Week 10- barium Flashcards
what are the 5 barium studies?
Barium Swallow
Barium Meal
Barium meal and follow through
Barium Small Bowel Series
Barium Enema
what anatomy is studied in a barium swallow and what is it used for
From mouth/tongue to Larynx
More often it is to assess the patients ability to swallow
what is the patient preparation for a barium swallow?
- check pregnancy
- check if patient has had other barium studies/biliary studies
- night before: pt doesn’t eat anything
- NBM or only clear fluids
- change into hospital gown, remove metal items from upper GIT
what is a normal barium swallow procedure
-Fluoroscopy is used initially to visualise swallowing mechanisms functionality and to make sure on initial swallow there is no aspiration.
A small amount of barium (a sip) is taken at this stage: held in the mouth until given the ok to swallow
Once safety has been established, a full cup of barium is given to the patient
The patient is standing upright or seated, in the fluoroscopic machine
List 6 indications for a barium swallow
- dysphagia
- dyspepsia
- nausea
- heart burn or reflex
- mass in oesophagus and pharynx areas
- unexpected weight loss
- unexpected weight loss
- suspected hiatus hernia
- inflammatory disease of the oesophagus
- foreign body
- ulcers
what happens if there is a total restriction (blockage) during a barium swallow?
immediately stop
Now to figure out how to remove barium
what is a general protocol for a barium swallow procedure
pre contrast scan taken PA/AP and lateral
- patient may stand lateral or PA inside fluoro unit
- test barium ‘sip’
- initial ‘mouth full’ is swallowd under fluoro
- static images, positioned:
- PA
- Lateral
- RAO
- LAO
imaging criteria for barium swallow (common exam Q)
- All Imaging must answer the clinical Q
- The images taken must display the sequence of events during the procedure.
- Correct annotations must be included.
- Patient identification
- Radiological identifications
- The projection the image was taken in
- Correct numbering of images
in any procedure with contrast, what must be included?
- The images must be sequenced
- The images must state how the image was taken
- The images must tell a “story”
- The images must answer the question on the referral
list 5 Barium swallow contraindications
previous allergy to barium
hematemesis
drooling
dysphagia
vocal cord paralysis
intubated
known aspiration
fistula evident
post-op oesophageal leak
pregnancy
anatomy covered in a barium meal
mouth to larynx plus the duodenum as well as the Oesophagus
indications for a barium meal
- dysphagia
- dyspepsia
- nausea
- heart burn or reflex
- mass in oesophagus and pharynx areas
- unexpected weight loss
- unexpected weight loss
- suspected hiatus hernia
- inflammatory disease of the oesophagus
- foreign body
- ulcers
- specific pathology in the duodenum or jejunum
contraindications for a barium meal
previous allergy to barium
hematemesis
drooling
dysphagia
vocal cord paralysis
intubated
known aspiration
fistula evident
post-op oesophageal leak
pregnancy
Complete bowel obstruction in Jejunum
Perforation in duodenum or small bowel
barium meal prep
- check pregnancy
- check if patient has had other barium studies/biliary studies
- night before: pt doesn’t eat anything
- NBM or only clear fluids
- change into hospital gown, remove metal items from upper GIT
use of buscopan
smooth muscle relaxant: slows the bowel to allow for good imaging
contraindications of buscopan (8)
- fructose intolerance
- myasthenia gravis
- glaucoma
- mega colon
- heart arythmia
- bowel/stumoch onstruction
- warfarin or heparin
- passed its use by date
how can buscopan cause problems
- it can affect other muscle groups besides the colon
- If eye muscles don’t work or are slowed down then pressure builds up in the eye.
- Glaucoma is when the optic nerve is slowly compromised. if Buscopan causes increased eye pressure, it can accelerate the underlying condition of Glaucoma.
imaging techniques for barium meal
Control image
Double contrast
Single contrast: barium only
Supine or erect
RAO: duodenal cap
Erect LPO and lateral: different views of duodenal cap
Prone shows the mid portion of the duodenum
Supine RPO shows the lower 2/3s of the duodenum
post care for barium meal
Bowel motions may be a “lighter” colour for up to 72 hours after the procedure
“pushing” to have a bowel motion too
hard may cause internal bleeding
Eat healthy foods like grains, vegetables to aid in bowel motion
Drink plenty of water for the next 24hrs after the procedure
Drinking dehydrating substances (eg alcohol, coffee, caffeine drinks etc) may cause the Barium to “set” or harden causing constipation
Prune juice will help in improving the motility of the bowel
complications of barium meal
Usually arise from lack of after care.
the patient will usually have a bowel blockage, react to the barium in some way.
barium meal and follow through vs. small bowel series
Barium meal and follow through: mouth to larynx plus the duodenum as well as the Oesophagus and small bowel
Small bowel series: only examines the small bowel
barium prep for barium meal and follow through and small bowel series
Larger dose of Barium is given so that ALL of the small bowel can be seen.
