Transcript Slide 1

Fluoroscopic Investigations
Of The Gastrointestinal Tract
Small & Large Bowel
References
• Radiographic procedures: By Stephen Chapman
• Positioning in Radiography: By k.C.Clarke.
• Text book of radiographic positioning and related
anatomy;bykenneth L.Bontrager.
Websites
• http://www.e-radiography.net/
Objectives
With the end of these lectures the student
will be able to:
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List common indications for ordering Ba F.th and Ba enema
Explain the contraindications for using barium sulphate in the
examination of the small and large bowel
Describe the anatomy of the small and large bowel
Describe room preparation and identify supplies for small and
large bowel barium studies
Describe how to perform the procedures
Explain patient care, after completing small and large bowel
barium exams
Critique small and large bowel barium radiographs in term of
positioning ,image quality, radiographic anatomy ,and pathology
Small Bowel
Barium follow through
Small intestine
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Continuous with stomach
& large intestine
5 metres long
Responsible for chemical
digestion of food
Three sections
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Duodenum
Jejunum
Ileum (ileoceacal valve)
Barium follow through
Barium Follow Through demonstrates the small
bowel from the duodenum to the ileoceacal region
encompassing the duodenum, jejunum and ileum
including the junctions superiorly with the stomach
and inferiorly with the ascending colon.
Barium follow through - Indications
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Partial obstruction
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Malabsorption
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Abdominal masses
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failed small bowel enema
Ulcer
Obstruction
Post-operative ileus
Crohn’s disease
SIGNS / SYMPTOMS
Pain
Hematemesis
Distention
Diarrhea
Barium follow through
Contra-indications
• Complete Obstruction
• Perforation (especially after recent surgery)
Contrast agents & patient preparation
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Barium sulphate
Gastrografin can be added to decrease transit time
in small bowel ( increase flow)
Plain radiograph before is useful
(Maxalon to increases gastric peristalsis )
Physical & psychological preparation
Explanation of procedure
Barium follow through - Technique
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Aim is to deliver a single column of barium into the
small bowel
If this examination is performed in conjunction with a
barium meal, then Glucagon is used
Prone abdomen taken every 20 minutes during the first
hour of patient drinking solution.
Subsequent radiographs taken at 30 minutes until the
colon is reached
Barium follow through - Technique
Spot films of the terminal ileum in supine position
( compression pad is used to separate any overlying
loops of small bowel that are obscuring the terminal
ileum
Additional films:
- Oblique's – to separate loops of small bowel
- Erect – To demonstrate Diverticula ( fluid level caused
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by contrast media retained within the Diverticula
Example Barium F. Through
Small bowel enema
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Indications & contra-indications same as for
barium follow through
+ Rapid infusion of continuous column of contrast
medium (avoids segmentation of barium column)
- Intubation may be unpleasant for patient
Small bowel enema
Specific preparation includes
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low residue diet for 2 days prior the exam
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Stopping of any anti spasmodic drugs 1 day prior
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anaesthetic spray immediately before the exam
for pharynx anaesthesia
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preliminary abdominal radiograph.
Contrast agent & specific equipment
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Infusion takes place via intubation
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Bilbao – Dotter tube / Silk tube
1500ml of barium introduced
< Viscosity gives better mucosal coating
Double contrast examination obtained by using a
100ml bolus of barium, followed by a continuous
infusion of methyl cellulose
Small bowel enema
Technique
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Intubation achieved either orally or nasally.
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Radiographs taken during infusion include
Spot films (possibly rapid sequence)
 Supine & prone films taken at the end of the
examination
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In patient with Malabsorption the volume of barium
should be increased to 240-260 ml) with compression
views of the loops
Small bowel enema
After care
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Reassurance for the patient (especially paediatrics)
Psychological reassurance (especially after tube is
withdrawn)
Nothing to eat for five hours after the procedure
The patient should be warned that diarrhoea may
occur as a result of large volume of fluid given.
Example of small bowel enema
Large Intestine
Barium Enema
Large Intestine
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1.5 metres in length
Consists of
 Caecum
 Appendix
 Ascending
colon
 Transverse colon
 Descending colon
 Sigmoid colon
 Rectum
 Anus
Large Intestine
Barium Enema examinations
Some Indications
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Change in bowel habits
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Mass (eg mass right iliac fossa)
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Appendicitis / diverticulitis
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Polyp / cancer
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Volvulus
Signs / Symptoms
Right / left lower quadrant pain
Fever / elevated wbc’s
Distension / obstruction
Weight loss
Melena (Is darkening of the feces by blood pigments)
Barium Enema examinations
contraindications
Absolute
 recent biopsy
 toxic mega colon
 Pseudo membranous colitis
Relative: incomplete bowel preparation
 recent Ba meal
Barium enema examinations
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Double contrast – demonstrates mucosal pattern
 Barium sulphate + air
Single contrast – Paediatrics, reduction of an
intussusceptions (Intussusceptions occurs when part of
the bowel or intestine is wrapped around itself
producing a mass like object on the right side of the
abdomen)
Patient Preparation
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Low residual diet ( 3 days before)
Laxative and fluids only (1day before )
Amoxicillin or Vancomycin prior and after the
procedures ( dose and type as instructed
Females – 10 day rule applies
Preliminary film taken in certain circumstances
full explanation of procedure
Catheter (miller) introduced
Muscle relaxant may be given
Drip stand, and hand pump for introducing air
Barium enema - Technique
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Patient lies on one side & catheter is inserted gently into the rectum
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Connections are made to the barium bag
Barium enema - Technique
Barium enema - Technique
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Patient lies on one side & catheter is inserted gently into the rectum
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Connections are made to the barium bag
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i.v. injection of Buscopan / glucagon is given
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The barium is infused slowly as far as the hepatic flexure under
fluoroscopic control.
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The column of barium within the sigmoid colon is run back out
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Air is gently pumped into the bowel, forcing the column of barium round
towards the caecum (double contrast effect)
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The patient position is adjusted under fluoroscopic control as the complete
colon is visualised as the barium travels round to the caecum
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From a prone position, the patient rolls onto the left side and over into an
RAO position
Barium enema - film series
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Spot films of rectum and sigmoid colon:
- RAO, prone, LPO, left lateral of the rectum
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Spot films of splenic flexure LAO
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Spot films of hepatic flexure RAO
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Spot film of caecum with compression
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Over couch film supine abdomen
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Over couch film prone abdomen
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Right and left lateral decubitus films
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Prone caudal angled sigmoid view
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Post evacuation supine film
Barium enema
Patient aftercare & complications
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Encourage patient to drink plenty of fluids
Inform patients where & when to obtain results
Warning of the side effects against the muscle relaxant that
may have been given during the examination
complications
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barium impaction
reaction to the rubber of the cuff
Cardiac arrhythmias due to rectal distension
Perforation of the bowel
Barium Enema
(1) caecum
(2) ascending colon,
(3) transverse colon
(4) descending colon
(5) rectum.
(6) right colic flexure (hepatic flexure)
(7) left colic flexure (splenic flexure)
Barium Enema
DIVERTICULOSIS
Barium Enema
Sigmoid Carcinoma
Barium Enema
GIT SUMMARY
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PLAIN X-RAY---bowel gas pattern
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BARIUM---outlines lumen
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CT---problem solving
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NM
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US
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ANGIO
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MR--- little use
special situations
Thank you