotics, give about 30 mL/kg of IV crystalloid for hypotension or a high lactate, and start vasopressors if hypotension persists, aiming for a mean arterial pressure of 65 mmHg or more.

Verify the order, consent and product with a second nurse at the bedside, use a filtered set with saline only, take baseline vital signs, start slowly (about 2 mL/min for 15 minutes), recheck vital signs, and complete within 4 hours.

Small, frequent meals, oral rehydration solutions, vitamin and mineral replacement (including B12 if the ileum is removed), antidiarrheals as ordered, and parenteral nutrition or intestinal growth factors such as teduglutide when needed.

Pancreatic fistula, delayed gastric emptying, bleeding, infection, and anastomotic leaks. Patients may develop diabetes and need pancreatic enzyme replacement.

Right patient, drug, dose, route and time are the core five. Others include right documentation, reason, response and the patient's right to refuse. Use two identifiers and check allergies every time.

Dehydration and loss of sodium, potassium and magnesium when output exceeds about 1,000 to 1,500 mL a day. Teach oral rehydration solutions, salty foods, antimotility drugs as ordered, and to report dizziness, thirst or low urine output.

Verify the order, patient and compatibility, dilute and give at the recommended rate, flush before and after, and watch the patient's response. Do not give medicines you cannot identify, and know that some drugs, such as concentrated potassium, must never be given by IV push.

Never give by IV push. Peripheral infusions are limited to about 10 mEq per hour, and higher rates need a central line with cardiac monitoring. Check kidney function, dilute properly, and watch the IV site.

Use a dedicated lumen, do not give blood, medicines or other infusions through it, use aseptic technique, a pump and an in-line filter as ordered, and change tubing about every 24 hours or per policy. This lowers the risk of line infection.

Fever, abdominal pain or tenderness, worsening ascites, confusion or kidney injury in a patient with cirrhosis. Treatment is IV antibiotics such as ceftriaxone plus albumin, and prophylaxis may follow.

Thirst, dry mucous membranes, poor skin turgor, tachycardia, low blood pressure, orthostatic changes, low urine output and concentrated urine, and in severe cases confusion.

Nausea, vomiting, abdominal pain or distension, diarrhea, and a hard abdomen. Slow or pause the feeding, check tube position, review medicines, and tell the provider.

Rectal pressure, abdominal pain, and liquid stool leaking around hard stool (overflow diarrhea). It is treated with an oil-retention enema or suppository, then manual disimpaction if ordered, followed by a bowel regimen.

Sudden severe colicky pain with the child drawing up the legs, vomiting, 'currant jelly' stool, and a sausage-shaped abdominal mass, most often at 6 months to 3 years. Air or contrast enema often reduces it.

Abdominal distension and pain, fever, tachycardia, hypotension and a dilated colon (over 6 cm) on imaging, usually in severe colitis. Treatment is NPO, IV fluids, steroids and antibiotics, with urgent surgical consultation.

Avoid IM injections and rectal temperatures, use a soft toothbrush and electric razor, apply pressure for longer after needle sticks, prevent falls, and report bruising, nosebleeds, black stools or vomiting blood.

Osmolarity and dextrose concentration. Solutions above about 900 mOsm/L or more than 10% dextrose are too irritating for peripheral veins and need a central line. Short-term lower-concentration PN may be given peripherally.

During flares or with strictures, a low-residue diet and small meals help. Keep up fluids and watch for deficiencies of iron, vitamin B12, vitamin D, calcium and folate. No single diet cures IBD, so work with a dietitian.

Foods and drinks are modified in texture, for example puree, minced and moist, or soft and bite-sized, and drinks are thickened to prescribed levels. The speech-language pathologist sets the level after a swallow evaluation.

Pink to red, moist and slightly raised, with swelling that settles over about 6 to 8 weeks. A dusky, purple or black stoma suggests poor blood supply and a pale stoma suggests anemia. Report these, and any bleeding, retraction or mucocutaneous separation.

