week 9 - GIT Flashcards
what anatomy does barium/ contrast swallow see
esophagus
indication for barium swallow
- dysphagia
- anemia
- pain (during swallow)
contraindication for barium swallow
- GIT perforation
- intravasation
- constipation
2 types of contraindications
absolute contraindication
relative contraindication
when is contrast swallow used instead of barium swallow
when barium swallow is contraindicated
most common iodinated contrast for contrast swallow
gastrografin
characteristics of barium swallow contrast
- barium sulfate
- most common oral contrast agent for GIT studies
- resembles a milk shake appearance
- available in various flavours, prepared by mixing with water
characteristics of contrast swallow contrast
- HOCM (gastrografin: yellowish, water-based solution mixed with iodine; bitter)
- any non-ionic iodinated contrast LOCM (eg Iopamiro)
rank of choices for esophageal contrast
- barium
- HOCM
- LOCM
indication for contrast swallow
- suspected lower GIT perforations
- short period after operation
- acute hemorrhage
- gastro-colic fistula
- localisation of FB or tumour before endoscopy
- acute condition which may require immediate surgery
contraindications for gastrografin swallow
- any GI studies of infant: risk of dehydration (HOCM)
- tracheoesophageal fistula: pulmonary edema
advantages of barium sulphate
- inert
- better coating properties
- low cost
single or double contrast for swallow study
single contrast
what are the possible single contrast media used for swallow study
- barium (E-Z-HD)
- gastrografin/ ioparimo/ omnipaque
how much water to add to barium sulfate to make a thicker suspesion
50ml
how much water to add to barium sulfate to make a thinner suspesion
65ml
advantages of thick barium
- better coating power
- assist passage as a bolus to distend the tract better
disadvantages of thick barium
- may mask fine lesions
- may have some residue barium stick onto the wall of the tract
how is swallow study procedure done
- patient in upright position
- feed CM to patient
- hold a mouthful of barium until immediately before exposure for the demonstration of deglutition
4.
a) swallow the contrast in bolus during normal breathing
b) swallow several mouthfuls of barium in rapid successions
what is the after care of barium swallow
- white fecal matter for a few days
- advised to drink adequate volumes of water
what is VFSS
- stimulate habitual swallowing behaviours in patients with signs and symptoms of dysphagia
limitation of VFSS
- time constraints due to radiation dose
- procedure only samples swallow function, it does not fully represent mealtime function
- barium increases viscosity and alter liquid and solid food composition and are not natural food - resulting in disordance between the result of VFSS and real meal
- limited ability to evaluate fatigue effect on swallowing
- barium is an unnatural food bolus with potential refusal by patient
indication of VFSS
- assess integrity of airway protection
- assess effectiveness of different postures, manoeuvres, bolus modifications, different viscosity of food to improve swallow
contraindication of VFSS
- medically unstable or uncooperative patients
- when the information obtained from the study is unlikely to change the patient’s management
- patient is unable to be adequately positioned
VFSS patient positioning
- imaging chair is primarily used, patient to be in true lateral position
- side-lying only for patients with medical conditions and cannot sit upright
order of contrast mixed with substrate given to patient for VFSS
thick fluid > solid food > thin fluid
after care for VFSS procedure
generally none except:
- CXR if aspiration suspected
- physio to do percussion
what is the function of barium meal
- peristalsis
- ? pyloric stenosis
what is the pre procedure preparation for barium meal study
- NPO for 8 hours before exam
- no smoking and chewing gums
what are the contrast used for barium meal
EZHD and baros
when is single contrast used in barium meal study
- infants/ children
- very ill adults
what is the radiographer’s main responsibility in barium meal study
- assist patient in achieving different postures
what are the projections taken for a barium meal study
supine: PA, RAO, LAO
when patient is in RAO undercouch position for a barium meal study, where would the residue barium collection be
fundus
when patient is in LAO undercouch position for a barium meal study, where would the residue barium collection be
split into 2 - fundus and pylorus
what is the after care for a barium meal study
- encourage fluid intake
- stool may become white in colour
- patient must not leave dpt until any blurring of vision caused by Buscopan has resolved
what is the after care for a barium meal study
- encourage fluid intake
- stool may become white in colour
- patient must not leave dpt until any blurring of vision caused by Buscopan has resolved
pre preparation for FT
- low residue diet for 2 days before exam
- NPO for 8 hours before exam
FT after care
- patient should be warned of white fecal matter
- patient should be advised to drink adequate volumes of water
- laxatives may be provided
patient preparation for SBE
- low residue diet for 2 days before exam
- NPO 8 hours
- pharynx anesthesized with Xylocaine spray
instrument used in SBE
bilbao-dotter tube with guidewire or silk tube
what preliminary film is needed for SBE
supine abdomen
after care of SBE
- NIL orally for 5hrs post procedure
- pt warned that diarrhea may occur
preparation of patient for barium enema
- low residue diet 3 days prior
- fluid intake and laxative on the day prior to exam
contraindication for buscopan
- glaucoma
- gravis
- pyloric stenosis
- benign prostate hypertrophy
contraindication of glucagon
- pheochromocytoma
- insulinoma
after care of barium enema
- stool might be white for a few days
- drink more water
- cannot leave dpt until blurring of vision resolves
complication for barium enema
- perforations
- obstruction
- intramural barium
- cardiac arrhythmia
- transient bacteraemia
- side effects of pharmacological agents used
what are the things to look out for in a barium/contrast swallow study
- size and location of esophagus
- shape and patency
- function
how is barium contrast prepared for barium meal and FT
EZ HD + 65ml warm water
how is barium contrast prepared for barium swallow
EZ HD + 50ml
Contrast used for VFSS
EZ-paque:
- EZ-HD thick (+52ml warm water)
- EZ-HD thin (+100ml warm water)
EZ paste
thicken up powder
what medical conditions will allow patients to do VFSS in a side lying position
- low BP
- acute stroke
- spinal cord injury bracing
- other skeletal limitations
Advantages of SBE over FT
- can avoid the obscuring of small bowel by the Barium filled upper GI tract
- can avoid pyloric control over rate of barium transit
why is low residue diet necessary
to prevent gas formation from excessive fermentation of intestinal contents
advantages of buscopan
- immediate action
- short duration (~15 mins)
- cheap
side effect of buscopan
- vision blur
- dry mouth
- tachycardia
- urinary retention
- acute gastric dilatation
advantages of glucagon
- more potent
- short duration
- not interefere with bowel transit time
side effect of glucagon
- longer waiting time (~1min)
- cost
