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A lower gastrointestinal series, barium enema. It is a medical procedure used to examine and diagnose the problem of the human large intestine.Barium enema examination is used to diagnose problems that effect large intestine,so the colon filled with barium contrast material to make the intestine visible on as x-ray image.Contrast material called barium is inserted through a tube into the rectum.Barium filled colon will show up clearly on the x-ray image.The examination evalustes the right or ascending colon,the transverse colon,the left or descending colon,the sigmoid colon and the rectum.The appendix and portion of the distal small intestine may also included.An x-ray is a noninvasive medical test that helps physicians diagnose and treat medical conditions.The lower gastrointestinal tract uses a special form of x-ray called fluoroscopy and contrast material called barium or a water soluble iodinated contrast.Fluroscopy makes it possible to view the internal organs in motion.The radiologist able to view and diagnose the anatomy and function of the rectum,colon andpart of the lower small intestine when the lower gastrointestinal tract filled with barium.
INDICATION OF BARIUM ENEMA EXAMINATION
Barium enema is used to exclude disease of the colon such as colorectal cancer.Barium enema has been used to evaluate other conditions such as,
Appendicitis,Colorectal adenoma(harmless tumors),Colonic diverticula(pooches or sacs in the colon),Crohn disease,Severe diarrhea/Toxic megacolon,Gross bleeding(lower gastrointestinal bleeding),Ulcerative colitis
Toxic megacolon-double contrast medium is not suitable and dangerous.
Incomplete bowel preparation
Recent barium meal
Barium sulfate is the most common type of positive-contrast media used for the barium enema.The range for a standard mixture used for single contrast is between 15%-25%weight-to-volume(W/V).The thicker barium used for double contrast barium enemas has a weight-to-volume contraction between 75%and 95% or higher.
CONTRAST MEDIA PREPATION
The mixing instruction as supplied by the manufacturer should follwed precisely.The cold water is reported to have an anesthetic effect on the colon and increase retention of the contrast media.Temperature is used to prepare the barium sulfate is(40-45F).If we used the hot water may scald the mucosal lining of the colon because of the barium sulfate produces a colloidal suspension.
Miller disposable enema tube.If the patient is incontinent,it is permissible to use a tube with an inflatable cuff.However,its use should be confined to such cases owing to the increase risk of perforation.The other equipment used for this examination consists of a radiographic table,an x-ray tube and a television like monitor that is located in the examining room.Whwn used for viewing images inreal time(fluoroscopy),the image intensifier(which convert x-rays into video images) is suspended over a table on which the patient lies.The image captured on the film.
WHEN A PATIENT NEED A BARIUM ENEMA
Since the advent of the colonoscope(endoscope of the colon),barium enema studies are less common.However,it still has a role to play if there is a change in bowel habits,passage of blood in the stools.Unexplained abdominal pain,chronic constipation and as a complement to other investigations.Barium enema is done in some cases where the colonoscope unable to assess the colon completely for various reasons.(unusually â€˜tortuousâ€™route of the colon).There is also a significant cost difference between colonoscope and barium enema examination.Barium enema is more affordable.Advantage of a colonoscope is the ability to perform a biopsy should any abnormality be seen.When there is a marked narrowing of the colon or cancer of the colon,a barium enema may able to show the whole colon and the presence of multiple cancers better.The scope may difficult to passing thought the narrowed portion,while barium sulphate solution can trickle past the narrowing.A detailed barium enema examination may reveal large bowel narrowing,ulceration,or lesions such as a polyp or a tumor.
PATIENT PREPARATION AND CARE
Intestine must be completely empty.Patient is advised to take only soft diet or a liquid diet for two days prior the examination.Patient also required to take a laxative(Magnesium citrate)the evening before the examination to cleansing the bowel.Patient is advised to fasting the night before examination. Tell the doctor if the patient have insulin-dependent diabetes,so that the doctor can arrange for the best time to the patient to stop eating and for the test to be done.
Before examination,radiographer will explain the procedure clearly to the patient.Radiographer will provide hospital gown to patient.Patient is instructed to remove all the artifact such as jewellery,belt and so on to prevent the film image from damage.
If the patient is a woman of childbearing ag,radiographer will ask the patient whether she is pregnant or not.It is important for the patient to tell radiographer the date of last menstrual period and whether there is a chances may be pregnant.
