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Fluoro and angio > week 9 - GIT > Flashcards

week 9 - GIT Flashcards

1
Q

what anatomy does barium/ contrast swallow see

A

esophagus

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2
Q

indication for barium swallow

A
  • dysphagia
  • anemia
  • pain (during swallow)
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3
Q

contraindication for barium swallow

A
  • GIT perforation
  • intravasation
  • constipation
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4
Q

2 types of contraindications

A

absolute contraindication
relative contraindication

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5
Q

when is contrast swallow used instead of barium swallow

A

when barium swallow is contraindicated

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6
Q

most common iodinated contrast for contrast swallow

A

gastrografin

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7
Q

characteristics of barium swallow contrast

A
  • barium sulfate
  • most common oral contrast agent for GIT studies
  • resembles a milk shake appearance
  • available in various flavours, prepared by mixing with water
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8
Q

characteristics of contrast swallow contrast

A
  • HOCM (gastrografin: yellowish, water-based solution mixed with iodine; bitter)
  • any non-ionic iodinated contrast LOCM (eg Iopamiro)
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9
Q

rank of choices for esophageal contrast

A
  1. barium
  2. HOCM
  3. LOCM
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10
Q

indication for contrast swallow

A
  1. suspected lower GIT perforations
  2. short period after operation
  3. acute hemorrhage
  4. gastro-colic fistula
  5. localisation of FB or tumour before endoscopy
  6. acute condition which may require immediate surgery
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11
Q

contraindications for gastrografin swallow

A
  • any GI studies of infant: risk of dehydration (HOCM)
  • tracheoesophageal fistula: pulmonary edema
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12
Q

advantages of barium sulphate

A
  1. inert
  2. better coating properties
  3. low cost
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13
Q

single or double contrast for swallow study

A

single contrast

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14
Q

what are the possible single contrast media used for swallow study

A
  1. barium (E-Z-HD)
  2. gastrografin/ ioparimo/ omnipaque
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15
Q

how much water to add to barium sulfate to make a thicker suspesion

A

50ml

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16
Q

how much water to add to barium sulfate to make a thinner suspesion

A

65ml

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17
Q

advantages of thick barium

A
  • better coating power
  • assist passage as a bolus to distend the tract better
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18
Q

disadvantages of thick barium

A
  • may mask fine lesions
  • may have some residue barium stick onto the wall of the tract
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19
Q

how is swallow study procedure done

A
  1. patient in upright position
  2. feed CM to patient
  3. hold a mouthful of barium until immediately before exposure for the demonstration of deglutition
    4.
    a) swallow the contrast in bolus during normal breathing
    b) swallow several mouthfuls of barium in rapid successions
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20
Q

what is the after care of barium swallow

A
  • white fecal matter for a few days
  • advised to drink adequate volumes of water
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21
Q

what is VFSS

A
  • stimulate habitual swallowing behaviours in patients with signs and symptoms of dysphagia
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22
Q

limitation of VFSS

A
  • time constraints due to radiation dose
  • procedure only samples swallow function, it does not fully represent mealtime function
  • barium increases viscosity and alter liquid and solid food composition and are not natural food - resulting in disordance between the result of VFSS and real meal
  • limited ability to evaluate fatigue effect on swallowing
  • barium is an unnatural food bolus with potential refusal by patient
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23
Q

indication of VFSS

A
  1. assess integrity of airway protection
  2. assess effectiveness of different postures, manoeuvres, bolus modifications, different viscosity of food to improve swallow
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24
Q

contraindication of VFSS

A
  1. medically unstable or uncooperative patients
  2. when the information obtained from the study is unlikely to change the patient’s management
  3. patient is unable to be adequately positioned
25
Q