Situation, Background, Assessment, Recommendation. It is a structured way to report a patient's change in condition clearly to a provider.

Avoid raw or undercooked meat, eggs and seafood, unpasteurized milk, juice and soft cheeses, and raw sprouts. Wash hands and produce, keep raw and cooked foods apart, and refrigerate leftovers quickly.

Broth, gelatin, clear juices without pulp, tea or coffee without cream, ice pops and sports drinks. It leaves little residue in the bowel but gives few calories, protein or nutrients, so it is used for only a short time.

All clear liquids plus milk, cream soups, ice cream, pudding and strained juices. It is used as a step between clear liquids and solid food, and is also given to some patients with chewing problems.

A sudden slow heart rate, low blood pressure, pallor, sweating or fainting triggered by stretching of the bowel or pain. Stop or reduce the stimulus, raise the legs, give fluids and oxygen, and give atropine if ordered for a severe slow rate.

A scoring system based on vital signs and level of consciousness, such as a modified early warning score. Rising scores trigger more frequent monitoring and escalation to catch deterioration early.

A full-thickness rupture of the esophagus after forceful vomiting, causing severe chest or upper abdominal pain, vomiting and subcutaneous emphysema. It is a surgical emergency requiring NPO, IV antibiotics and urgent repair or stenting.

A blockage at the pylorus or duodenum from ulcer scarring or tumor, causing vomiting of undigested food and a succussion splash. Care includes NPO, NG decompression, IV fluids, correcting low potassium and chloride with metabolic alkalosis, and endoscopic or surgical relief.

Kidney failure in advanced cirrhosis with ascites caused by severe changes in blood flow. Diuretics and nephrotoxins are stopped, albumin and vasoconstrictors such as terlipressin or norepinephrine are given, and liver transplant evaluation is considered.

A congenital absence of ganglion cells in the distal bowel causing delayed passage of meconium (over 48 hours), constipation, distension and ribbon-like stools. Enterocolitis is a danger, and treatment is surgery after rectal biopsy confirms it.

Severe nausea and vomiting in pregnancy with weight loss of over 5%, dehydration and electrolyte problems. Treatment includes IV fluids, thiamine, antiemetics and small frequent meals.

Intense itching, especially of the palms and soles, in the third trimester with raised bile acids. It raises the risk of preterm birth and stillbirth, so it needs close monitoring, ursodiol and planned delivery.

Sudden closure of the vocal cords causing stridor and no air movement. Stop the stimulus, give 100% oxygen with a jaw thrust and positive pressure ventilation, call for help, and be ready to give a rescue drug such as succinylcholine under the provider's orders.

Temporary paralysis of bowel motility after surgery, causing nausea, distension and no flatus. Management includes ambulation, minimizing opioids, correcting electrolytes, and NPO with NG decompression if severe. Alvimopan may be used after bowel resection.

A dangerous shift of phosphate, potassium and magnesium into cells when nutrition is restarted in a malnourished patient, causing heart, breathing and neurologic problems. Start nutrition slowly, give thiamine, and replace and monitor electrolytes.

Twisting of the sigmoid colon around its mesentery, causing obstruction with a large, distended abdomen. A 'coffee bean' sign appears on X-ray. Endoscopic detorsion is tried first, and surgery is needed if it recurs or the bowel is ischemic.

A balanced mix of sodium and glucose (the WHO low-osmolarity formula) that uses sodium-glucose co-transport to absorb water in the gut. It replaces fluid and electrolytes in diarrhea and is better than plain water or sports drinks.

A high-fiber diet with plenty of fluids. Nuts, seeds and popcorn do not need to be avoided. During an acute attack, a clear liquid or low-residue diet may be used briefly.

In acute pancreatitis, oral or enteral feeding is started early as tolerated, with small low-fat meals. In chronic pancreatitis, a low-fat diet, small frequent meals, no alcohol and enzyme replacement with meals are used.

