Effect And Importance Of Contrast Media Biology Essay

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A barium meal, also known as an upper gastrointestinal series is a procedure in which radiographs of the esophagus, stomach and duodenum are taken after barium sulfate is ingested by a patient. Barium meals are useful in the diagnosis of structural and motility abnormalities of the foregut.

The gastrointestinal tract, like other soft-tissue structures, does not show clearly enough for diagnostic purposes on plain radiographs. Barium salts are radioopaque: they show clearly on a radiograph. If barium is swallowed before radiographs are taken, the barium within the esophagus, stomach or duodenum shows the shape of the lumina of these organs.

Liquid suspensions of barium sulfate are non-toxic, apart from a small risk of producing a disturbance in bowel function for 48 hours after ingestion. They usually have a chalky taste that can be disguised by adding flavours.[1]

A barium meal usually takes less than an hour. The patient ingests gas pellets and citric acid to expand the stomach. Then about 3 cups (about 709mL) of Barium is ingested. The patient may move or roll over to coat the stomach and esophagus in barium. A needle may also be used to relax the muscle between the stomach and the duodenum. Following these preparations, an x-ray is taken.

There are two varieties of barium meal: single and double contrast meals. A single contrast meal uses only barium, a radioopaque (or positive) contrast medium, to image the upper gastrointestinal tract. A double contrast meal uses barium as well as a radiolucent (or negative) contrast medium such as air, nitrogen, or carbon dioxide. The double contrast meal is more useful as a diagnostic test, demonstrating mucosal details and allowing the detection of small mucosal lesions such as diverticula or polyps.

The diagnostic usage of barium studies has declined in recent years with the increasing use of the practice of esophagogastroduodenoscopy, which allows direct visual inspection of suspicious areas within the oesophagus, stomach and duodenumSome compounds of barium are poisonous, but barium sulphate is a harmless, white, insoluble substance that can be made into a tasteless suspension which is 'radio-opaque'. This can be swallowed as a 'barium meal' to aid diagnosis of disorders of the upper gastrointestinal tract (a 'barium enema' is a similar suspension that is introduced into the large intestine through the rectum, for the investigation of disorders of the lower tract). The opaqueness of the material allows it to be visualized easily by X-ray as it passes down the oesophagus and through the stomach and upper intestine. The material will fill cavities caused by ulcers, and outline abnormal growths in the tract, thus giving visual information about dysfunction or disease of component pbarium meal Some compounds of barium are

poisonous, but barium sulphate is a harmless, white, insoluble substance that can be made into a tasteless suspension which is 'radio-opaque'. This can be swallowed as a 'barium meal' to aid diagnosis of disorders of the upper gastrointestinal tract (a 'barium enema' is a similar suspension that is introduced into the large intestine through the rectum, for the investigation of disorders of the lower tract). The opaqueness of the material allows it to be visualized easily by X-ray as it passes down the oesophagus and through the stomach and upper intestine. The material will fill cavities caused by ulcers, and outline abnormal growths in the tract, thus giving visual information about dysfunction or disease of component parts, such as duodenal ulcer or stomach cancerarts, such as duodenal ulcer or stomach cancer

ON EXMINITION

A barium meal is an x-ray examination of your stomach and your oesophagus (gullet). Often pictures of the first part of your small intestine (the duodenum) are also taken.

For the test to be successful your stomach should be as empty as possible and so you will probably be asked not to eat or drink anything for six hours before the examination.

When you have the examination you will be asked to swallow some fizzy tablets or granules, with a little water. These will expand your stomach with gas which makes it easier to get a clear view of things. It is very important that you do not belch once you have taken these.

Sometimes you are also given an injection of a drug to relax the stomach and stop it moving while the x-rays are taken (this can cause some blurring of your vision for an hour or so and if this happens it is best not to drive).

You will then be given a cup of barium to drink. This is often fruit flavoured and is not at all unpleasant. The barium shows up on the x-rays and outlines your gullet and stomach.

A number of x-ray pictures will then be taken. This is completely painless.

The examination is usually completed within 30 minutes.

You can eat and drink quite normally once the test is completed. The barium will be passed out with your bowel motions during the next few days, it may make your motions paler in colour than normal.

The results of the examination will usually be available a few days later.

After the test

After the procedure, you can expect:

Constipation

Light-coloured faeces

Flatulence (depending on the examination)

Blurred vision, if you have been given a muscle relaxant - you should not drive until your vision returns to normal.

