Systems-Large Bowel BE Flashcards
What are the two types of contrast that can be used for large bowel images?
- Single contrast using barium only
- Double contrast using barium and room air/carbon dioxide
T/F
For large bowel imaging, double contrast is used more often.
True
Why is using CO2 better than just using regular air for GI imaging?
Carbon dioxide is more rapidly absorbed compared to the nitrogen in room air which produces less cramping
What are 3 examples of clinical indications for large bowel imaging?
- Change in bowel habits
- Abdominal pain
- Palpable Mass
What pathology is being shown here?
Apple core lesion
What pathology is being shown here?
Diverticulitus
What are the contraindications to barium?
- Suspected perforation/bowel obstruction
- Immediately prior to surgery
- Bowel biopsy in past 24hrs
- Recent pelvic irradiation
- Poor bowel preparations
T/F
It is essential that the bowel be completely cleansed of stool for large bowel imaging. Why or why not?
True; Retained ‘stool’ can resemble polyps or obstruct visualization of anatomy or pathology and prevents the barium from sticking to the bowel wall
What is the first image done for bowel imaging?
Scout images
What are the arrows pointing to?
Arrows pointing to residual stool mimicking pathology
What patient prep needs to be done prior to imaging for the large bowel series?
- Low residue diet 3 days prior
- Fluids only 24 hrs prior
- Laxative day before –
- Possible suppository or cleansing enema the morning of the exam
- Remove all clothing - hospital gown
What patient prep is done for infants for the large bowel series?
None
What are the contraindications to laxatives/cathartics?
- Gross bleeding
- Severe diarrhea
- Known obstruction
- Inflammatory conditions (appendicitis)
T/F
Patients with diabetes require special instructions from thier physicians for pre medications.
True
When are anticholinergic drugs adminsitered in large bowel imaging? What is it’s purpose?
-Administered intravenously before enema
-Administered to reduce motility, relieve spasm and allow bowel to expand for images
What are the contraindications to recieving anticholinergic drugs?
Cardiac disease, glaucoma
What should the tempeture of the varium be for large bowel imaging?
-Cold or warm
-Never hot
What are the benefits of cold barium?
- less irritation
- Has a mild anesthetic effect – relaxes colon
- Stimulates tonic contraction of the anal sphincter making it easier to retain
What are the benefits of warm barium?
Maximum patient comfort
What is the most common type of enema tube?
Double lumen tub
If a patient has an abnormal anus, what enema tube should you use?
A Foley catheter
What are the pathologies that require a foley catheter?
- Severe hemorrhoids
- Fissures
- Stricture
What does A and B inflate?
A=Air into the rectum
B=Inflates the balloon
What is this?
A CO2 machine for double contrast
Read over the steps of the large bowel imaging proceedure:
Slide 26
What body position should the patient be placed in for large bowel imaging?
Sims position
How should the enema tube be inserted into the patients anus?
- On expiration, direct enema tip anteriorly toward the umbilicus approximately 1 to 1 ½ “
- Advance tip superiorly. The total insertion should not exceed 4” or 10 cm.
How should the IV pole/enema bag be above the table?
No more than 24 inches (60 cm) above the table
Is this the initial insertment or final placement?
Initial insertment
T/F
The benefit of putting the patient in the sims position is that it reduces abdominal pressure and relaxes abdominal muscles.
True
What are the two methods for imaging the large bowel?
- Single contrast
- Double contrast
What does using single contrast for the large bowel demonstrate?
Demonstrates general anatomy of colon and tonus (muscle definition)
T/F
For single contrast studies, thinner barium is used
True
T/F
For double contrast studies, thicker barium is required
True
What best demonstrates polypoid lesions, single or double contrast?
Double contrast
T/F
With double contrast, air distends the colon
True
What is the proceedure for imaging the large bowel with single contrast step by step?
- Scout
- Ba run intermittently, rotate pt. to inspect all area of the bowel, spot images
- Overhead tube views
- Patient evacuates the barium in the bathroom
- Post evacuation erect image obtained
What are the overhead tube veiws for the single contrast studies of the large bowel?
- PA or AP,
- PA Axial or AP Axial,
- both obliques,
- lateral rectum
What kVp is used for the overhead tube views of the large bowel (single contrast)?
High kVp – 100-125 kVp
What kVp is used for the scout views for the single contrast study of the large bowel?
80-85 kVp
Label 1-9
- Left colic flexure
- Right colic flexure
- Transverse colon
- Descending colon
- Ascending colon
- Terminal ileum
- Cecum
- Sigmoid
- Rectum
Is this image taken using single or double contrast?
Single contrast
What type of image is this? What are the arrows pointing to?
