Barium Enema

Question 1

barium enema purpose

Answer 1

to study the form and function of the large intestine to detect abnormal conditions
performed as single or double contrast

Question 2

barium enema contraindications

Answer 2

possible perforated hollow viscus
possible large bowel obstruction
appendicitis

Question 3

clinical indications for barium enemas

Answer 3

colitis 
diverticulum 
intussusception
neoplasms
annular carcinoma 
polyps 
volvulus

Question 4

colitis

Answer 4

inflammatory condition of the large intestine

Question 5

ulcerative colitis

Answer 5

severe form of colitis
most commonly in young adults
chronic condition

Question 6

long term bouts of ulcerative colitis may lead to

Answer 6

stovepipe or leadpipe colon

loss of haustral markings

Question 7

diverticulum

Answer 7

outpouching of mucosal wall

Question 8

diverticulosis

Answer 8

having numerous diverticula

Question 9

diverticulitis

Answer 9

inflamed diverticula due to infection

Question 10

is diverticula best demonstrated with a single or a double contrast BE ?

Answer 10

double contrast BE

Question 11

intussusception

Answer 11

telescoping or invagination of one part of intestine into another

Question 12

annular carcinoma

Answer 12

typical form of colon cancer
forms apple core or napkin ring
results in large bowel obstruction

Question 13

polyps

Answer 13

saclike projections that project inward into the lumen of the intestine

Question 14

volvulus

Answer 14

twisting of portion of intestine on its own mesentary
leads to mechanical obstruction
most common in men ages 20-50

Question 15

barium enema patient prep

Answer 15

large bowel must be completely empty of its contents
light evening meal prior 
bowel cleansing cathartics  
NPO after midnight 8HRS 
no gum chewing
no smoking
cleansing enema morning of exam 
(NO LAXITIVES MORNING OF EXAM)

Question 16

contraindications to laxatives (cathartics)

Answer 16

gross bleeding
diarrhea
obstruction
inflammatory conditions

Question 17

2 types of laxatives

Answer 17

1. irritant laxatives

2. saline laxatives

Question 18

irritant laxatives

Answer 18

ex: caster oil

rarely used for BE’s

Question 19

Saline laxatives

Answer 19

magnesium citrate

magnesium sulfate

Question 20

3 most common types of enema tips

Answer 20

1. plastic disposable
2. rectal retention
3. contrast retention (double contrast)

Question 21

T or F
retention catheters should be fully inflated only under fluoroscopic guidance provided by the radiologist because of potential danger of intestinal rupture

Answer 21

true

Question 22

when is iodinated water soluble contrast used

Answer 22

in case of perforated or lacerated intestinal wall

or if pt. is scheduled for surgery right after

Question 23

temp of water

Answer 23

some say cold between 40-50 degrees F

some say room temp 85-90 degrees F

Question 24

what is a common side effect of a BE

Answer 24

a spasm

can be caused by pt. anxiety, discomfort etc.

Question 25

what my be added to the contrast to minimize spasm

Answer 25

lidocaine

Question 26

if spasm occurs during procedure what can be given intravenously

Answer 26

glucagon

Question 27

pt is placed in what position before enema tip is inserted

Answer 27

sims position

Question 28

what does sim's position do

Answer 28

relaxes abdominal muscles and decreases pressure

Question 29

enema tip insertion

Answer 29

elevate right buttock laterally tell pt. relax take deep breaths tip inserted on expiration

Question 30

how should the tip be directed

Answer 30

1-1and1/2 inches aimed toward umbilicus then follow the curve of the rectum slightly superior

Question 31

the total insertion of the tip should not exceed

Answer 31

4 inches (10cm)

Question 32

the enema contents should be NO HIGHER than

Answer 32

24 inches (60 cm) above the xray table

Question 33

list of lower GI procedures

Answer 33

1. single contrast BE 2. double contrast BE 3. evacuative proctography (defecography)

Question 34

single contrast BE

Answer 34

``` positive contrast only barium fills large intestine rectum fills slowly when exam is done bag is lowered so barium flows back into bag pt. sent to bathroom postevac radiograph is taken ```

Question 35

most commonly obtained projections for a single contrast BE

Answer 35

``` scout PA or AP PA or PA oblique axial lateral post evac AP or PA ```

Question 36

double contrast barium enema

Answer 36

more effective for demonstrating polyps and diverticula | air and barium introduced into large intestine

Question 37

evacuative proctograpy purpose

Answer 37

functional study of anus and rectum that is conducted during the evacuation and rest phases of defecation

Question 38

T or F | no pt. prep necessary for defacography

Answer 38

TRUE

Question 39

defacography pathologic indications

Answer 39

rectocele rectal intussusception rectal prolapse

Question 40

rectocele

Answer 40

blind pouch of rectum caused by weakening of anterior or posterior wall

Question 41

rectal intussusception

Answer 41

telescoping or invagination of the rectal portion of the bowel

Question 42

rectal prolapse

Answer 42

protrusion of rectal tissue through the anus to the exterior of the body

Question 43

do you need very high density barium sulfate for defacography

Answer 43

yes | some departments mix barium with potato starch

Question 44

applicator for defacography

Answer 44

resembles a caulking gun anatrast is the contrast put into the gun flexible enema tip attatched

Question 45

defacography procedure

Answer 45

pt. in a lateral recumbant position on the cart contrast media put into rectum small BB placed at the anal orifice pt. put on the commode for filming during defecation a lateral recumbant post evac radiograph is taken

Question 46

anorectal angle

Answer 46

alignment between the anus and rectum that shifts between the rest and evacuation phases

Question 47

radiologist measures the anorectal angle during rest and evacuation phases to determine whether any abnormalities exist

Answer 47

TRUE

Question 48

colostomy

Answer 48

an incision into the colon to create an artificial opening to the exterior of the abdomen serves as a substitute anus

Question 49

clinical indications for a colostomy barium enema

Answer 49

to asses for proper healing, obstruction or leakage, or to perform presurgical evaluation