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Lecture Notes

Bowel Elimination 

  1. Anatomy of the large intestine
    1. extends from the ileocecal valve to the anus
    2. 125 to 150 centimeters (50 - 60 inches) long
    3. divided into seven parts:
      1. cecum
      2. ascending colon
      3. transverse colon
      4. descending colon
      5. sigmoid colon
      6. rectum
      7. anus
        1. bound by two anal spinchters
          1. internal (involuntary control)
          2. external (voluntary control)
    4. functions
      1. absorb water and nutrients from the chyme
        1. 1500 milliliters of chyme per day pass through the large intestine
        2. all but 100 milliliters of water is reaborbed from the 1500 milliliters of chyme that pass through the large intestine per day
      2. secrete mucus into the large intestine
        1. protect the large intestine from bacterial activity
        2. act as an adherent for the feces
      3. eliminate the products of digestion
        1. flatus
        2. feces
    5. three types of large intestine movments
      1. haustral churning
        1. back and forth movement in the haustra that helps mix the chyme
      2. peristalsis
        1. wave like movement that propels the chyme forward
      3. mass peristalsis
        1. wave of powerful muscular contraction over large areas of the large intestine
  2. Process of fecal elimination
    1. expulsion of feces from the rectum and anus
      1. feces enters the rectum
      2. stimulates a signal that initiates peristaltic waves in the descending and sigmoid colon and the rectum
      3. peristaltic waves force feces into the anus
      4. as the peristaltic waves approach the anus, the internal spinchter is inhibited from closing (opened involuntarily)
      5. individual senses need to defecate and finds a toilet
      6. the individual relaxes the external anal spinchter (opened voluntarily)
      7. defecation occurs
  3. Factors influencing fecal elimination
    1. age and development
      1. children
        1. desire to control daytime fecal elimination occurs when a child becomes aware of the following (usually around two 1/2 years old):
          1. discomfort of soiled diaper
          2. sensation that indicates need for elimination of feces
        2. nurses can become involved in a child’s bowel training in the following ways:
          1. continuing the bowel training program established at home while the child is in the hospital
          2. educating parents on methods for successful bowel training, such as providing their child with the following:
            1. clothes that can be removed independently
            2. a personal toilet seat
            3. sufficient time to eliminate feces
            4. a consistent, relaxed atmosphere
            5. praise for successful behavior while avoiding punishment for unsuccessful behavior
            6. a non-stressful period in which to initiate toilet-training
      2. elderly
        1. changes in the elderly that can effect fecal elimination include the following:
          1. decreased esophageal and gastrointestinal (GI) peristalsis
            1. can result in slower passage of chyme in the large intestine, more water being reabsorbed from the chyme, and accumulation of air and gas and constipation
          2. poor dentition and decreased digestive enzyme (e.g., pytalin, pepsin, trypsin, lipase) and gastric acid secretion
            1. can result in partially digested food which may result in indigestion
          3. decreased tone of the abdominal, pelvic, and thigh muscles
            1. can result in a decreased amount of intra-abdominal pressure that can be exerted during defecation
          4. decreased anal spinchter tone
            1. can result in urgency to defecate or fecal incontinence
    2. diet
      1. insufficient fiber (undigested residue) in the diet can effect fecal elimination
        1. does not provide the fecal volume necessary to stretch the walls of the large intestine, stimulate peristalsis, and initiate the defecation reflex which may result in accumulation of air and gas and constipation
        2. foods high in fiber
          1. raw fruits (e.g., apples, oranges)
          2. cooked fruits (e.g., prunes, apricots)
          3. greens (e.g., spinach, kale, cabbage)
          4. raw vegetables (e.g., celery, zucchini)
          5. whole grains (e.g., cereal, bread)
      2. certain foods can effect fecal elimination by encouraging the following:
        1. gas (e.g., cabbage, onions, cauliflower, bananas, and apples)
        2. diarrhea (e.g., bran, prunes, figs, chocolate, and alcohol)
        3. constipation (e.g., cheese, pasta, eggs, and lean meat)
      3. certain food conditions can effect fecal elimination, such as the following:
        1. lactose intolerance
          1. increases peristalsis and mucus secretion in the large intestine which results in rapid passage of chyme through the large intestine, less water being reabsorbed from the chyme, and diarrhea