-Post evac image
-Pointing to haustra
What are the 2 methods of double contrast imaging of the large bowel?
- Single stage procedure
- Two stage procedure
What is the step by step proceedure of the single stage procedure for the double contrast method?
-Barium and air are introduced together
What are the benefits of the double contrast single stage procedure?
Reduces the time for the exam and radiation exposure
What is the step by step proceedure of the double step procedure for the double contrast method?
- Barium injected until it fills the intestine to the splenic flexure
sims positioning and moving around - Air injected to push the barium through to the right side
- Enema bag is lowered to the ground and as much barium is drained as possible
- Leaves behind only the barium coating the wall
Is this a single or a double contrast image?
Double contrast image
What is the centering point for the AP/PA imaging of the large bowel?
Iliac crests
What projection is this?
AP or PA of the large bowel
What does the RAO/LPO imaging of the large bowel demonstrate?
Best demonstrates the hepatic flexure, ascending colon, and sigmoid colon
How much should the patient be obliqued for imaging of the large bowel?
45 degrees from table
What is the centering point for the oblique images for the large bowel?
1”-2”(2.5-5cm) lateral to the midline on the elevated side at level of iliac crests
What is best demonstrated in the LAO/RPO position for the oblique images of the large bowel?
Best demonstrates the splenic flexure, descending colon, and cecum
What body position is this? What side is it best demonstrating?
-LAO or RPO
-Showing left side
What flexure is best demonstrated here?
Splenic flexure
Is this done standing or recumbant? How do you know?
Standing-barium in the inf portion of the bowels
Which side is being demonstrated in a lateral rectum?
The side that is down
T/F
Do NOT remove the enema tip prior to taking lateral rectum images.
False; remove enema tip prior to lateral rectum images
What ussually is the body position for the lateral rectum?
Ventral decubitus position
T/F
The CP for the lateral rectum is anterior to midcoronal plane.
False; CP posterior to midcoronal plane
What does the Right Lateral Decubitus View of the large bowel best demonstrate?
- Lateral wall of descending colon
- Medial wall of ascending colon
What is the centering point for the Right Lateral Decubitus View of the large bowel?
– 2” above iliac crests and MSP
What position is this of the large bowel? What is it best demonstrating?
-Right Lateral Decubitus View
-Best demonstrates the lateral portion of the descending and the lateral portion of the ascending
What is best demonstrated in a Left Lateral Decubitus View of the large bowel?
- Lateral wall of ascending colon
- Medial wall of descending colon
What type of grid is preferred for the lateral decubitus positions of the large bowel?
Parrellel
What is best demonstrated in the AP Axial or PA Axial of the large bowel?
Best demonstrates the recto-sigmoid area
What is the angle and the centering point for the AP Axial of the large bowel?
-30°-40° cephalad
-CP 2” below ASIS in the MSP
What is the angle and the centering point for the PA Axial of the large bowel?
-30-40 degrees caudad
-CP – PSIS in the MSP
What projection of the large bowel is this?
AP Axial or PA Axial large bowel
What are the two post evac views for the large bowel?
AP or PA supine or erect
What post care instructions should be given for the large bowel proceedure?
-Inform about White stools
-Can suggest hot tea or coffee: stimulates evacuation
-Drink lots of liquids
What are the two methods for colostomy imaging?
S/C OR D/C Enema
How is an ostomy named?
Ostomy is Named by the Area of Surgery
If the If the opening for the ostomy is from the colon what is it called?
Colostomy
T/F
Stomas are permenent.
False; can be temporary or permenent
T/F
The best position to place a patient with an ostomy is in prone position due to the forces of gravity acting on the bowel.
False; NEVER place a patient with an ostomy in prone position
What equipment is required when performing colosomy images?
-Stomal disks to prevent leakage
-LAIRD irrigation tips
-Foley catheter
What patient prep is required prior to colostomy imaging?
-Irrigation of the stoma the night prior and in a.m.
-NPO after 10pm evening before
-Patient to supply clean pouch or seal for after enema
What type of catheter is this?
A foley catheter
What is the process step by step for colosomy imaging?
- Patient supine
- Remove and discard dressing and/or bag
- clean skin around stoma and place gauze over stoma until ready
- Lubricate tube, insert (patient may assist)
- Fluoro, spot images, over table images
What position is this and what flexure is best being demonstrated?
-RPO
-The splenic flexure
T/F
Post care for colostomy imaging can include possible irrigation of colostomy by radiologist
True
Watch videos
http://www.youtube.com/watch?v=AwGt8TKOrnI
https://www.youtube.com/watch?v=OW7BC8OHBl0