Stay with the patient, cover the exposed bowel with a sterile dressing moistened with sterile saline, place the patient in low Fowler's position with knees bent, keep the patient NPO, and notify the surgeon immediately.

Intramuscular epinephrine, 0.3 to 0.5 mg of a 1 mg/mL solution (1:1000) into the outer thigh in adults, followed by oxygen, IV fluids, positioning and calling the emergency team. Antihistamines and steroids are second-line.

A diet that limits fermentable carbohydrates that can cause gas and pain in irritable bowel syndrome. It has three phases: elimination (about 2 to 6 weeks), reintroduction of food groups one at a time, and a personalized long-term diet. A dietitian should guide it.

Monitor for leak (tachycardia over 120, fever, abdominal or shoulder pain), give early ambulation and DVT prophylaxis, advance from sips to purees slowly, and teach lifelong vitamin and mineral supplements such as B12, iron, calcium and vitamin D.

Pain control, sitz baths, stool softeners and fiber, fluids, and watching for urinary retention and bleeding. The first bowel movement is often feared, so reassure and teach the patient not to strain.

Keep the patient NPO, give IV fluids, monitor vital signs and pain, avoid heat and laxatives, give pain medicine as ordered because it does not mask the diagnosis, prepare for imaging and surgery, and report guarding, rigidity or worsening pain.

Daily weights, abdominal girth, intake and output, sodium restriction of about 2 g a day, diuretics as ordered, fluid restriction only if sodium is very low (below 125), skin care, and positioning for comfort. Report fever and pain.

Protect the airway by positioning the patient on the side and suctioning, give oxygen, place two large-bore IV lines, send type and crossmatch, start fluids and blood as ordered, call the provider and endoscopy team, and prepare for intubation.

A thiamine-deficiency emergency, often in alcohol use disorder or malnutrition, with confusion, unsteady gait and eye movement problems. Give IV thiamine before or with glucose-containing fluids.

Regular meals, adequate sleep, regular exercise, stress management, cognitive behavioral therapy or gut-directed hypnotherapy, a symptom diary, and a dietitian-led trial of a low-FODMAP diet if appropriate.

Give antiemetics before symptoms get severe, offer small sips of clear fluids, keep the room cool and free of strong smells, avoid triggers, and give oral care. Watch for dehydration and electrolyte problems.

Avoid NSAIDs, limit acetaminophen to no more than 2 g a day, avoid sedatives and herbal supplements without checking, and take diuretics and lactulose as prescribed.

Comfortable positioning, relaxation and breathing, distraction, a calm environment and, when the cause is known and safe, a warm compress. Heat is avoided when the cause is unknown or inflammation or bleeding is suspected.

Skin care with gentle cleansing and barrier cream, a scheduled toileting plan, a bowel regimen to control stool consistency, pelvic floor exercises, dignity and privacy, and checking for impaction.

Pain scores, fluid balance, vital signs, oxygen saturation, glucose and calcium. Low calcium can cause tingling and spasms (Chvostek and Trousseau signs), and the abdomen should be reassessed for infection or bleeding.

Incentive spirometry about 10 times an hour while awake, coughing and deep breathing, early ambulation, sequential compression devices, and prophylactic anticoagulants as ordered.

Nasogastric or nasoenteric tubes for short-term use, and gastrostomy (PEG) or jejunostomy tubes for long-term use (more than about 4 weeks). Post-pyloric feeding may be chosen for patients at high risk for aspiration.

Use a closed system, double chemotherapy gloves and a gown, avoid contact with body fluids for 48 hours after treatment, and dispose of waste in hazardous waste containers. Patients with a very low neutrophil count need neutropenic precautions.

Start low in older and opioid-naive patients, monitor sedation and respiratory rate, have naloxone available, avoid combining with other sedatives, and avoid meperidine in older adults and kidney disease because its metabolite can cause seizures and confusion.