        2. food allergies
          1. reduces digestion of food elements which increases peristalsis in the large intestine, results in rapid pasage of chyme through the large intestine, less water being reabsorbed from the chyme, and diarrhea
    3. fluid
      1. inadequate fluid intake (less than 2,000 to 3,000 milliliters per day) or excessive fluid output can effect fecal elimination
        1. can result in slower passage of chyme in the large intestine, more water being reabsorbed from the chyme, and constipation
    4. activity
      1. inadequate activity can effect fecal elimination
        1. inhibits peristalsis which results in slower passage of chyme in the large intestine, more water being reabsorbed from the chyme, and accumulation of air or gas and constipation
        2. decreases the tone of the abdominal, pelvic and thigh muscles which can result in a decreased amount of intra-abdominal pressure that can be exerted during defecation
    5. psychologic factors
      1. certain emotional states can effect fecal elimination
        1. anxiety/stress activates the sympathetic portion of the autonomic nervous system (ANS) which inhibits large intestine peristalsis, increases the tone of the internal and external anal spinchters, and may potentially lead to accumulation of air and gas and constipation
      2. certain diseases of the large intestine are thought to have a psychological component
        1. e.g., ulcerative colitis, Chron’s disease
    6. life-style
      1. certain life-style behaviors can effect fecal elimination by delaying defecation which allows water to be reabsorbed from the chyme in the large intestine and constipation, such as the following:
        1. not defecating at a regular time
          1. e.g., after breakfast to take advantage of the gastrocolic and duodenocolic reflexes
        2. ignoring the urge to defecate
          1. unavailability of toilet facilities
          2. embarrassment about odors and noises
          3. lack of privacy
        3. not exerting intra-abdominal pressure while defecating
          1. e.g., assuming a squatting position, contracting the abdominal, pelvic, and thigh muscles, and leaning forward
    7. medications
      1. certain medications can effect fecal elimination, such as the following:
        1. those that decrease peristalsis which results in slower passage of chyme in the large intestine, more water being reabsorbed from the chyme, and accumulation of air and gas and constipation, e.g.:
          1. narcotic analgesics (e.g., morphine sulphate)
          2. antidepressants (e.g., isocarboxazid [Marplan])
          3. anticholinergics (e.g., benzotropine [Cogentin]
        2. those that increase peristalsis in the large intestine which results in faster passage of chyme in the large intestine, less water being reabsorbed from the chyme, and diarrhea, e.g.:
          1. antibiotics (e.g., penicillin)
            1. it is thought that the normal flora of bacteria in the large intestine keep the pathogenic flora under control
            2. antibiotics (especially broad-spectrum) can suppress the normal flora of bacteria in the large intestine allowing pathogenic bacteria to multiply and produce toxins irritating to large intestine which may result in diarrhea (suprainfection)
          2. ferrous sulfate
            1. irritates the mucosa of the large intestine which may result in diarrhea
          3. laxatives
            1. normal defecation reflexes are so inhibited that habitual users require larger or stronger doses to be able to defecate
    8. diagnostic procedures
      1. certain diagnostic procedures can effect fecal elimination in the following ways:
        1. barium remaining in the colon after a barium enema can harden producing constipation or possibly an impaction
        2. cleansing enemas given to empty the colon of fecal material prior to certain diagnostic procedures can interrupt normal fecal elimination
    9. anesthesia and surgery
      1. general anesthetic agents can effect fecal elimination in the following way:
        1. use of general anesthetic agents may cause temporary slowing or cessation of peristalsis which may result in accumulation of air and gas and constipation
      2. surgery on the large intestine can effect fecal elimination in the following way:
        1. manipulation of the large intestine during surgery may cause temporary cessation of peristalsis for 24 - 48 hours (paralytic ileus) which can result in accumulation of air and gas and constipation
      3. surgical alterations of gastrointestinal anatomy can effect fecal elimination in the following ways:
        1. gastrectomy
          1. the loss of the reservoir function of the stomach results in dumping of food into the duodenum too rapidly for proper absorption and diarrhea
        2. colon resection
          1. the reduced size of the large intestine results in less area for reabsorption of water from the chyme in the large intestine and diarrhea
