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Gastrointestinal Protocols

#NAMEINDICATIONDESCRIPTION
G1 UGI/BE (on-call) r/o leak
r/o volvulus
Gastrografin usage for esophagus, stomach, and small bowel. Cystografin enema for colon.
G2 IVP (on-call) r/o kidney stone IVP if Urology specifically requests the exam, otherwise do non-contrasted CT to r/o stone.
G3 Cystografin enema
(on-call)
Ogilvie's Syndrome Have referring service do on floor if there is no contraindication. This can be done on the ward just like a water cleansing enema. Set up the bag with cystografin (2500 cc), enema tip with inflator, and the inflatable plastic ring.  Nurse can instill the Cystografin over 10 min. and clamp the enema tip for 15-20 min, then drop the bag and unclamp to drain the colon. Get abdomen film in AM.
G4 R/O Stone CT (on-call) r/o kidney stone See Body CT Protocol
G5 Enteric Feeding Tube Placement (on-call)   There is no reason to place a feeding tube after hours. If it is requested during day working hours on the weekend it should be done early.
G6 Retrograde Urethrogram (on-call) r/o urethral inj See Fluoro Manual. There is a large version of the manual in a blue 3-ring binger in the GI reading room above the computer monitors.
G7 Cystogram (on-call) r/o bladder rupt Do CT cystogram if possible. Otherwise try to instill at least 250-275 cc of Cystografin to exclude a leak.  Be sure to get a post-drainage film, as leaks are sometimes seen at this time.
G8 Video Swallow Exam (on-call) r/o leak Use dense barium if trachea is thought to be involved (do not use Gastrografin in this setting).  If esophageal perforation is suspected, use Gastrografin first, then follow with barium. Use 14x14 film size for the esophagus.
G9 Post Gastric Wrap Exam (on-call) r/o leak These are commonly asked for on Saturday morning following Friday surgery.   Do early in the day and use Gastrografin followed by barium.