What diagnostic test should the nurse anticipate for an older patient who is vomiting “coffee-ground” emesis?
A.
Endoscopy
B.
Barium studies
C.
Angiography
D.
Gastric analysis
The Correct Answer and Explanation is:
The correct answer is A. Endoscopy.
Explanation:
“Coffee-ground” emesis is a term used to describe vomitus that appears dark brown or black, resembling coffee grounds. This appearance typically indicates that the vomit contains blood that has been partially digested by stomach acids. The most common cause of this condition is gastrointestinal bleeding, often from the upper gastrointestinal (GI) tract, which includes the esophagus, stomach, and the first part of the small intestine (duodenum).
Endoscopy is the diagnostic test of choice for evaluating “coffee-ground” emesis. An endoscopy involves the insertion of a flexible tube with a camera (an endoscope) through the mouth and into the upper GI tract. This allows the healthcare provider to visually inspect the esophagus, stomach, and duodenum for sources of bleeding, such as ulcers, gastritis, esophagitis, or varices. The endoscope can also be used to perform therapeutic interventions, such as cauterizing a bleeding ulcer, injecting medications, or placing clips to control the bleeding. This makes endoscopy both a diagnostic and potentially therapeutic tool.
Other options listed are less appropriate for this scenario:
- Barium studies involve swallowing a barium solution, which coats the lining of the GI tract and allows it to be seen on X-rays. While useful for detecting structural abnormalities like strictures or tumors, it is less effective for identifying active bleeding and cannot provide real-time visualization or treatment of bleeding sites.
- Angiography is used to visualize blood vessels and can detect the source of bleeding in the GI tract, particularly in cases of lower GI bleeding. However, it is usually reserved for situations where endoscopy is not effective or feasible, as it is more invasive and primarily diagnostic.
- Gastric analysis involves measuring the acid content of stomach secretions and is used to evaluate conditions like Zollinger-Ellison syndrome or achlorhydria, but it is not suitable for diagnosing the cause of “coffee-ground” emesis.
Given the potential severity of gastrointestinal bleeding, an endoscopy is the most appropriate initial test to directly visualize and possibly treat the source of bleeding, making it the best choice for an older patient presenting with “coffee-ground” emesis.