    10. pathologic conditions
      1. certain pathologic conditions can effect fecal elimination
        1. particularly those that do the following:
          1. decrease or eliminate sensory stimulation necessary for competence of the external anal spinchter and defecation
          2. result in atony of the large intestine
          3. decrease physical mobility
        2. examples of such pathologic conditions
          1. spinal-cord injury, cerebral vascular accident (CVA), arthritis, multiple sclerosis
      2. certain pathologic conditions of the colon (ulcerative colitis, irritable bowel syndrome, Chron's disease) can effect fecal elimination in the following ways:
        1. the inflammation and/or ulceration in the large intestine increases peristalsis which results in the faster passage of chyme in the large intestine, decreased reabsorption of water from the chyme, and diarrhea
    11. pain
      1. certain conditions which cause pain upon defecation can effect fecal elimination, such as the following:
        1. hemorrhoids
        2. anal fissures
  4. Common fecal elimination problems
    1. constipation
      1. the state in which an individual’s pattern of elimination is characterized by dry, hard stool that results from a delay in passage of food residue
      2. related factors (etiology)
        1. less than adequate fluid/dietary intake
        2. less than adequate physical activity
        3. lack of privacy
        4. emotional disturbances
        5. stress
        6. change in daily routine
        7. chronic use of medications and enemas
        8. metabolic problems
        9. neuromuscular impairment
        10. musculoskeletal impairment
        11. weak abdominal musculature
        12. pain on defecation
        13. diagnostic procedures
        14. medication side-effects
        15. pregnancy
      3. defining characteristics
        1. decreased frequency
        2. painful defecation
        3. abdominal distention
        4. abdominal pain
        5. rectal pressure
        6. appetite impairment
        7. headache
        8. dry, hard stool
        9. straining at stool
        10. palpable mass
      4. interventions
        1. cleansing enema
        2. cathartics
          1. bulk-forming
            1. uses synthetic or natural polysaccharides and cellulose derivatives to absorb water into the fecal mass to add bulk
              1. plantago seed (psyllium seed)
          2. lubricant
            1. prevents excessive absorption of water from the feces thus delaying drying of the feces
              1. mineral oil
              2. Haley's MO
          3. wetting agent
            1. lowers the surface tension of the feces which helps water and fatty substances to penetrate the feces
              1. doucasate sodium (Colace)
          4. stimulant
            1. irritates the intestinal mucosa causing increased peristalsis and rapid expulsion of feces
              1. castor oil
              2. cascara sagrada
              3. bisacodyl (Dulcolax, Bisco-lax)
              4. senna
          5. saline
            1. uses salts, which are poorly absorbed in the intestine, to draw fluid into the intestine which increases fecal bulk and possibly lubricates the feces
              1. magnesium sulfate (Epsom salts)
              2. magnesium hydroxide (Milk of Magnesia)
              3. magnesium citrate
      5. danger of constipation is that it causes straining at defecation which can result in the following:
        1. put pressure on abdominal or perineal sutures which may precipitate wound dehisence or eviseration
        2. promote the development of hemorroids
        3. elicit the valsalva manuever (holding breath while straining) which can be dangerous in clients with heart, respiratory, or brain injuries because it does the following:
          1. slows the heart rate by stimulating the vagus (10th cranial) nerve and, consequently:
            1. decreases the return of blood to the heart
            2. may precipitate dysrhythmias
          2. increases intra-abdominal pressure
            1. which concomittantly increases venous, intrathoracic, and intracranial pressure
    2. fecal impaction (etiology)
      1. mass or collection of hardened feces, wedged in the folds of the rectum and possibly higher, accompanied by inability to pass a normal stool and seepage of liquid fecal material from the anus
      2. related factors
        1. same as for constipation
      3. defining characteristics
        1. inability to pass a stool
        2. seepage of liquid fecal material from the anus
        3. palpable mass
      4. interventions
        1. digital exam (if impaction is suspected)
          1. may be too far up to feel
          2. may need a physician’s order since it can precipitate the valsalva manuever
        2. oil retention enema
        3. cleansing enema 2 - 4 hours later
        4. digital removal of impaction (if the above are not ineffective)
