Barium enema 3

Question 1

What two substances are introduced into the colon to achieve the double-contrast effect? What is the approximate volume of the second substance?

Answer 1

Barium suspension and air or carbon dioxide (approximately 1000ml of air or carbon dioxide).

Question 2

What initial position is the patient placed in for the insertion of the catheter during a double contrast barium enema?

Answer 2

Left lateral position.

Question 3

What two pharmacological agents are commonly administered intravenously during a double contrast barium enema, and what are their respective dosages?

Answer 3

Buscopan (20 mg) or glucagon (1 mg). (Reduces peristalsis)

Question 3

List the four suggested initial radiographic projections obtained when sufficient distention of the colon has been achieved during a double contrast barium enema, ensuring the rectum is included.

Answer 3

• Postero-Anterior (PA) projection; Left Postero-Anterior Oblique (LAO) projection; Right Postero-Anterior Oblique (RAO) projection; Right lateral projection.

Question 4

After the barium infusion, how is the double-contrast effect achieved?

Answer 4

The catheter tube is occluded, and air or carbon dioxide is gently pumped into the bowel to distend it and coat the mucosal surfaces with barium.

Question 4

List the three radiographic projections typically obtained with the patient in the supine position during a double contrast barium enema.

Answer 4

• Antero-Posterior (AP) projection
• Left Antero-Posterior Oblique (LPO) projection
• Right Antero-Posterior Oblique (RPO) projection.

Question 5

After the initial projections, what position is the patient turned to for imaging the transverse colon and its flexures during a double contrast barium enema?

Answer 5

Supine position.

Question 5

What decubitus projections are performed to include the rectum during a double contrast barium enema?

Answer 5

Right lateral decubitus and Left lateral decubitus.

Question 5

List the three radiographic projections typically obtained with the patient in the erect position during a double contrast barium enema.

Answer 5

LAO
RAO

Question 6

In what position is the patient placed for the final projections of the horizontal colon and the colic flexures during a double contrast barium enema?

Answer 6

Erect position.

Question 7

What are three advantages of double contrast barium enema over single contrast?

Answer 7

Better surface details; surface lesions can be demonstrated to the best effect; easy unraveling of the colon as it is possible to look through loops.

Question 7

What are three disadvantages of double contrast barium enema compared to single contrast?

Answer 7

Difficult in uncooperative patients; fistulae/sinuses can be missed; effacement of submucosal detail and overlooking of annular/polypoid lesions is possible.

Question 8

What two post-procedure instructions should be given to a patient after a barium enema?

Answer 8

The patient should be warned that their bowel motion will be white for a few days; laxatives should be used to avoid barium impaction in patients with constipation.

Question 9

What are the three general categories of causes for complications following a barium enema procedure?

Answer 9

Preparation of patient, pharmacological agents, and the procedure itself.

Question 10

List six specific complications that can occur following a barium enema procedure.

Answer 10

• Perforation
• Inspissation of barium
• Water intoxication and electrolyte imbalance
• Caustic colitis
• Transient bacteremia.
• Complications due to pharmacological agents.