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RG2A BariumStudies2
Ba follow through, small bowel enema & Ba enema
Question | Answer |
---|---|
What is valvulae conniventes? | mucosal folds that go right across bowel |
What are the limitations of plain AXR? | 1. cant evaluate mucosa 2. cant assess bowel motility 3. cant assess level of obstruction accurately 4. cant detect perforation/leaks |
When the couch is in erect position, where do the patient stand? | on the foot rest |
What is 'screening' (fluorscopy) used for? | Fluoroscopy used to view the passage of barium/contrast through the bowel. Done intermittently throughout the examination. |
What are spot films? | spot films are x-ray films taken at specific times and of a specific area of the bowel |
When is usually the procedure Barium follow-through performed? | At the end of either barium meal or swallow examination |
Barium follow-through procedure checks for _______? | Small intestine |
Patient is to drink barium till barium reaches __________. | the Colon. |
X-rays are taken at every_________ minutes until barium is seen in the colon. | 20-30 |
Patient preparation includes (2 answers) | 1. Laxative on the evening before (to help flow of barium into colon) 2. Fast 6 hours before |
Indications for Ba follow-through: GPAD (mcm Ipad) | GIT bleeding partial obstruction abdominal pain diarrhoea |
Contra-indications for Ba follow through: CSI | Complete Obstruction Suspected perforation (have to use water-soluble CM) Inflammatory diseases (eg Chrohn's disease. inflammations on bowel walls) |
For the condition Valvulae Conniventes, what is the appearance of the small bowels with CM? | Feathery appearance |
Indications for small bowel enema: GPAD (mcm Ipad) | GIT bleeding partial obstruction abdominal pain diarrhoea |
How is CM introduced? | By inserting a tube into patient's nose/mouth through the stomach to reach the fourth part of duodenum. the dilute barium is then infused |
Spot films are taken until the barium reaches the __________. | colon |
What is the CM used for small bowel enema? | Barium sulphate |
Why is the barium sulphate being diluted? | 1. there will be reduced viscosit to achieve better mucosal coating 2. there will be reduced density to allow visualisation of bowel loops |
Disadvantages of small bowel enema? | -intubation process may be uncomfortable for patient, thus taking longer time -higher radiation dose (intermittent spot films to check if ba fill colon already or not) |
Indications for Barium enema: | CARASO (rmb korean arasso) |
Indications for Ba enema (II): | -Chronic diarrhoea/constipation -abdominal pain -rectal bleeding -alteration in bowel habit -suspected abdominal mass -obstruction |
Definition of barium enema: | a radiographic study of the large intestine using a contrast media to demonstrate its components |
Patient preparation (Ba enema): | -laxative and clear fluid one day before -colonic washout with tepid water on day of examination(to cleanse colon of any faecal material) |
What are the two types of Ba enema? | Single contrast and double contrast |
What does SINGLE contrasted Ba enema show? | -entire colon filled with barium -shows LARGE surface abnormality |
What does DOUBLE contrasted Ba enema show? | -thicker barium fluid first -followed by air (double contrast) -shows finer surface abnormalities |
Why is SINGLE contrasted Ba enema done? | -usually done in children in whom it is not essential to demonstrate the mucosal pattern -to show site and extent of mucosal lesion urgently |
Why is DOUBLE contrasted Ba enema done? | -to demonstrate mucosal abnormalities |
Contra-indication of Ba enema (initials): | SpORT |
Contra-indication of Ba enema (II): | -Suspected perforation -Obstruction (complete colonic) -rectal biopsy w/in 7 days -toxic megacolon -toxic megacolon |
Like barium meal preocedure, patient is rolled ________ around to coat the walls. | around |
"Spot films" are made with patient in various ________ to image various parts of the _______. | position; colon |
When preparing the enema solution, the water should be at a temperature of about ________ degree Celsius (human body temperature) | 37 to 40.5 |
Why is using water colder than 30 degrees not favourable? | may cause cramping |
Why is using water warmer than 45 degrees not favourable? | may scald the rectal area |
what is the minimum and maximum temperature of the water to be mixed with Ba solution? | 30 and 45 degree Celsius |
What is the 1st thing to do when administering the enema? | let enough enema solution flow through the tubing to force air out of it. this will reduce cramping when enema is administered. |
After forcing air out of the tubing, what should the radiographer do to the tubing nozzle? | Coat the tubing nozzle with lubricant. |
which area of the patient should be lubricated? | exterior of anus and as far up the rectal area as possible |
why must the anus and rectal area be lubricated? | tp make the tubing insertion easier and to protect skin around rectal area |
the most common position for patient to receive the enema is the ______ position. | Sim's |
Describe the Sim's position. | Lie on left side, left leg straight, right leg bent at the knee. left arm behind your back. right hand under/above the pillow on your head |
to make the tube insertion easier, the tube should be ___________. | twisted back and forth |
the tube should be inserted no more than _____ (inches) / ____ (cm) without ________. | 3; 7.5; forcing |
to make it easier for patient to take in the tube, patient should be instructed to take __________. | deep breaths |
After successful insertion of the enema tube into the rectal area, the enema solution should be ___________. | let flowing into the colon slowly |
while letting the enema solution flow, the enema bag should be suspended _______ cm above patient's anus. | 60-100 |
Suspending the enema bag too high will increase __________, and thus cause patient discomfort | incoming pressure |
What will happen if the enema bag is suspended too low? | the fluid will flow back into the enema bag, leaving little fluid to reach colon. |
Once the enema is stopped, the tube should be ________. | clamped. to prevent backflow |
for elderly patients doing barium enema procedure, a ______ attack could occur. | vasovagal (dizzy, lost of concious) |
Complications of Ba Studies: | -50% mortality if barium spills into peritoneal cavity -30% will develop peritoneal adhesion |
for contra-indicated Ba enema procedures, _____ CM is used. | water-soluble (Gastografin) |
other modalities to evaluate the GIT further: | -ultrasound -CT |
In US/CT, _____ and _______ can be seen (conditions of the GIT) | bowel wall thickening; free/loculated fluid |
US/CT can be used to check for spread of ______ in bowel cancer to _______ (other parts of body). | metastases; mesentry or lymph nodes |