DURING THE EXAMINATION
Inside the x-ray room,patient is asked to lie on a tilting table attached to a fluoroscope which is an x-ray unit combined with a monitor screen.
Radiographer will take a x-ray of the patient abdomen to make sure the patientâ€™s bowel is clean and well prepared for the examination.
Radiographer will wear a rectal glove and enfolds the enema tip in several sheet of paper toweling(The ractal tip is well lubricated with a water soluble lubricant)
Before the examination,the patient is asked to keep the anal sphincter tightly contracted again the rectal tube to hold it to prevent leakage.Then,relax the abdominal muscles to prevent hyper intraabdominal pressure and patient is advised to concentrate on breathing by mouth to reduce spasms and cramping.Patient should be take few deep breaths before actual insertion of lubricant enema tip.The total insertion of tip is not exceeding 3 to 4cm to prevent possible injury to the colon.
Liquid barium will begin to flow through the enema tip slowly into the colon.It coats the walls of the lower digestive tract,casting shadows that can be seen on the x-ray fim.Air is pumped into the bowel gently to produce double contrast effect. In a double contrast examination,the barium is allowed to drain from the colon leving a coating of the barium on the inside surface of the colon.After this air is introduced carefully and under direct fluoroscopy so that a relief of the inside lining of the colon is seen.this is necessary as in a collapsed and contracted state,it ia difficult to see any abnormality of the colon so patient is asked to move into various positions on the x-ray tables so that the different part of the colon can be x-rayed.Patient must retain the barium and air until the examination is over.
Normally this examination will not take longer than an hour,and if the bowel is well prepared and there are no other factors,it may only about half an hour.
After the administration of barium enema,the radiographer will take a series of x-rays of the large intestines.Image will be observed in the monitor screen to observe the flow of barium and will be taken throughout the process. As the barium is delivered,radiologist will instruct the patient to turn from side to side so that can allow the barium to coat at the walls of the colon.
Patient instructed to hold breath and remain still during the exposure to hold In the enema.Once the fims are complete,radiographer will assist the patient.Patient will be asked to go to the toilet to pass out the barium and air and clean up if there has been any leakage around the anus onto the buttocks. Radiographer will take another x-ray to assess whether any barium remains.
AFTER THE EXAMINATION
The radiographs are read by a qualifield radiologist who communicates the finding to the doctor.the doctor will receive a report of the findings. The patient stools will be white for a few days after the examination.Patient adviced to increase water consumption in the days following the examinations. Patient can resume normal diet unless they are advised otherwise by the doctor.Patient is advised to eat food with lots of fiber such as raw fruits and raw vegetables.
If the patient have any unusual problems such as bleeding in stools,abdominal pain,constant vomiting,chest pain or any other symptoms.Patient is advised to consult the doctor immediately at the nearest hospitals.
During the barium enema procedure,the contrast may perforate the colon and spill into the abdominal cavity.The lining of the abdominal cavity become infected(Peritonitis).The colon may narrowed or blocked.
Distention of the colon is uncomfortable,but only a few patient are feel very painful.
Any x-ray examination procedure involves some risk of radiation exposure dose.
The tip of enema catheter or distention of the colon can penetrate the surface of the colon and give rise to infection.This usually occur when excessive pressure
Is used to infuse the barium into the colon or diseased colon which is weakened.
Pregnant woman should inform the radiographer as there is a potential risk of harm to the fetus with radiation exposure.
Perforation rate among different types of the enema are probably due more to perforations that occurred prior to the enema,and the pressure exerted within the colon,rather than from the contrast material used.
This ia a verry safe examination.Patient who do not move their bowel daily,the small amount of barium that is left within the colon may dry out and constipation may occur.However if the patient consumes plenty of fluids,vegetables and fruits,this rarely occurs will be passed out with the normal bowel motion
The perforation of the large bowel with passage of the barium outside of the bowel wall into the abdominal cavity.As the examination is done under direct vision of the radiologist,such a complication is extremely rare and would be treated immediately.A well prepared bowel will ensure that minimal bowel contents will spill if there is ever a leak.There is a small amount of radiation is involved in the examination.The potential benefits of this test far outweigh any risk.
Computer Tomography(CT scans) and ultrasounds are the present days tests of choice for the initial evaluation of abdominal masses and colonoscopies are becoming the standrard for routine colon screening.
Barium enema test remains useful for identifying anatomical abnormalities in patients with strictures of the colon that are too small for a colonoscope tp pass through for examination purposes.