      5. danger of fecal impacation
        1. same as for constipation
        2. if allowed to persist, may require surgery for removal of a fecalith
    3. diarrhea
      1. the state in which an individual experiences a change in normal bowel habits characterized by the frequent passage of loose, fluid, unformed stools
      2. related factors (etiology)
        1. gastrointestinal disorders
        2. metabolic/endocrine disorders
        3. nutritional disorders
        4. change in dietary intake
        5. infectious processes
        6. tube feedings
        7. adverse effects of medications
        8. high stress level
      3. defining characteristics
        1. abdominal pain
        2. urgency
        3. cramping
        4. increased frequency
        5. increased frequency of bowel sounds
        6. loose, liquid stools
      4. interventions
        1. decrease or eliminate food intake to decrease peristalsis
        2. antidiarrheals
          1. adsorbents
            1. coat the walls of the large intestine, absorbing the bacteria or toxins causing diarrhea, and passing them out with the feces
              1. bismuth subsalicylate (Pepto-Bismol)
              2. activated charcoal (Charcocaps)
              3. attapulgite (Kaopectate)
          2. anticholinergics
            1. not conclusively known to decrease peristalsis, but used to prevent spasm and cramping associated with acute diarrhea (in a sufficient dose)
              1. atropine
              2. hyoscyamine
              3. hyoscine
              4. homatropine methylbromide
          3. opiates
            1. reduce large intestinal tone and peristalsis, reduce pain, and relieve tenesmus (rectal spasms)
              1. tincture of opium
              2. paregoric
              3. codeine
          4. intestinal flora modifiers
            1. Lactobacillus organisms that reestablish the normal flora of bacteria in the large intestine which is though to help suppress the growth of diarrhea-producing pathogenic bacteria in the large intestine
              1. lactobacillus acidophilus and lactobacillus bulgaricus (Lactinex)
              2. lactobacillus acidophilus in sodium carboxymethylcellulose (Bacid)
      5. danger of diarrhea
        1. can precipitate serious fluid and electrolyte imbalances
          1. especially in infants and small children
    4. fecal incontinence
      1. the state in which an individual experiences a change in normal bowel habits characterized by involuntary passage of stool
      2. related factors
        1. gastrointestinal disorders
        2. neuromuscular disorders
        3. colostomy
        4. loss of rectal spinchter control
        5. impaired cognition
      3. defining characteristics
        1. involuntary passage of stool
      4. interventions
        1. bowel training
          1. determine the client’s usual bowel habits and factors that facilitate or hinder normal defecation
          2. design a plan to promote normal elimination habits, e.g.,
            1. a fluid intake of 2,000 - 3,000 mililiters per day
            2. increased fiber in the diet
            3. increased exercise
            4. privacy
          3. empty the large intestine
            1. use a purgative if necessary
          4. begin daily bowel training program
            1. administer a daily mixture of cathartics
            2. have client drink a hot drink before the daily scheduled defecation time
            3. insert a cathartic suppository or apply digital stimulation after hot drink
            4. assist client to the toilet or on to a bedpan
            5. have client (or nurse) apply intra-abdominal pressure during attempt to defecate
            6. set time limit for defecation
        2. fecal incontinence pouch
          1. a pouch that is secured around the anal opening and may or may not be attached to drainage
    5. flatulence (tympanities)
      1. presence of excessive flatus (air or gas) in the large intestine in the intestinal tract
      2. related factors (etiology)
        1. accumulation of air or gas in the large intestine through swallowing air, the action of bacteria on the chyme in the large intestine, and/or diffusion of gas from the bloodstream into the large intestine which cannot escape from the mouth (belched) or the anus (as flatus)
      3. defining characteristics
        1. abdominal distention
        2. abdominal pain
      4. interventions
        1. carminative enema
        2. return flow or Harris flush enema
        3. rectal tube
  5. Characteristics of feces
    1. normal feces
      1. color: adult = brown; infant = yellow
      2. consistency: formed, soft, semisolid, moist
      3. shape: cylindrical (contour of rectum), about one inch in diameter (adults)amount: varies with diet, but about 100 - 400 grams per day
      4. odor: aromatic; affected by ingested food and client’s own bacterial flora
