Fluoroscopically Guided Contrast Examinations Flashcards
what barium studies can be undertaken? - 3 points
barium swallow
barium meal
barium follow through
what iodinated studies can be undertaken? - 3 points
shoulder arthography
ERCP
HSG
what are barium swallows used to investigate - 3 points
hypopharynx, oesophagus, fundus
what is the prep for a barium swallow
no prep but some protocols = overnight fasting in case stomach is to be examined, avoid smoking and chewing gum to decrease the secretions in ora cavity and pharynx - can prevent the barium contrast from adhering to the mucosal lining preventing clear visualisation of any defects or pathology
what is the procedure for a barium swallow
barium sulphate powder is mixed with required amount of drinking water to make up the barium solution, patient stands erect in AP position in front of the fluoroscopy unit and asked to take a mouthful and hold it in the oral cavity until asked to swallow, during swallowing = epiglottis covers trachea entry to prevent contrast entering, directed towards oesophagus (posteriorly)
what screening is used in a barium swallow
dynamic imaging of the swallowing mechanism along with still images if required
pulsed/intermittent screening - to reduce dose
images acquired with patient in AP and lateral positions
what are the normal radiographic appearances on a barium swallow
oesophagus should have smooth outline demonstrated by the barium sulphate
when oesophagus is empty and contracted, barium should lie in the folds of the mucosa and appear as 3/4 parallel straight lines
several indentations along the length of the oesophagus = aortic arch, cervical vertebrae, diaphragm = NORMAL therefore shouldnt be misdiagnosed
what are barium meals used to investigate - 2 points
stomach and duodenum
what is the preparation for a barium meal
NBM 6 hrs prior, avoid smoking the day of - increases gastric motility and contrast will move too quickly through the stomach
what is the procedure for a barium meal
what positions are the patient in and why
patient asked to take a spoonful of carbex granules and a measure of carbex liquid - when mixed they form C02 to distend the stomach assisting the barium sulphate solution in coating the lining of the stomach allowing visualisation of the rugae of the stomach - too much barium sulphate decreases the image quality
patient stands initially to drink then is tilted horizontally, patient lies supine, prone and laterally to coat the stomach walls and the images are taken accordingly
anti-spasmodic may be administered as part of the barium meal procedure before or part way through the exam
describe anti-spasmodic
BUSCOPAN - muscle relaxant
20mg administered intravenously to reduce spasm by relaxing the smooth muscle of the GIT - also more comfortable for the patient
can also relax the smooth muscle in the eye causing blurred vision so glucagon can be used as an alternative for patients with certain ocular or cardiovascular conditions
which position demonstrates which anatomy in a barium meal
LPO - antrum and greater curve
supine - antrum, body and lesser curve
RPO - lesser curve en face
right lateral (45 degree upward tilt of head end of table ) - fundus
what do small bowel barium studies investigate
duodeno-jujenal flexure to the ileo-caecal valve
what is the preparation for a barium follow through
NBM 6 hrs prior
what is the procedure for a barium follow through
static images taken to check progress of the barium sulphate though the small intestine
prone position to compress the abdominal soft tissue which helps separate bowel loops and reduce scatter enhancing image quality
images at different time intervals until the barium sulphate reaches the ileo-caecal valve
can take several hours depending on individual patient and how active their bowel is therefore static x-ray unit used
why must the time interval be recorded on each barium follow through image
so the motility rate of the small bowel can be identified and related to certain pathology
what is the preparation for a shoulder arthography
none or NBM 4 hrs prior
if MR arthrogram after then let MR know when the procedure is going to commence
aseptic technique
what images should be taken for a shoulder arthrogram
assess position of needle
needle entry point and distension of the capsule
full distension of the capsule with contrast
what does ERCP stand for
endoscopic retrograde cholangiopancreatography
what is the preparation for ERCP
why are ERCPs done
NBM 4-6 hrs prior
antibiotic cover
to examine using an endoscope the common bile duct between the gall bladder and the bowel - can identify gall stones and/or tumours that may be blocking the duct and with the correct endoscope can remove any material causing the blockage and take biopsies of affected area
what is the procedure of an ERCP
pharynx anaesthetised to aid passage of endoscope and sedative administered
patient lies prone with right side raised 30-45 degrees and endoscope introduced
patients vital signs monitored throughout procedure
what does HSG stand for
hysterosalpingography
what is the preparation for a HSG
consider pregnancy status and application of 10 day rule
empty bladder
reassurance and support for patient - may have several miscarriages prior to exam
what is the procedure for a HSG
patient lies supine, area cleansed and speculum inserted to allow location of cervix
forceps may be used to stabilise cervix position
catheter inserted into external os and contrast media injected into uterus (speculum may be removed at this point)
what is the aftercare for a HSG
advice on use of analgesia
sanitary pad - slight bleeding may occur
advice/guidance on heavy bleeding
if uterine tubes = open then patient happy but may be told they’re blocked and so patient may be sad
procedure sometimes can be a treatment with the injection of contrast opening up the tubes
