Large Bowel Barium Enema : Systems Flashcards
What are Lower GI Tract Studies?
Studies performed to diagnose pathological conditions of the large intestine
Requires contrast for visualization.
What is the difference between single and double contrast in bowel studies?
Single contrast uses barium only, while double contrast uses barium and room air/carbon dioxide
Carbon dioxide is absorbed more rapidly than nitrogen in room air, producing less cramping.
What are common indications for a bowel study?
- Change in bowel habits
- Abdominal pain
- Palpable mass
- Ulcerative colitis/Crohn’s disease
- Intussusception
- Volvulus
- Polyps
- Diverticulitis vs. diverticulosis
- Fistulas
- R/O cancer
- Hirschsprung’s disease
- Congenital aganglionic megacolon
What are the contraindications to using barium for imaging?
- Suspected perforation
- Known bowel obstruction
- Immediately prior to surgery
- Bowel biopsy in the past 24 hours
- Recent pelvic irradiation
- Poor bowel preparations
What is essential for bowel preparation prior to a study?
The bowel must be completely cleansed of stool
Retained stool can resemble polyps and obstruct visualization.
What dietary preparation is recommended before a bowel study?
- Low residue diet 3 days prior
- Fluids only 24 hours prior
- Laxative day before (e.g., Citro-Mag, PEG, Picolax)
What are contraindications to laxative or cathartic use?
- Gross bleeding
- Severe diarrhea
- Known obstruction
- Inflammatory conditions (e.g., appendicitis)
What should be done to help manage patient discomfort during a bowel study?
Administer anticholinergic drugs such as Buscopan or glucagon
These drugs reduce motility and relieve spasms.
What is the recommended temperature for barium used in studies?
Cold: 41°F (5°C) for less irritation and a mild anesthetic effect; Warm: 85-90°F (29-30°C) for maximum patient comfort
Never use hot water.
What is the procedure for enema tip insertion?
- Check retention balloon
- Describe procedure to the patient
- Place patient in Sim’s position
- Shake enema bag
- Coat enema tip with lubricant
- Insert tip toward umbilicus
- Advance tip superiorly
- Inflate retention tip when directed
- Ensure IV pole/enema bag is no more than 24 inches above the table
What are common complications of bowel studies?
- Rectal perforation
- Hypersensitivity reactions
- Latex allergy
More common in infants and the elderly.
What does a single contrast study demonstrate?
General anatomy of the colon and tonus using thinner barium
Barium is run intermittently with rotation of the patient.
What is the purpose of using air in double contrast studies?
Air distends the colon for optimum visualization of the barium-coated mucosa
Best demonstrates polypoid lesions.
What are the key views obtained during overhead imaging?
- PA or AP
- PA Axial or AP Axial
- Lateral rectum
- RAO & LAO or RPO & LPO
- Erect obliques for flexures
What post-examination care should be provided to patients?
- Drain as much barium as possible
- Escort to washroom
- Provide post-care instructions
- Advise on white stools and encourage fluid intake
What are the characteristics of colostomy imaging methods?
Ostomy is named by the area of surgery, colostomy for colon and ileostomy for ileum
Stoma may be temporary or permanent.
What preparations should be made for a patient with a colostomy?
- Irrigation of the stoma the night prior and in the morning
- NPO after 10 PM the evening before
- Patient to supply clean pouch or seal for after the enema
What techniques are used for colostomy imaging?
- Patient supine
- Remove and discard dressing/bag
- Clean skin around stoma and place gauze until ready
- Lubricate and insert tube
When is the trendelenberg position used?
During PA and AP images
Why use a trendelenberg position?
To separate redundant and overlapping loops of bowel
To separate redundant and overlapping loops of bowel