      5. constituents: small amounts of undigested roughage, sloughed dead bacteria and epithelial cells, fat, protein; dried constituents of digestive juices (e.g., bile), inorganic matter (e.g., calcium, phosphates)
    2. abnormal feces
      1. color: clay or white; black or tarry; red or pale; orange or green
      2. consistency: hard, dry, diarrhea
      3. shape: narrow; pencil-shaped; or string-like feces
      4. amount: more than 400 grams per day
      5. odor: pungent
      6. constituents: pus, mucus, parasites, blood, large amounts of fat, foreign objects
  6. Diagnostic studies
    1. indirect visualization of the GI tract
      1. flat-plate of the abdomen
        1. description
          1. plain radiograph of the abdomen to determine gross anatomic features of the organs of the abdomen
        2. patient preparation
          1. none
        3. follow-up
          1. none
      2. barium swallow
        1. description
          1. ingestion of a contrast medium that allows indirect visualization of the pharynx and esophagus
        2. patient preparation
          1. NPO after midnight the evening before the test
        3. follow-up
          1. drink fluids to eliminate the barium
          2. mild laxative or stool softener if necessary
          3. educate patient that stools will be chalky white or lighter in color for several days
      3. upper GI series and small bowel follow through (SBFT)
        1. description
          1. ingestion of a contrast medium that allows indirect visualization of the lower esophagus, stomach, duodenum, ileum, and jejunum
        2. patient preparation
          1. NPO after midnight the evening before the test
          2. educate the patient that he/she will be on a rotating x-ray table
          3. educate the patient that he/she will need to assume many positions
        3. follow-up
          1. drink fluids to eliminate the barium
          2. mild laxative or stool softener if necessary
          3. educate patient that stools will be chalky white or lighter in color for several days
      4. barium enema
        1. description
          1. administration of a contrast medium enema to allow indirect visualization of the large intestine
        2. patient preparation
          1. low residue diet 2 days prior to the test
          2. clear liquid diet the evening before the test
          3. NPO after midnight the evening before the test
          4. potent laxative the night before the test (e.g., magnesium citrate)
          5. oral liquid preparation the night before the test (e.g., GoLytely)
          6. cleansing enema the night before the test
        3. follow-up
          1. drink fluids to eliminate the barium
          2. mild laxative or stool softener if necessary
          3. cleansing enema if necessary
          4. educate patient that stools will be chalky white or lighter in color for several days
      5. liver scan (renography)
        1. description
          1. injection of a radionuclide medium into a vein and monitoring its uptake in the liever to provide gross information about liver blood flow, structure, and function
        2. patient preparation
          1. ascertain that a consent form is signed
        3. follow-up
          1. monitor vital signs according to agency protocol
          2. wear rubber gloves when discarding the patient's urine for 24 hours
          3. wash the gloved hands with soap and water after discarding the patient's urine for 24 hours
          4. wash the ungloved hands with soap and water after discarding the patient's urine for 24 hours
          5. educate the patient to wash hands with soap and water after each voiding for 24 hours
      6. gastric analysis
        1. description
          1. measurement of hydrochloric acid and pepsin secretion by the stomiach through insertion of a nasogastric tube and collection of samples of gastric secretions at 15 minute intervals for 1 hour
        2. patient preparation
          1. NPO at least 12 hours prior to the test
          2. educate the patient to not chew gum or smoke cigarettes for 6 hours prior to the test
          3. educate the patient that a nasogastric tube will be inserted into his/her stomach
          4. educate the patient that samples of gastric secretions will be collected, measured, and labled every 15 minutes for an hour
          5. educate the patient that the nasogastric tube will be removed after the procedure
        3. follow-up
          1. none
    2. direct visualization of the GI tract
      1. proctoscopy
        1. description
          1. viewing of rectum with a proctoscope
        1. patient preparation
          1. liquid diet 24 hours prior to the test
          2. cleansing enema or Fleet’s enema prior to test
          3. laxative the eveing before the test
        1. follow-up
          1. check for s/s of perforation (pain, bleeding)
      1. sigmoidoscopy
        1. viewing of the sigmoid colon with a sigmoidoscope
        2. patient preparation
          1. proctoscopy
        1. follow-up care
          1. same as for proctoscopy
      1. colonoscopy
