Barium Enema Flashcards
(56 cards)
1
Q
Why are lower GI studies performed
A
to diagnose pathological conditions of the large intestine
2
Q
contrast of Lower GI
A
- Single contrast using barium only
- Double contrast using barium and room air/carbon dioxide - carbon dioxide is more rapidly absorbed compared to the nitrogen in room air (produces less cramping!)
3
Q
indications
A
- Change in bowel habits
- Abdominal pain
- Palpable Mass
- Ulcerative Colitis / Crohn’s Disease
- Intussusception
- Volvulus
- Polyps
- Diverticulitis vs. Diverticulosis
- Fistulas
- R/O Ca
- Hirschsprung’s/ Congenital Aganglionic Megacolon
4
Q
slide 6
A
“apple core” lesions
- radiographic appearance of cancer
5
Q
slide 7
A
diverticulosis - out pouching of the bowel walls
- radiographic appearance of low fiber/low residue diet - due to constipation
6
Q
contraindications to barium
A
- Suspected perforation
- Known bowel obstruction
- Immediately prior to surgery
- Bowel biopsy in past 24hrs
- Recent pelvic irradiation
- Poor bowel preparations
7
Q
equipment
A
- Fluoroscope
- Over table tube
- Enema tube and bag
- O2 or CO2
- IV Pole, towels, rags
8
Q
Bowel preparation
A
- It is essential that the bowel be completely cleansed of stool - retained “stool” can resemble polyps or obstruct visualization of anatomy or pathology (prevents the barium from sticking to the bowel wall)
- Scout radiograph - check for stool and assess gross anatomy
9
Q
slide 12
A
residual stool mimicking pathology
10
Q
patient prep
A
- Low residue diet 3 days prior
- Fluids only 24 hrs prior
- Laxative day before – this will be hospital specific
- Possible suppository or cleansing enema the morning of the exam
- Remove all clothing - hospital gown
- Infants – No Prep
11
Q
condraindication to prep
A
- Gross bleeding
- Severe diarrhea
- Known obstruction
- Inflammatory conditions (appendicitis)
12
Q
Patient care
A
- Uncomfortable
- Pain (in some cases)
- High anxiety
- Embarrassed- keep them covered at ALL TIMES!!
- Fear
- Abdominal cramping
- Inform the patient of the various positions throughout the exam
- The patient will feel the urge to defecate
- Give breathing instructions
13
Q
Anticholinergic drugs
A
Administered intravenously before enema
Buscopan or glucagon
- Reduce motility
- Relieve spasm, allow bowel to expand
14
Q
contraindications to anticholinergic drugs?
A
- cardiac disease and glaucoma
15
Q
glucagon
A
- Hormone found in the pancreas - used to raise blood sugar an antispasmodic medication for imaging
- Used if patient has contraindication to buscopan
- 1mg IV
Contraindicated for diabetics
16
Q
double air contrast study
A
- patient will experience much more discomfort
- reassure the patient
- Assist the patient with any difficult movements
- Remember to deflate the cuff prior to removing the enema tip
- Assist the patient to the bathroom
- Give the patient clean towels and extra gown
17
Q
cold barium
A
- 41F or 5C
- Produces less irritation
- Has a mild anesthetic effect – relaxes colon
- Stimulates tonic contraction of the anal sphincter making it easier to retain
18
Q
warm barium
A
- 85-90F or 29-30C
- Maximum patient comfort
- Warm in a sink of warm water
19
Q
common enema tubes
A
- disposable rectal retention tip
- double lumen tube
- inflatable balloon - inflater – 90 mL of air (1 full squeeze)
20
Q
abnormal anus considerations
A
Use a Foley catheter
- Severe hemorrhoids
- Fissures
- Stricture
21
Q
slide 23
A
know which tip is for barium only versus double contrast
22
Q
slide 24
A
what is squeezed for what
23
Q
slide 26 device
A
used for CO2 versus room air
24
Q
enema tip insertion procedure
A
Step 1 - check that the retention balloon works
Step 2- Describe the tip insertion procedure to the patient. Answer any questions.
Step 3- Place patient in Sim’s position - expose only anus, keep patient covered – modesty
Step 4- Shake enema bag to ensure proper mixing of suspension. Allow barium to flow through the tubing to remove any air in the system – clamp the tube
Step 5- Wearing gloves, coat enema tip well with water-soluble lubricant.
Step 6- On expiration, direct enema tip anteriorly toward the umbilicus approximately 1 to 1 ½ “
Step 7- Advance tip superiorly. The total insertion should not exceed 4” or 10 cm. Do NOT force enema tip – any resistance, call the Radiologist
Step 8- May tape tubing in place to prevent slippage. Inflate retention tip when directed by radiologist.
Step 9- Ensure IV pole/enema bag is no more than 24 inches (60 cm) above the table and tubing stopcock/clamp is in the closed position - no barium flows into the patient at this time.