VFSS patient positioning

A
  • imaging chair is primarily used, patient to be in true lateral position
  • side-lying only for patients with medical conditions and cannot sit upright
26
Q

order of contrast mixed with substrate given to patient for VFSS

A

thick fluid > solid food > thin fluid

27
Q

after care for VFSS procedure

A

generally none except:
- CXR if aspiration suspected
- physio to do percussion

28
Q

what is the function of barium meal

A
  • peristalsis
  • ? pyloric stenosis
29
Q

what is the pre procedure preparation for barium meal study

A
  • NPO for 8 hours before exam
  • no smoking and chewing gums
30
Q

what are the contrast used for barium meal

A

EZHD and baros

31
Q

when is single contrast used in barium meal study

A
  • infants/ children
  • very ill adults
32
Q

what is the radiographer’s main responsibility in barium meal study

A
  • assist patient in achieving different postures
33
Q

what are the projections taken for a barium meal study

A

supine: PA, RAO, LAO

34
Q

when patient is in RAO undercouch position for a barium meal study, where would the residue barium collection be

A

fundus

35
Q

when patient is in LAO undercouch position for a barium meal study, where would the residue barium collection be

A

split into 2 - fundus and pylorus

36
Q

what is the after care for a barium meal study

A
  • encourage fluid intake
  • stool may become white in colour
  • patient must not leave dpt until any blurring of vision caused by Buscopan has resolved
36
Q

what is the after care for a barium meal study

A
  • encourage fluid intake
  • stool may become white in colour
  • patient must not leave dpt until any blurring of vision caused by Buscopan has resolved
37
Q

pre preparation for FT

A
  • low residue diet for 2 days before exam
  • NPO for 8 hours before exam
38
Q

FT after care

A
  • patient should be warned of white fecal matter
  • patient should be advised to drink adequate volumes of water
  • laxatives may be provided
39
Q

patient preparation for SBE

A
  • low residue diet for 2 days before exam
  • NPO 8 hours
  • pharynx anesthesized with Xylocaine spray
40
Q

instrument used in SBE

A

bilbao-dotter tube with guidewire or silk tube

41
Q

what preliminary film is needed for SBE

A

supine abdomen

42
Q

after care of SBE

A
  • NIL orally for 5hrs post procedure
  • pt warned that diarrhea may occur
43
Q

preparation of patient for barium enema

A
  • low residue diet 3 days prior
  • fluid intake and laxative on the day prior to exam
44
Q

contraindication for buscopan

A
  • glaucoma
  • gravis
  • pyloric stenosis
  • benign prostate hypertrophy
45
Q

contraindication of glucagon

A
  • pheochromocytoma
  • insulinoma
46
Q

after care of barium enema

A
  • stool might be white for a few days
  • drink more water
  • cannot leave dpt until blurring of vision resolves
47
Q

complication for barium enema

A
  • perforations
  • obstruction
  • intramural barium
  • cardiac arrhythmia
  • transient bacteraemia
  • side effects of pharmacological agents used
48
Q

what are the things to look out for in a barium/contrast swallow study

A
  • size and location of esophagus
  • shape and patency
  • function
49
Q

how is barium contrast prepared for barium meal and FT

A

EZ HD + 65ml warm water

50
Q

how is barium contrast prepared for barium swallow

A

EZ HD + 50ml

51
Q

Contrast used for VFSS

A

EZ-paque:
- EZ-HD thick (+52ml warm water)
- EZ-HD thin (+100ml warm water)

EZ paste

thicken up powder

52
Q

what medical conditions will allow patients to do VFSS in a side lying position

A
  • low BP
  • acute stroke
  • spinal cord injury bracing
  • other skeletal limitations
53
Q

Advantages of SBE over FT

A
  • can avoid the obscuring of small bowel by the Barium filled upper GI tract
  • can avoid pyloric control over rate of barium transit
54
Q

why is low residue diet necessary

A

to prevent gas formation from excessive fermentation of intestinal contents

55
Q

advantages of buscopan

A
  • immediate action
  • short duration (~15 mins)
  • cheap
56
Q

side effect of buscopan

A
  • vision blur
  • dry mouth
  • tachycardia
  • urinary retention
  • acute gastric dilatation
57
Q

advantages of glucagon

A
  • more potent
  • short duration
  • not interefere with bowel transit time
58
Q

side effect of glucagon

A
  • longer waiting time (~1min)
  • cost

Fluoro and angio (9 decks)

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