Small Bowel Series Flashcards
1
Q
what does the small intestine run between?
A
runs between the pyloric sphincter and ileocecal valve
2
Q
what is the small intestine composed of?
A
duodenum, jejunum and ileum
3
Q
when doing small bowel imaging include down to?
A
pubic symphysis
4
Q
differences in the 3 parts of the small intestine?
A
duodenum - shortest
Jejunum - coiled spring feathery appearance
Ileum - longest, few indentations, small diameter
5
Q
What is Ileus?
A
lack of movement of the intestines that can cause an obstruction
6
Q
Indications for small bowel imaging
A
- Pain
- Bleeding
- Enteritis
- Ileus (obstruction)
- Various malabsorption syndromes
- Crohn’s disease
- Diarrhea
- Partial obstruction
- Neoplasm
7
Q
contrast by mouth?
A
- in combination with an UGI
- SBFT only - oral method
- Can be done as part of an Upper GI study, where the contrast will be followed afterwards as it moves through the intestines
- Can also be done only to look at the small bowels, this usually involves the patient drinking oral contrast and taking images periodically as it moves through the bowels
8
Q
enteroclysis
A
- Direct injection of contrast into the bowel through an intestinal tube
- Can be referred to as a small intestine enema
- Enteroclysis is not as common
9
Q
contraindications
A
- Complete obstruction
- Suspected perforation
- Pre-surgical patients
- Concern regarding fecal impaction
10
Q
equipment
A
- barium
- fluoroscope
- spot image device
- over table tube
- video recording system
- time markers on all images
- May take video recordings, but will likely be single images taken at intervals using the spot image device
11
Q
Prep for SBFT
A
- low residue diet 2-3 days prior to exam
- NPO 8-12 hours before the exam
- No smoking or chewing gum
- Remove all clothing, put on hospital gown
- Possible cleansing enema before
- make sure to warn patient about the taste and texture of the barium mixture
12
Q
Contrast media
A
- Ba. Sulphate – BaSO4 (30%-50% w/v) - 1-2 cups (department specific)
- Optional 8 oz. gastric stimulants- Ice water, tea, coffee, water-soluble contrast media
- If perforation or obstruction -water-soluble iodinated contrast
- Possible negative contrast - CO2 crystals – ‘fizzy tablets’
- Gastric stimulants may be required if the contrast is moving too slowly through the patients. Standing up and walking around may also increase the rate of movement of the contrast. Often, these measures will be requested by the radiologist after reviewing the images if they feel that you need to pick up the pace
13
Q
Procedure
A
- Preliminary ‘Scout image’ – non contrast abdomen (optional)
- 35x43cm CR plates or Flat Panel Detectors as specified by the Radiologist (show radiologist after each image) Notation of time patient ingested first cup (8 oz) of barium
- Fluoroscopist will perform a routine UGI first - Ingestion of second cup of barium
- Sometimes you will do an Upper GI study first, followed by a small bowel follow through. In this case perform a non-contrast abdomen, followed by the UGI series, followed by the SBFT
- Radiologist must always be shown the images upon completing them. They will let you know when they want the next images taken, as well as if they want any additional views.
14
Q
Images for Upper GI and SBFT combination
A
- 1st image taken immediately following ingestion or at 15 minutes – PA/AP abdomen - Centered (L2) for stomach and proximal Small Bowel
- 30-minute image – PA/AP abdomen - Centered at (L2) for stomach and proximal Small Bowel
Include a time marker for each image
15
Q
Oral method SBFT
A
- After 30 min. image every half-hour - Centered at iliac crest (contrast usually in lower abdomen at this point)
- Image until Ba reaches the terminal ileum - (usually 2 hours)
- Possible delayed images every 30min – 1hr intervals
- Fluoroscopy and spot imaging of ileocecal valve and terminal ileum
If more time is needed –images every 2 hours - Remember to use time marker*
16
Q
Prone
A
- To compress the abdominal contents
- Provides radiation protection, better image quality
17
Q
Supine
A
- Demonstrates superior and lateral shift of barium-filled stomach
- Prevents compression of overlapping loops of intestine
18
Q
LPO
A
- Oblique view to demo the stomach and 1st part of duodenum
- Obliquity determined by anatomy
- Optional view in early stage
19
Q
PA or AP
A
Place time markers on all images
* don’t forget to show the radiologist each image after it is taken*
20
Q
Technique
A
- CP - L2 for early images 0 min. & 15 min.
- CP - at the iliac crest for delayed images
- Use high kVp – approx. 125kVp
- Trendelenburg – to unfold low-lying and superimposed bowel loops of ileum
- Full length imaging is complete when Ba. reaches ileocecal valve/region
- Fluoro with compression to follow
21
Q
Evaluation criteria
A
- Entire intestine on each image
- Stomach on initial image
- Time markers
- No rotation - Vertebral Column in the center
22
Q
compression paddle
A
- You may be required to perform imaging with a compression paddle afterwards to better show specific parts of the small intestine
- Paddle is used to reduce overlap of the bowel loops and separate the area of interest
- warn patient about compression beforehand
23
Q
Post-care
A
- Patient is encouraged to drink plenty of liquids
- Resume normal diet
- Warn about possible white bowel movements
24
Q
Enteroclysis
A
- Used when oral method fails to provide conclusive information
- Small bowel enema - using an NG, Bilbao-Dotter or Sellink tube passed to the duodenojejunal flexure - near ligament of Treitz
- no enema beforehand, as some enema fluid can be retained in the small intestine
25
Q
Bilbao-Dotter and Sellink tubes
A
specially designed for enteroclysis procedures
26
Q
rate of enteroclysis
A
- Ba. runs in at rate of 100 ml/min until contrast reaches cecum
- D/C examination - Air injected as well as contrast
- Spot images, with and without compression
