large bowel barium enema Flashcards
if doing an upper and lower GI what do you start with
- always start with lower
- non contrast first
- IV contrast second
- Barium enema
- Upper GI
Why do we do lower bowel imaging
- diagnose pathological conditions of the large intestine
how do we get contrast in whole Large bowel
- rolling patient around
- gravity
What does the bowel look like Single contrast study
- Barium filled
What does bowel look like in double contrast study
- air filled
- barium coated
Indications of Large Bowel Series
- change in bowel habits
- abdomnial pain
- palpable mass
What pathology is this
- diverticulosis
Bowel Preperation
- essential that bowel completely cleansed of stool
- retained stool resembles pathology
- scout radiograph to assess for stool and gross anatomy
What is wrong with this image
Arrow pointing to residual stool
Patient preparation for Bowel enema
- low residue diet
- fluids only 24 hours prior
- laxative day before exam
- possible suppository before exam
Contraindications to Prep for Large Bowel Enema (laxative/cathartic)
- gross bleeding
- severe diarrhea
- known obstruction
- inflammatory conditions
Insulin Dependent patients Large Bowel prep
- require special preexam instructions concerning administration of morning insulin
Anticholinergic Drugs
- Buscopan or Glucagon
- reduces motility
- relieve spasm to allowe bowel to expand
SIngle and Double Contrast Barium Enema Tips
Enema Tip Insertion Procedure
- Check Balloon
- Describe tip insertion & answer questions
- Place patient in sims position while keeping patient covered
- Shake enema bag to ensure proper mixture
- Lube up enema tip
- On expiration direct enema tip in up to 10cm
- Tape tubing to patient
- Ensure enema pole is 60cm above the table
Safety Concerns for Barium Enema
- review patients chart
- never force enema tip into rectum
- height of the bag does not exceed 60cm
- verify water temp
- escort patients to washroom after study
Complications of Barium Enema
more common in infants and elderly
- patients on steroids weaken the bowel wall
- rectal perforation
- hypersensitivity/latex allergy
What is being performed in this image
- Double contrast barium study
Overhead images for barium enema
- PA/AP
- PA/AP axial
- RAO & LAO or RPO and LPO
- Lateral Rectum
- R/L decubitus views
- Erect obliques for flexures
Centering Point and positon for AP/PA Large Bowel Studies
- Iliac Crest
- Trendelenburg: seperates redundant and overlapping loops of bowel
What is demonstrated in LPO/RAO large bowel
- hepatic flexure, ascending colon, and sigmoid colon
What is seen in RPO/LAO Large bowel
- splenic flexure
- descending colon
- cecum
Lateral Rectum Technique
- similar to lat sacrum/coccyx
- remove enema tip
- often done prone with XTL
- last image we do
What does right lateral decubitus view demonstrate
- center 2” above crest
- lateral wall of descending colon
- medial wall of ascending colon
- other walls are filled with barium