        1. definition
          1. viewing of the large intestine with an endoscope
        1. patient preparation
          1. liquid diet 24 hours prior to the test
          2. NPO after midnight the night of the test
          3. potent laxative the night before the test (e.g., GoLytely)
        1. follow-up care
          1. check vital signs per policy
          2. siderails up
          3. check for s/s of perforation (pain, bleeding)
      1. esophophagogastroduodenoscopy
        1. definition
          1. viewing of the esophogus, stomach, and upper duodenum with an endoscope
        1. patient preparation
          1. NPO after midnight the night of the test
        1. follow-up care
          1. check vital signs per policy
          2. siderails up
          3. NPO for 1 - 2 hours or until gag reflex returns
          4. check for s/s of perforation (pain, bleeding)
    1. blood tests
      1. prothrombin time
        1. collection of a specimin of blood to determine prothrombin time
        2. normal findings:
          1. 11 - 12.5 seconds
        3. significance of abnormal findings:
          1. increased values, possible:
            1. deficiency in prothrombin, fibrinogen, or extrinsic factors
            2. liver disease
            3. vitamin K deficiency
      2. calcium
        1. collection of a specimin of blood to determine serum calcium levels
        2. normal findings:
          1. 9 - 10.5 mg/dL or
          2. 2.25 - 2.75 mmol/L
        3. significance of abnormal findings:
          1. decreased values, possible
          2. malabsorption
          3. renal failure
          4. acute pancreatitis
      3. potassium
        1. collection of a specimin of blood to determine serum potassium levels
        2. normal findings:
          1. 3.5 mEq/L
          2. 3.5 mmol/L
        3. significance of abnormal findings:
          1. decreased values, possible
            1. vomiting
            2. gastric suctioning
            3. diarrhea
            4. drainage from intestinal fistulas
      4. serum electrophoresis
        1. collection of a specimin of blood to determine serum electrophoresis
        2. normal findings:
          1. total protein = 6 - 8 g/dL
          2. albumin = 3.5 - 5 g/dL
          3. alpha1-globulin = 0.1 - 0.4 g/dL
          4. aplha2-globulin = 0.5 - 1g/dL
          5. beta globulin = 0.7 - 1.2 g/dL
          6. gamma globulin = 0.5 - 1.6 g/dL
        3. significance of abnormal findings:
          1. decreased values, possible
            1. hepatic disease
            2. GI disorders
            3. peptic ulcer
            4. acute cholecystitis
            5. malabsorption
      5. AST, SGOT
        1. collection of a specimin of blood to determine serum AST, SGOT levels
        2. normal findings:
          1. 8 - 20 units/L or
          2. 5 - 40 IU/L
        3. significance of abnormal findings:
          1. increased values, possible
            1. viral hepatitis
            2. cirrhosis
            3. acute pancreatitis
            4. malabsorption
            5. other liver damage
      6. ALT, or SGPT
        1. collection of a specimin of blood to determine serum ALT or SGPT levels
        2. normal findings:
          1. 5 - 35 IU/L
        3. significance of abnormal findings:
          1. increased values, possible
            1. hepatitis
            2. cirrhosis
      7. LDH
        1. collection of a specimin of blood to determine serum LDH levels
        2. normal findings:
          1. 45 - 90 units/L or
          2. 115 - 225 IU/L or
          3. 0.4 - 1.7 mmol/L
        3. significance of abnormal findings:
          1. damaged liver caused by hepatitis or hepatocellular disorders
      8. alkaline phosphatase
        1. collection of a specimin of blood to determine serum alkaline phosphatase levels
        2. normal findings:
          1. 30 - 90 IU/L
        3. significance of abnormal findings:
          1. hepatic disease
          2. biliary obstruction
      9. bilirubin (total serum)
        1. collection of a specimin of blood to determine serum bilirubin levels
        2. normal findings:
          1. 0.1 - 1 mg/dL or
          2. 5.1 - 17 mmol/L
        3. significance of abnormal findings:
          1. hemolysis
          2. biliary obstruction
          3. hepatic damage
      10. bilirubin (conjugated, direct)
        1. collection of a specimin of blood to determine serum bilirubin levels
        2. normal findings:
          1. 0.1 - 0.3 mg/dL or
          2. 1.7 - 5. mmol/L
        3. significance of abnormal findings:
          1. biliary obstruction
      11. bilirubin (unconjugated, indirect)
        1. collection of a specimin of blood to determine serum bilirubin levels
        2. normal findings:
          1. 0.2 - 0.8 mg/dL or
          2. 3.4 - 12 mmol/L
        3. significance of abnormal findings:
          1. hemolysis
          2. hepatic damage
      12. ammonia
        1. collection of a specimin of blood to determine serum ammonia levels