Possible complications

Barium examinations are safe tests, but complications can sometimes occur. These may include:

If a section of the digestive tract has an undiagnosed break or split (perforation), the barium meal may leak into the abdominal cavity.

If the bowel is obstructed, the barium can become impacted.

The barium can lodge in the appendix and cause appendicitis.

There may be side effects (such as blurred vision) from the drugs used during the test.

It is possible to accidentally breathe in the barium meal instead of swallowing it (this is very rare).

Taking care

Be advised by your doctor, but general suggestions include:

Barium can cause constipation, so it is best to drink plenty of fluids for at least one full day following the test.

Eat more fruit than usual for the next day or two to help move your bowels.

See your doctor if you haven't had a bowel motion within three days.

Long-term outlook

You will need to make another appointment with your doctor to discuss the results of your barium examination. A negative result may require further tests if symptoms persist. Treatment depends on the diagnosis.

Other tests

Other tests are now more commonly used than the barium test to examine the digestive tract. These include:

Flexible endoscopy - an endoscope is a slender tube with a lens at one end and a telescope at the other. This is inserted through an orifice (such as mouth or anus) or a small incision and the doctor looks down the telescoped end for a magnified view.

Computed tomography (CT) scan - the CT scan uses x-rays and digital computer technology to create an image of internal body structures. Nowadays CT can be used to

replace an endoscopy - this test is called a virtual colonoscopy

EQUIPMENT

Rapid serial radiography (2 frames per s) or video recording may be required for assessment of the laryngopharynx and upper esophagus during deglutition.

BEFORE

Home care: Patient may be asked to eat a low-fiber diet for 2-3 days before the barium swallow test. And will be asked not to eat or smoke after midnight before the exam.

All clothing and any metallic (all jewelry including body jewelry such as nipple and belly-button rings, dentures, hair clips, or other objects) between the mouth and the waist should be remove, and the patient should ware a hospital gown.

Patient history should be taken and the examinations carefully explain to the patient.

Patient should understand the form and agree with it before signing it.

The examination room should be clean and tidy, and have sufficient contrast medium before patients comes.

DURING

The barium swallow procedure may take about 30 minutes to finish. In certain cases, it may take up to 60 minutes to fill the stomach.

Patient will drink about 1 1/2 cups of a barium preparation-a chalky drink with the consistency (but not the flavor) of a milk shake. Children will drink less.

You will be strapped securely on your back to a table that tilts forward. X-rays to examine your heart, lungs, and abdomen will be taken before you drink the barium. Then will be asked to swallow the barium mixture.

X-rays will be taken again as the barium moves through the digestive system. Patient will be asked to take more swallows so more pictures can be taken.

As the barium moves down your digestive system, the table will be tilted at various angles to

help spread the barium for different views.

Pressure may be applied to your abdomen to spread the barium. Finally, you will be placed horizontally, asked to take a few more swallows of barium, and x-rayed again.

AFTER

When patient return home, they can resume your normal diet unless they are advised otherwise by the doctor. Because the barium is white, your stools will be chalky and light-colored for 1-3 days. Do not be concerned about this.

Should try to drink lots of fluids to help alleviate the constipation.

Eat food with lots of roughage and fiber such as raw fruits and raw vegetables.

Call the doctor if you have any unusual problems after the barium swallow test, such as vomiting, bleeding, pain, or trouble breathing. If you do not have a bowel movement in 2-3 days after the test, you should also call or see your doctor.

You should go to the hospital's emergency department if you have severe pain, difficulty breathing, constant vomiting, chest pain, or any other symptoms that you think might be an emergency.

Barium Enema

A barium enema is a diagnostic test. During the test, the doctor puts a contrast material called barium into the rectum. Enough barium is given to fill up the colon (large intestines). A plain x-ray of the abdomen is then taken.

By filling the entire cavity of the colon, the doctor can see the contour of the colon's lining. Polyps, diverticula (outpocketings), ulcers, fistula (openings), crypts (certain types of cavities), and inflammatory changes can be detected. Masses (such as tumors) are specifically of interest because this test is often used to screen for colon cancer.

Primarily, barium enema is used to exclude diseases of the colon such as colorectal cancer. Over the years, barium enema has been used to evaluate a wide range of other conditions such as these:

Appendicitis

Celiac sprue

Colorectal adenoma (harmless tumors)

Colonic diverticula (pouches or sacs in the colon)

Colonic polyps

Crohn disease

Diarrhea

Diverticulitis of the colon

Chronic intestinal pseudo-obstruction

Lower gastrointestinal bleeding

Ulcerative colitis

Although the barium enema was originally intended as a way to diagnose disease, its role has changed. Doctors use the test as a screening tool for certain people who are at risk for colorectal cancer.

