Transcript Barium Enema - WordPress.com

Midterm
 It begins in right iliac region when
it joins the ileum of the small
intestine.
 The length is approximately 5 ft.
(152cm) long and is greater in
diameter than the small bowel (2.5
in diameter).
CECUM
COLON
RECTUM
ANAL
Ascending
Transverse
Descending
Sigmoid
Rectal Ampulla
Anal canal
Anus
 It is a Radiographic study of the
large intestine.
 Purpose:
 to study radiographically the
form and function of the large
intestine, as well as to detect any
abnormal conditions.

Colitis
 caused by many factors including bacterial
infection, diet, stress, and other environmental
conditions.

Diverticulum
 outpouching of the mucosal wall resulting from
herniation of the inner wall of the colon.

Neoplasm
 tumors in large intestine.

Volvulus
 twisting of a portion of the intestine on its own
mesentery.
 Intussusceptions
 telescoping of one part of the bowel
into another.
 Polyps
 A polyp is an abnormal growth of
tissue projecting from a mucous
membrane.
 Gross bleeding
 Severe diarrhea
 Obstruction
 Inflammatory lesions
(appendicitis)
 Pregnancy
The final objective is that the section
of alimentary canal to be examined
must be empty.
2 – classes of Cathartics
 Irritant cathartic – castor oil
 Saline cathartic – magnesium citrate
or sulfate


High – density Barium Sulfate
 It is excellent for use in double-contrast
studies of the alimentary tract in which
uniform coating of the lumen is required.

Air contrast
 Carbon dioxide may also be used because
it is more rapidly absorbed than nitrogen
of air when evacuation.
 Single contrast
12 % - 25% weight / volume
 Double contrast
75% - 95% weight / volume
Closed system type
enema
Open system type enema
Closed system type
Open system type
3 – common enema tips
 Plastic disposable
 Rectal retention
 Air contrast retention
 Sims position – relaxes
the abdominal muscles
and decreases pressure
within the abdomen.
1.
2.
3.
Describe the tip insertion to pt.
Place pt. in sims position. (pt. should lie on
the left side, with the right leg flexed at
the knee and hip
Shake and inspect the enema container to
provide good mixture. Allow the barium to
flow through the tubing and from tip to
remove any air in the system
4.
5.
6.
Wearing gloves, coat enema tip with
water-soluble lubricant.(KY jelly or any
sterile lubricant)
On expiration, direct enema tip toward
the umbilicus proximally 1 to 1.5 inches
After initial insertion, advance up
superiorly and slightly anteriorly. Do not
force enema tip.
7.
8.
Tape tubing in place to prevent slippage.
Do not inflate unless directed by
radiologist
Ensure IV pole/enema bag is no more than
24 inches (60cm) above the table. Ensure
tubing stopcock is in the closed position
and no barium flows into the pt.
 3 – Types of Examinations of
Colon
 Single – contrast Ba. Enema
 Double – contrast Ba. Enema
 Defecogram
 Single – contrast
 utilizes only a positive contrast
medium.
 Double – contrast
 Difference is that in an
examination there is both air and
barium.
A. In which the entire colon is
filled with a barium suspension.
B. Patient evacuates the barium
and immediately returns to the
fluoroscopic table for injection
of air or other gaseous contrast
into the colon.
 The barium and the air are
instilled in a single
procedure as compared to
the two-stage which
reduces time and radiation
to patient.
1)
2)
3)
4)
5)
6)
7)
7 pumps, left lateral position
7 pumps, LAO position(left PAoblique)
7 pumps, prone position
7 pumps, RAO position
7 pumps, right lateral position
7 pumps, RPO position
+7 pumps, supine position
AP – to include flexures
Left lateral rectum
AP – 15 – 25 degs. Cephalic(CR) to
include rectum.
4) 15 – 25 degs.RPO – to include Left
colic
5) Right lateral – to include rectum
1)
2)
3)
Prone PA – to include flexures
7) Prone PA with 15 – 25 degs caudal
angulation (Angle Prone)– to include
rectum.
8) 15 – 25 degs LPO- to include the right colic
flexure.
9) Supine – AP tightly collimated ileocecal
region proj. taken in 2 – 3 degs obliquity.
10) Using horizontal central ray, upright proj.
of both flexures and lateral rectum.
6)
Usually used in the hospital
Position and film
used
Structure Shown
Central Ray
• AP (rectosigmoid area) • AP view of the
• Film: 10x12cm crosswise
Rectum &Sigmoid
should be included
• 5-7 cm above the level
of the pubic symphysis
• Left/Right position of • True lateral position
the recto sigmoid area
of the Recto sigmoid
• Film: 10x12cm
lengthwise
• 5-7 cm above the level
of the pubic symphysis
inthe midaxillary plane
• AP (Single Contrast)
• Film: 14x17cm
• An Entire colon filled • At the level of the L4or
with contrast media at the level of the iliac
should
be crest
demonstrated
including the splenic
flexure and the
rectum.
Position and film
used
Structure Shown
Central Ray
• AP Double Contrast
• Film: 14x17cm
lengthwise
• An Entire colon filled
with positive and
negative contrast media
should be demonstrated
including the splenic
flexure and the rectum.
• At the level of the L4 or
at the level of the iliac
crest
• RAO Position
(optional)
• Film: 14x17cm
lengthwise
• Entire colon should be
included
• Right colic (hepatic)
flexure should be less
superimposed or open
when compared to the
PA
• At the level of the L4 or
at the level of the iliac
crest
• LPO Position
(optional)
• Film: 14x17cm
lengthwise
• Entire colon should be
included
• Left colic (splenic)
flexure should be less
superimposed or open
when compared to the
PA
• At the level of the L4 or
at the level of the iliac
crest
Position and film used
Structure Shown
Central Ray
• Right Lateral
Decubitus
• Film: 14x17cm
lengthwise
• Best demonstrate
the “up”, medial
side of the
ascending colon
and the lateral
side of the
descending colon,
when the colon is
inflated with air.
• At the level of the L4
or at the level of the
iliac crest
• Left Lateral
Decubitus
• Film: 14x17cm
lengthwise
• Best demonstrate • At the level of the L4
the “up”, medial
or at the level of the
side
of
the
iliac crest
descending colon
and the lateral
side
of
the
ascending colon,
when the colon is
inflated with air.
Position and film
used
Structure Shown
Central Ray
• Ventral Decubitus
• Film: 10x12cm
lengthwise
• A cross table view • 5-7 cm above the
of the recto
level of the pubic
sigmoid area
symphysis in the
• Demonstrate the
midaxillary plane
air-fluid level of
the recto sigmoid
area
• PA Axial position
(Angle Prone)
• Film: 10x12cm or
11x14cm crosswise
• Rectosigmoid
• Center it the
area must be less
midline of the body
superimposition
with an angulation
than in the PA
of 30-400 caudad
projection
at approximate
because of the
level of the anterior
angulation of the
superior iliac
CR
spines.
Position and film
used
Structure Shown
Central Ray
• Supine position
• A
postevacuation • At the level of the L4
• Film:
14x17cm
radiograph view of
or at the level of the
lengthwise
the colon is taken
iliac crest
after the procedure
is done
• If
inadequate
satisfactory
delineation of the
mucus the patient
may be given hot
beverage
(tea/coffee)
to
stimulate evacuation
• After care
• Patient is advised to drink plenty of water, or laxative is taken
to remove excess barium sulfate.