        2. normal findings:
          1. 15 - 110 mg/dL or
          2. 47 - 65 mmol/L
        3. significance of abnormal findings:
          1. hepatic disease (e.g., cirrhosis)
      13. d-Xylose absorption
        1. collection of a specimin of blood to determine serum d-Xylose levels
        2. normal findings:
          1. 25 - 40 mg/dL in 2 hours or
          2. 3.5 g in 5 hours or
          3. 5 g in 24 hours
        3. significance of abnormal findings:
          1. malabsorption in the small intestine
      14. serum amylase
        1. collection of a specimin of blood to determine serum amylase levels
        2. normal findings:
          1. 80 - 150 Somogyi units/dL or
          2. 56 - 90 IU/L or
          3. 25 - 125 units/L
        3. significance of abnormal findings:
          1. acute pancreatitis
      15. serum lipase
        1. collection of a specimin of blood to determine serum lipase levels
        2. normal findings:
          1. 0 - 110 units/L or
          2. 0 - 417 units/L
        3. significance of abnormal findings:
          1. acute pancreatitis
      16. cholesterol
        1. collection of a specimin of blood to determine serum cholesterol levels
        2. normal findings:
          1. 150 - 200 mg/dL or
          2. 3.9 - 6.5 mmolL
        3. significance of abnormal findings:
          1. increased values, possible,
            1. pancreatitis
            2. biliary obstruction
          2. decreased values, possible
            1. liver cell damage
    1. urine tests
      1. bilirubin
        1. collection of a specimin of urine to determine urinary bilirubin levels
        2. normal findings:
          1. negative
        3. significance of abnormal findings:
          1. biliary obstruction
          2. cirrohsis
          3. hepatitis
      1. urobilinogen
        1. collection of a specimin of urine to determine urinary urobilinogen levels
        2. normal findings:
          1. 0.1 - 1 unit/mL
        3. significance of abnormal findings:
          1. hepatitis
          2. cirrhosis
      1. amylase
        1. collection of a specimin of urine to determine urinary amylase levels
        2. normal findings:
          1. various levels, depending on unit of measure
        3. significance of abnormal findings:
          1. acute pancreatitis
          2. pancreatic obstruction
    1. stool specimins
      1. collection of a specimin of stool to ascertain the presence of normal/abnormal constituents of stool
    1. stool for occult blood
      1. collection of a specimin of stool to ascertain the presence/absence of occult (hidden) blood in the stool
      2. normal findings:
        1. negative
      1. presence, diagnostic for
        1. carcinoma
        2. peptic ulcer
        3. ulcerative colitis
    1. stool for ova and parasites
      1. collection of a specimin of stool to ascertain the presence/absence of ova or parasites in the stool
      2. normal findings:
        1. negative
      1. presence, diagnostic for
        1. infection
    1. stool for fecal fat
      1. collection of a specimin of stool to ascertain the amount of fat in the stool
      2. normal findings:
        1. 2 - 5 g/24 hours with normal diet
      1. increased values, possible
        1. Chron's disease
        2. malabsorption syndrome
        3. pancreatic disease
  7. Bowel diversion ostomies
    1. jejunostomy
      1. diversion of chyme from the small intestine by surgically implanting the jejunum onto the skin surface and creating an opening (stoma)
    1. ileostomy
      1. diversion of chyme from the small intestine by surgically implanting the ileum onto the skin surface and creating an opening (stoma)
    2. cecostomy
      1. diversion of feces from the large intestine by surgically implanting the cecum onto the skin surface and creating an opening (stoma)
    3. ascending colostomy
      1. diversion of feces from the large intestine by surgically implanting the ascending colon onto the skin surface and creating an opening (stoma)
    4. transverse loop colostomy
      1. diversion of feces from the large intestine by surgically implanting the transverse colon onto the skin surface and creating an opening (stoma)
    5. transverse double-barreled colostomy
      1. diversion of feces and mucous from the large intestion by surgically implanting the proximal transverse colon onto the skin surface and creating an opening (stoma) (the colostomy) and surgically implanting the distal transverse colon onto the skin surface and creating an opening (stoma) (the mucous fistula)
    6. descending colostomy
      1. diversion of feces from the large intestine by surgically implanting the descending colon onto the skin surface and creating an opening (stoma)
    7. sigmoid colostomy
      1. diversion of feces from the large intestine by surgically implanting the sigmoid colon onto the skin surface and creating an opening (stoma) 

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This page was last modified on 1/1/02