Also, a barium enema is used in some cases to treat a condition. The pressure exerted when the barium is put into the colon often results in resolving an intussusception (a telescoping effect in which the colon folds in on itself)-a condition seen in infants.

A modified test, the double-contrast barium enema, has been developed in order to see the mucous membrane in the colon better. This is achieved by using a fluoroscope (a machine for viewing the internal structure) and by manipulating the position of the person and the amount of barium and air that is introduced.

Preparation

To obtain an accurate x-ray image of the contours of the colon, fecal material must be cleared. This is achieved by a cleansing enema.

Also, a laxative may be given orally to clear the colon of fecal material that may interfere with the procedure and the test interpretation.

Usually, you will not be allowed to take food or fluid after midnight the night before your procedure. You may be given fluids by IV that contain dextrose (sugar) just prior to the test

During the Procedure

Barium enema is performed at an outpatient x-ray center or in a major hospital. You usually go home the same day.

When you arrive, the staff will check the last time that you had food or fluids. They will also make sure that your bowel has been prepared adequately (by the cleansing enema or laxative or both).

You will remain awake throughout the barium enema procedure. The contrast material (barium) will be put into the rectum through a plastic tube. Aside from that discomfort, you may feel the pressure of the liquid that is being administered. Otherwise, pain should be minimal.

Several x-rays will be taken. The duration of the whole procedure depends on the speed of the barium to fill the necessary areas of interest, the number of images required to properly evaluate the colon, and whether additional barium or images are required.

After the Procedure

Most people have a short recovery time and go home after the procedure.

The images are read by a qualified radiologist who communicates the findings to your doctor who may opt to see the images too. Your doctor usually calls you within a week with the results.

If there are abnormal results such as irregularities in the contour of the colon suggesting abnormal masses, your doctor will discuss additional diagnostic and management plans, which may include biopsy or surgery.

The Preparation:

For the bowels involves eating only a light diet, fluids and taking laxatives which the staff will give you. You will be provided with written instructions of what you can eat and drink and when to take the laxatives. If you are a diabetic please ensure you ask the staff for any special instructions. The laxative is very strong and it is recommended to stay close to a toilet. The preparation for the procedure is very important if the bowels are not clear the procedure will not be done and will have to be rescheduled.

Risks:

The risks of the procedure are few; the bowel may perforate and the barium might leak into the abdominal cavity, this happens extremely rarely. The radiation dose you receive will be the same as you would naturally be exposed to over a three year period. You may be given a drug to relax the bowels during the procedure; if you suffer from heart disease or glaucoma you should inform the staff of this.

The Procedure:

Will be done in the X-ray department and will normally be done as an outpatient procedure. If you believe you may be pregnant you should inform the staff prior to the commencement of the investigation. When you arrive in the department you will be shown to a cubical and shown the location of the nearest available toilet, you will then be asked to remove all your clothing and put on a gown, all metal objects, watches and jewellery should be removed.

You will be made comfortable lying on the X-ray table with a blanket over you

You will be asked to turn onto your side; a soft rectal tube will be passed a small way into your rectum.

The barium liquid will then be introduced slowly the radiologist will then ask you to change positions on the table to coat the inside of the bowel with the liquid.

Air may also be introduced into the bowel via the same rectal tube this gives the radiologist a clearer picture of the bowel.

This procedure is more uncomfortable than painful; you may experience stomach cramps, and fullness.

You may be given an injection to relax the muscles of the bowel wall, this may cause blurring of your vision, but it will pass.

You will have X-rays taken of you in various positions

The procedure can take approximately 20 minutes although you could be in the department for longer, waiting for x-rays and visiting the toilet.

When the procedure is over you will be able to go to the toilet. Some but not all of the barium will be passed. Your stools when eliminated will be white as this is the colour of the barium, your stools will continue to be slightly pale for the next few bowel movements.

The remainder of the barium will naturally be excreted in your bowel movements; however it can cause constipation so it is advised that you drink plenty of fluids and eat a high fibre diet for the next few days.

Side-effects

These are the unwanted but mostly temporary effects of a successful test. After having a barium enema you may feel bloated for a short while. You may also feel constipated for a few days and may need to take a mild laxative. You can buy these over the counter at a pharmacy. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

The muscle relaxant that is commonly used for this test can temporarily blur your eyesight, give you a dry mouth and make it harder than usual to pass urine. These effects usually wear off after about 15 to 30 minutes.

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