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Barium enema, or better known (GI) examination, is a test to check the large intestine (colon and rectum). The test is used to help diagnose diseases and other problems affecting the large intestine. To view the large intestine is filled with contrast material containing barium. It can highlight specific areas on the desired section and produce a clearer image. This test is done by inserting a contrast material through the tube into the anus. Barium will be out of the body with the stool. Enema Division is divided into 2 types, single and double Contras, or water Contras.
Double contrast or air contrast is the result of a combination of barium and air used to clean the colon wall that is seen clearly in the radiograph. It is also used to display the mucosal pattern is more detailed and more sensitive to detect polips and inflammatory bowel disease. Single contrast barium sulphate which is inserted into the rectum to obtain images of the large intestine is a technique often used for colon obstruction, acute diverticulitis, acute apendicitis or fistula.
Types of Barium
In contrast to the single, large bowel filled with barium, which describes the intestine and reveals differences in shape.
In contrast to double or air contrast, the first of the large intestine is filled with barium and then released only to level of barium in the large intestine wall besar.Usus then filled with air, it is to look in more detail in the surface of the colon making it easier to see the narrow structure, diverticuli, or inflammation.
In some cases, a single contrast studies may be used for certain medical reasons or for older patients who can not take a long time, but if the result is not satisfactory double contrast examination will be conducted.
Information that should be taken for identification purposes for the barium examination of the films.
- The name of the patient.
- No x-ray.
- Date of inspection when done.
- Anatomical markers / marker (either supine, prone, left (L), right (R)) to avoid errors.
The importance of identification in the barium examination.
- To ensure the correct patient.
- In order to determine the correct sequence according to the following positions.
- Facilitate the doctor to see the film to diagnose patients quickly.
Anatomical parts involved in barium enema procedure:-
2. Lower GIT
Identification of the intestinal wall inflammation, such as ulcerative colitis or Crohn's disease. Detect problems with the structure of the large intestine, such as narrowing or wall divertikula colon. Also help improve the condition called ileocolic intususepsi, where the tip of the small intestine into the colon. Evaluation of abdominal symptoms such as bowel habits change, anemia, or a decrease in the body.patient suffer pain in the abdomen.Change in bowel habits. Abdominal Mass.Melaena (black stools, such as the presence of half-digested blood from upper gastrointestinal tract)and lastly appendicitis.
Structure of colon:
Radiograph picture of colon:
Rectal biopsy with 7 days, Pseudomembranous colitis, abdominal bowel surgery Imminent, Toxic megacolon (colonic elongation of the restrictions caused by the colon, Hirschsprung disease, constipation, or prolonged).
patients with early preparation to provide the abdomen, which can be given and the description of the intestine to facilitate detecting stones or tumors. This requires early detection studies (radiographic image) was taken after a colon cleansing before receiving the contrast media. This is to prevent scarring or wound in the intestines and colon that are sure to be tested completely clean. Patients should also be given early information about the procedure for patients can be prepared in advance and radiation tests can be conducted smoothly. Make sure the patient's medical history review, aims to ensure free patients undergoing intestinal surgery around the room. As an interpreter of x-ray, is a duty to remind the patient to fast for 8-9 hours before the procedure. Quantity of food intake in low-and high-fiber is allowed to prevent and reduce excessive gas due to the digestion process is also entitled to be supplied makanan.Pesakit saline enema / laxative (bowel drug) and instructed to eat the day before testing to remove all air and digestion / feces in the intestines and digestive organs and intestinal facilitate image can be seen clearly. Some interpreters x-ray of the opinion that smoking and chewing gum can stimulate the secretion of gastric fluids and saliva. Therefore, patients were also asked to stop smoking and chewing gum to prevent excess fluid from gathering in the stomach and the thicker barium sulfate. After the explanation given (x-ray interpreters must ensure that patients understand the procedure), the patient must sign the letter of agreement as a sign of understanding and agreed to undergo screening.
- Buscopan / glucagon injection.
- 115% w / v 500 ml
Fluroscopy machine with output capacity 10 frames / second, fluoroscopy table can slanting about 90/20, canulation equipment, equipment bags of barium / systems of aircraft, equipment and contrast agent injection.
Before the barium enema is inserted:
- Is the patient pregnant?
- Inventory general psychology and guidance examination.
- Take less food waste (low residue diet) 2 days before the examination.
- Fasting 6 hours before the examination.
- Is allergic to latex, latex products commonly used to provide material kontras. If patients have latex allergy, other products will be used.
- Knowing that the patient is allergic to barium.
- Has tests for barium digestion. Preparation barium enema usually involves cleaning the colon with very carefully because of the large intestine must be completely clean of dirt and impurities or gas . small gas may affect the accuracy of the test.
- Prior to 1 or 3 days before the test, you usually need to diet.
- In the days before the test, you should not drink large amounts of carbonated liquids, unless your doctor not recommended. Then you need to empty the stomach may be recommended in oder to clean dirt in your colon.
- Know your doctor about any concerns, you need to test it and the risks and how it was done or whether the side effects.