The examination can take up to 8 hours. To aid in the flow of Barium, the patient can walk around the department, drink a little water to help flush things through
barium meal and follow through and SBS prep
- check pregnancy
- check if patient has had other barium studies/biliary studies
- night before: pt doesn’t eat anything
- NBM or only clear fluids
- change into hospital gown, remove metal items from upper GIT
barium meal and follow through and SBS indications
- Strictures
- Mass
- Abnormal motility of the small bowel
- Bloating
- Generalised pain
- Excessive Nausea
- Non synchronized contractions of the small bowel
- Diarrhoea
- Constipation
- Gastroparesis
imaging for barium meal and follow through
Control image
Double contrast
Single contrast: barium only
Supine or erect
RAO: duodenal cap
Erect LPO and lateral: different views of duodenal cap
Prone shows the mid portion of the duodenum
Supine RPO shows the lower 2/3s of the duodenum
imaging for SBS
- Immediate AXR
- 15 minute AXR
- 30 minute AXR
Some images may be done Prone to “spread out” the small bowel. Sometimes sponges are used to put pressure on various parts of the small bowel.
The aim of the sequence of images is to demonstrate ALL of the small bowel.
Imaging ends when the Ileocecal junction is reached.
post care for barium meal and follow through and SBS
Bowel motions may be a “lighter” colour for up to 72 hours after the procedure
“pushing” to have a bowel motion too
hard may cause internal bleeding
Eat healthy foods like grains, vegetables to aid in bowel motion
Drink plenty of water for the next 24hrs after the procedure
Drinking dehydrating substances (eg alcohol, coffee, caffeine drinks etc) may cause the Barium to “set” or harden causing constipation
Prune juice will help in improving the motility of the bowel
complications of barium meal and follow through and SBS
bowel blockage
gastrografin use in SBS indications
- Suspected Bowel perforation
- Peptic ulcer causing perforation
- Resection of bowel (post-operative)
- Complete obstruction in bowel
- Post-operative ileus (decreased motility)
- Acute haemorrhage
- Pre-operative investigation
- Megacolon
- Fistula
preparation for gastrografin SBS
check pregnancy
- check if patient has had other barium studies/biliary studies
- night before: pt doesn’t eat anything
- NBM or only clear fluids
- change into hospital gown, remove metal items from upper GIT
contraindications for gastrografin SBS
- Suspected Aspiration
- Broncho Fistula
- Allergy/sensitivity to Gastrografin or Iodine
- Pregnancy
- Same contraindications as for Iodine studies
barium enema antomy covered
large bowel only
barium enema bag prep
- Clamp the end of the tub
- Pour the Barium into the bag
- Before tipping the bag up, fill the bag with air
- Once the bag is full of air and Barium tip the bag up so that the barium runs to the bottom of the tube
- Hang the bag up on an IV pole
- Have tape ready so the tube can be secured.
- For single contrast Barium study you do not need to blow the bag up with air
barium enema indications
- Generalised persistent abdominal pain
- Suspected blood loss from rectal area
- Change in bowel habit
- Unexplained weight loss
- Irritable Bowel Syndrome
- Constipation
- Blood in Stool
- Chronic Diarrhoea
- Inflammation
- Cancer
- Abdominal mass
- Polyps
- Partial Obstruction
- Crohn’s Disease
barium enema contraindications
- Suspected “leak”
- Allergy (sensitivity to Barium)
- Pregnancy
- Megacolon
- Acute abdominal pain
- Rectal pathology that could be perforated on inserting the tube
imaging sequence for barium enema
- Pre Contrast AXR(s).
- KV setting should be around 90kv
- The patient may be required to roll 360 degrees to coat the inner lining of the bowel
- Supine projection: general anatomical view
- Prone projection: to move the area to the ascending and descending colon
- RAO to include rectum
- LPO for Hepatic Flexure
- RPO for Splenic Flexure
- Supine Caudal (20 degrees) over rectum area
- L and R decubitus to see filling of Ascending and Descending Colon
- Lateral (patient prone) Rectal X-ray
after care for barium enema
- The tube is withdrawn, and the patient is asked to void in the toilet
- Let the patient know that the stool will be white colour for up to 72 hours
- Bloating can occur and flatulence is a normal affect, and not to hold it in as it can cause an obstruction
- Patient should drink water, LOTS of water
- Patient should avoid dehydrating substances
complications of barium enema
- Cardiac arrhythmia
- Impaction
- Bloating
- Reaction to Contrast
- Nausea/vomiting
- Fever
- Tender hard/ distended abdomen
- Unable to have a bowel motion
- Blood in stool or bile in stool or both
- Acute breathlessness
