Questioning your GI patient

We all know that an experienced technologist will ask many questions before taking a scout film for an upper GI series. A typical prep is for the patient to be NPO past midnight of the night before the exam, and how many times do we walk into the waiting room to find a patient sipping on a mocha latte with a half-eaten pastry in the other hand? Here are a few things that technologists should be asking their GI patients before the procedure:

When was the last time you ate or drank anything? If it was clear liquids even recently, most Radiologists will let it slide because of the fast rate it will empty from the stomach. If it was anything else, make sure to write what it was and when the patient ate it in the history.

Have you had any abdominal surgeries? Another important question - it could have been a recent surgery that did not heal properly. In that case, there would be a perforation still, and barium can spill out into the peritoneal cavity to harden like cement after all the water is absorbed from it - a GI surgeon's nightmare. Besides, if the patient has had an obvious surgery that is visible once the Radiologist is performing the exam and you don't disclose that, you may be subject to receiving the "stink-eye" from the physician, or even worse, verbal reprimand in front of your patient.

Have they had a recent endoscopy? If it's been within the past couple of hours, there could still be a lot of air in the stomach, which may influence the amount of gas crystals you would use for a double-contrast study. Also, ask if they performed a biopsy during their endoscopy. It is possible to perforate the stomach during a biopsy, which could lead to the scenario described above. The Radiologist may decide to avoid using air contrast or use a water-soluble contrast agent such as Gastroview or Gastrograffin.

Have they been previously diagnosed with any conditions involving the stomach or esophagus? It sounds redundant, but I've experienced several patients who assume you have access to their entire medical history, and fail to mention they had an ulcer last year after gastric bypass surgery. This is just another way to be thorough.

Do you have any allergies? I have yet to experience a patient having an allergic reaction during a UGI, but it is possible. Barium, in and of itself, is an inert element which is impossible to have a reaction to, but there are preservatives added to the barium that make it possible for patients to have a response. It is rare, but I always include this in my pre-exam questioning.

Why are you having this exam? This is possibly the most important question you can ask. The answer might be "I have right lower quadrant pain." This might be disconcerting because we all know that the stomach is not in the right lower quadrant. However, you can further ask questions to see if studies have been performed to evaluate that pain (such as ultrasound to r/o appendicitis, small bowel series, or barium enema). Chances are, all or some of those may have been performed and were negative studies. Upon further questioning, you may learn that the patient might have found blood in their stool, but all other studies were normal.

Do you have blood in your stool? If so, is it dark red/brown or bright red? A dark color usually indicates bleeding from somewhere proximally in the GI tract; esophagus, stomach, or small intestine. Bright red blood indicates very low in the GI tract, either in the large intestine, or it could be hemorrhoids. It would also be beneficial to ask if the patient is anemic if they have blood in the stool, and to obtain a copy of their lab test results (if available).

And last, but not least, ask what types of medications the patient is taking. Sometimes, the history proves to be rather simple and uncomplicated, but then the patient states they are currently taking prilosec for GERD or Zantac... the point is, it is just another thorough way to evaluate the patient's condition, as well as obtain more information for the Radiologist. If the patient is taking medication, make sure to find out the doseage and frequency, as well as the last time they had their medication.

I'm sure there are some other questions that can be asked, but if any patient answers yes to a question, chances are that will lead to further investigation. As we all know, sometimes acquiring a good patient history can take slightly longer than the procedure itself, but it is more than worth it to the competent Radiographer.