Inventories are necessary for abdominal barium examination:
- To be free from faeces abdomen that prevents the flow of barium into the ileum.
- That did not happen due to errors in the diagnose diseases of the image blurring because of the preparation of the abdomen are not perfect.
Inventories abdomen performed for patients with colostomy:
- Inventory abdomen as usual.
- Before inspection, clean the colostomy bag and empty the bag.
A radiograph taken (prelim PA abdomen) is taken to assess the early stages of patient preparation, exposure and anatomical structures. The patient lay with both legs at the knee in flexion. Catheter was inserted into the rectum and attached with adhesive tape and connected to the equipment to include barium. IV Buscopan @ glucagon injections done. Fluroscopy done to see Barium. Patients lay in the position (supine). Barium added slowly, until the infusion is discontinued when the flexure spleenik. Strontium barium liquid is released. Generated air into the rectum to yield double-contrast images. Turning the patient's body from left to 'right anterior oblique' (RAO) to barium coating the mucosal wall. Cassette 10 x 8 inch film used to spot the RAO projection, Lao, and Left Lateral Supine.
After the barium enema examination:
- You can go home.
- Some people may feel pain for a few hours later.
- You can eat after the barium test.
- The barium may make you constipated. Therefore, to help prevent constipation you should drink a lot of water to help the excretion of barium from your colon. You can also eat fruits for a day or two. Referring to the doctor if you do not remove any stool after three or four days.
-Barium look like white or pale yellow liquid until it is clean out of your colon (after one or two days).
- If you have an injection to relax the muscles of your stomach, may cause blurring of your eyes for one or more. If this occurs, you are advised not to drive.
TYPICAL FILM SERIES:
Spot film of splenic flexure LAO.
Overcouch film supine abdomen.
Spot film of caecum with compression.
Spot film of hepatic flexure RAO.
Right and left lateral decubitus films.
Spot films of rectum and sigmoid region, RAO, prone,LPO, Lateral.
Overcouch film prone abdomen.
Prone caudal angled sigmoid view.
Before the inspection:
- Keep the room clean and tidy.
- Make sure the name is the same patient with the patient.
- Explain the procedure and time frame required for this examination so that patients can give their cooperation.
- Ensure the type, volume, and the concentration of barium is correct for these inspections.
During the inspection:
- Calm the patient if the patient is restless and uncomfortable.
- Provide full comfort to the patient.
- Communicate with the patient in order to reduce patient anxiety.
- Ask the patient if the patient needs something.
- Always observe the patient from time to time.
After the inspection:
- Cleaning barium spilled on the patient's body.
- Tell patients the effects of the test after a few days.
- Notify the likelihood of diarrhea.
- Encourage patients to drink plenty of water.
- Ensure that patients do not experience any problem before returning.
- Ensure that patients make an appointment with the doctor for follow up treatment.
- Record the volume and evidence of contrast media and drugs were used.
- General Care of psychology to understand the procedures to collect revenue.
- Ensure that patients understand the procedures to collect revenue.
- Provide warnings to patients about the possibility of constipation and undesirable effects.
Ensure that patients are not pregnant and cut the power at fluoroscopy. Collimation is required to enter the area only to the radiation field. Using the image of a modern observer is more sensitive, (eg CSI) photocathodes and digital image processing is also using video recorders to replace cine camera during fluoroscopy, if possible. Implementing QA programs to optimize the performance of staff and equipment. Provide protection and give gonad explanations about the procedure to the patient, the patient can cooperate, then screening may be done without the need to be repeated many times.
Specific care should be given to patients in the following circumstances:
• Structure / refinements:
- Provide oversight of reflux occurred, and enter the respiratory tract.
• blockage / obstruction:
- Monitor the rate of admission to Barium Barium is not abundant in the respiratory tract.
• Fistula (opening between the anal canal and the skin that may develop in the rectum after the abscess had burst):
- Watch the fistula if there is any output from the fistula causes artifacts in the image.
• Diabetes (diabetes mellitus):
- Make sure that the normal kidney patients because if there is kidney failure, the possibility of barium can not excrete properly.
• Leaking anastomosis:
- Use of Gastrografin barium as possible going into the lungs and blocks breathing.
• Infants and children:
- Keep the movement ban will be because of the possibility of patient motion.
- The screening time must be limited to avoid moving the patient.
- The volume of barium must be correct based on the rate of children or infants.
• Geriatric (elderly):
- Provide information to expedite and facilitate the inspection.
Although barium enema is supposedly safe to use in the examination, but it will affect complications in some people / patients. The following indications should be taken to know and understand prior to barium enema procedures.
For those who have a fast heart rate problems, some cancers, megacolon (toxic). Suggested that they did not have to do barium enema examination. For patients with clogged bowel disease, ulcerative colitis and diverculitis. Inspection shall be cautious and gentle.
Barium enema is a special inspection to check the colon and its structure. This inspection specifically to check if you have colon problems such as appendicitis and abdominal pain. Patients will be given a contrast medium through the anus. Contrast media used to help demonstrate the radiographic images better. It will also facilitate the doctor's diagnosis of disease faced by patients.