25
sims position
reduces abdominal pressure and relaxes abdominal muscles
26
safety concerns
- Never force enema tip into rectum
- The height of the bag does should not exceed 24” (60cm) above the level of the anus
- Verify water temperature - never hot
- Escort patient to washroom after study
27
more common complications
Rectal PERFORATION
- in infants and elderly
- if obstructing neoplasm present
- if bowel wall ulcerated
- patients on steroids
28
hypersensitivity for barium enemas
latex sensitivity
29
single contrast method
- Demonstrates general anatomy of colon and tonus
- Thinner barium is used
30
Air contrast
- Double contrast (thicker barium is required)
- Air distends the colon
- Optimum visualization of the barium-coated mucosa - best demonstrates polypoid lesions
** areas best demonstrated are air-filled and barium coated**
31
Air-contrast barium single stage procedure
- Barium and air are introduced together
- Reduces the time for the exam and radiation exposure
32
Air-contrast barium two stage procedure
- Barium is instilled until it fills the intestine to the splenic flexure
- Air is instilled to push the barium through to the right side
- The enema bag is lowered to the ground and as much barium is drained as possible
- Second stage consists of filling the entire colon with air that pushes any barium forward leaving behind only the barium coating the wall
33
if there is ever a Ba enema and upper GI in the same day what goes first?
Ba enema
34
order of procedures
1. non-contrast
2. IV contrast
3. Ba enema
4. upper GI exam
35
overhead images
- PA or AP
- PA Axial or AP Axial
- RAO & LAO or RPO & LPO
- Lateral rectum
- Rt. and Lt. Lateral Decubitus views
- Erect - obliques for flexures (spot imaging or fluoro) - post evacuation (full length)
36
PA or AP
- CP - iliac crests
** trendelenberg - separates redundant and overlapping loops of bowel**
37
redundant mean?
extra bowel
- massive loops cause constipation
38
PA oblique (RAO)/ AP oblique (LPO)
- obliquity 45 to table
- CR - 1-2" lateral to midline on elevated side
- CP - level of iliac crests
**best demonstrates the hepatic flexure, ascending colon and sigmoid colon**
39
PA oblique (LAO)/ AP oblique (RPO)
- obliquity 35-45 to table
- CR - 1-2" lateral to midline on the elevated side
- CP - level of iliac crests (or a bit above the crests)
**best demonstrates the splenic flexure, descending colon and cecum**
40
how do we rotate patient to get gravity to move the barium through the entire large bowel
- stomach
- left side
- stomach
- right side
- back
- left side
41
Lateral rectum
- right or left side down
- CR - posterior to mid coronal plane
- CP - similar to lat sacrum/coccyx
- remove enema tip
- often done prone with horizontal CR **ventral decubitus position**
42
intussusception meaning
telescoping of the bowel into itself
- inner bowel risk of dying because of pinching off blood supply
- can cause obstruction
43
Right lateral decubitus view
- may be done AP or PA
- pt. lies on right side - arms above head
- elevated on radiolucent sponge
- use a portable grid
- CR - horizontal beam
- CP - 2" above iliac crests and along MSP
*best demonstrates lateral wall of descending colon and medial wall of ascending colon*
44
Left lateral decubitus view
- lying on left side AP or PA
- elevated on radiolucent sponge
- use a portable grid
- CR - horizontal beam
- CP - iliac crests along MSP
*best demonstrates lateral wall of ascending colon and medial wall of descending colon*
45
why is the rt. lateral decubitus CP higher?
because splenic flexure is more superior
46
AP Axial or PA Axial
- "butterfly"
- AP 30-40 cephalad - CP - 2" below ASIS in the MSP
- PA 30-40 caudad - CP - PSIS in the MSP
**best demonstrated the recto-sigmoid area**
47
Post examination
- Place bag on the floor and drain as much barium as possible
- Escort patient to the washroom to evacuate more barium and as much of the gas (air) as possible
- May perform final image(s) labeled: post evac
- Patient will be given post care instructions and sent to the changeroom
48
Post evacuation views
- PA or AP - erect or supine
- CP - at iliac crest for recumbent view
- CP - slightly lower for erect view
49
Colostomy imaging methods
- S/C or D/C enema
50
ostomy named by?
area of surgery
- If the opening is from the colon = colostomy; if it is from the ileum = ileostomy.
51
colostomy imaging
- The stoma (loop of bowel brought to the surface) could be temporary or permanent.
- Be sensitive to the patient and be professional at all times.
- Never use the prone position
52
colostomy imaging equipment
- As per Ba Enema
- Stomal disks to prevent leakage
- LAIRD irrigation tips
- Foley catheter - inflate balloon and use as a seal
- Stoma fragile and high risk of perforation
- BE CAREFUL
53
what does cathartic mean?
laxative
54
Patient prep for colostomy imaging?
- Irrigation of the stoma the night prior and in a.m.
- NPO after 10pm evening before
- Patient to supply clean pouch or seal for after enema - May reuse existing one
55
technique for colostomy imaging
- Patient supine – depends on site of colostomy
- Remove and discard dressing and/or bag
clean skin around stoma and place gauze over stoma until ready
- Lubricate tube, insert (patient may assist)
- Fluoro, spot images, over table images
56
Post care of colostomy enema
- possible irrigation of colostomy by radiologist
- patient can resume normal diet
- encouraged to drink lots of fluids