A positive stool test is not a diagnosis, but it must be followed by a colonoscopy to look for polyps or cancer. Delays in follow-up colonoscopy reduce the benefit of screening, so the nurse should help arrange it.

Shoulder pain from carbon dioxide is common and settles in a day or two. Start with light, low-fat food, ambulate, and report fever, jaundice, severe or increasing abdominal pain, or vomiting, which may signal bile leak or retained stones.

Evidence supports only some uses, and benefits depend on the strain. They should be used with caution in people with severe immune suppression, central lines or severe acute pancreatitis because of rare infections.

The patient's name, order, contents and expiration date, as verified by two nurses. Look for cloudiness, particles or separation (oiling out) of the lipid emulsion. Do not use a bag with these changes. Let the bag reach room temperature as directed.

Stop the transfusion, keep the IV open with normal saline using new tubing, check vital signs, notify the provider and blood bank, send the bag and tubing back with samples, and treat symptoms as ordered.

Hands-on pouch care practice, referral to a wound, ostomy and continence (WOC) nurse, discussion of body image, sexuality and clothing, and information about peer support groups and supplies.

Avoid wheat, barley and rye in all forms, read labels, watch for hidden gluten in sauces, soups and medicines, prevent cross-contamination in the kitchen, and know that 'gluten-free' foods in the United States contain under 20 parts per million. A dietitian and follow-up testing are essential.

Temporary trouble swallowing is common, so progress the diet slowly. The patient will not be able to belch or vomit easily, may feel gas-bloat, and should avoid carbonated drinks and heavy lifting as directed.

It can make stools dark and cause constipation or stomach upset. It is best absorbed on an empty stomach with vitamin C, apart from antacids, PPIs, tea, coffee and calcium. Every-other-day dosing improves absorption and tolerance.

For sudden changes such as a drop in blood pressure, heart rate or respiratory rate beyond set limits, new confusion, low oxygen saturation, chest pain, or a nurse's strong concern that the patient is getting worse. The nurse does not need to wait for a score.

When the gut works but the patient cannot eat enough by mouth, for example with dysphagia, neurologic disease, head and neck cancer or critical illness. It is preferred to parenteral nutrition.

When the GI tract cannot be used safely for long enough, such as with obstruction, severe ileus, short bowel syndrome, a high-output fistula or severe malabsorption. It gives nutrients directly into a vein.

Diarrhea causes loss of bicarbonate and potassium, leading to metabolic acidosis. Vomiting or nasogastric suction causes loss of hydrochloric acid, leading to metabolic alkalosis, with low potassium and chloride.

Metronidazole raises the INR in patients on warfarin. Omeprazole and esomeprazole may reduce the effect of clopidogrel. Sucralfate, antacids and iron reduce absorption of other drugs, so doses are separated.

Stringy or fibrous foods such as celery, popcorn, nuts, corn, mushrooms and fruit skins can cause blockage, so chew well. Beans, cabbage, onions and fish can cause gas and odor. Patients can try foods one at a time.

Hepatitis A and hepatitis B (if not immune), pneumococcal, influenza, COVID-19 and tetanus-diphtheria-pertussis. Live vaccines are avoided in people on immunosuppressants.

It is hyperoncotic and draws fluid into the bloodstream, which expands blood volume. It is used in large-volume paracentesis, spontaneous bacterial peritonitis and hepatorenal syndrome. Monitor for fluid overload.

To compare everything the patient takes (prescription, over-the-counter and herbal) with the new orders, find omissions, duplications and interactions, and make sure the patient leaves with one accurate list. It reduces medication errors at transitions of care.

A WOC nurse marks a site on the rectus muscle that the patient can see and reach while sitting, standing and lying, away from folds, scars and the belt line. A well-placed stoma helps the pouch seal and prevents leaks.