A lower gastrointestinal series, also called a barium enema, is a medical procedure used to examine and diagnose problems with the human colon (large intestine). X-ray pictures are taken while barium sulfate fills the colon via the rectum.This examination is used to investigation changes in bowel habit, pain, any abdominal mass, malaena (blood in faeces) or abdominal obstruction. Because of the severity of reaction when barium enters the circulation, it is contraindicated in patients who have had recent bowel surgery or rectal biopsy. If a tight stricture is demonstrated, only run a small volume of barium proximally to define the upper margin, for otherwise the barium may impact. A barium enema also is a diagnostic test. During the test, the doctor puts a contrast material called barium into the rectrum. Enough barium is given to fill up the colon (large intestines). A plain x-ray of the abdomen is then taken.
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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 specially 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:
-Colorectal adenoma (harmless tumors)
-Colonic diverticula (pouches or sacs in the colon)
-Diverticulitis of the colon
-Chronic intestinal pseudo-obstruction
-Lower gastrointestinal bleeding
Although the barium enema was originally 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 intussusceptions (a telescoping effect in which the colon folds in on itelf) 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.
A barium enema clearly displays a colonic herniation. Barium enemas are most commonly used to check bowel health, they can help diagnose and evaluate the extent of inflammatory bowel disease such as ulcerative colitis. Polyps can be seen through not removed during the exam like with a colonoscopy, they may be cancerous. Other problems such as diverticulosis (small pouches formed on the colon wall that can become inflamed) and intussusceptions can be found (and in certain cases the test itself can treat intussusceptions). An acute appendicitis or twisted loop of the bowel may also be seen. If the picture is normal a functional cause such as irritable bowel syndrome (IBS) may be considered.
In a health colon, barium should fill the colon uniformly and show normal bowel contour, patency (should be freely open) and position.
During the barium enema procedure, the contrast material may perforate the colon and spill into the during abdominal cavity. The lining of the abdominal cavity may become infected (the condition is called chemical peritonitis). The colon may narrow and become blocked.
Because of these possible problems, certain people may not be good candidates for this procedure.
The bowel is prepared before the procedure. Anyone undergoing a barium enema must be monitored during the bowel preparation procedure.
Perforation rates among the different types of enemas 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.
There is less radiation exposure than an abdominal CT. X-ray are monitored and regulates to provide the minimum amount of radiation exposure needed to produce the image. Most expert feel that the risk is low compared with the benefits. Pregnant women and children are more sensitive to the risks of ionizing radiation.
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CT scans and ultrasound are now the tests of choice for the initial evaluation of abdominal masses, and colonoscopies are becoming the standard for routine colon screening for those over age 50 or with a familial history of polyps or colon cancer, although it is not uncommon for a barium enema to be done after a colonoscopy for further evaluation.
Miller disposable enema tube. If the patient is incontinent, it is permissible to use a tube with an inflatable cuff. However, it is use should be confined to such cases, owing to the increase risk of perforation.
Barium sulphate is the most common type of positive-contrast media used for the barium enema. The concentration of the barium sulphate suspension varies according to the study performed. A standard mixture used for single contrast media barium enemas range between 15% and 25% weight to volume (w/v). The thicker barium used for double contrast barium enemas has a weight to volume contration between 75% and 95% or higher.
CONTRAST MEDIA PREPARATION
The mixing instruction as supplied by the manufacturer should be followed precisely. The cold water is reported to have an anesthetic effect on the colon and increase retention of the contrast media. And cold water may be lead to colonic spasm, so the recommended temperature is used to prepare the barium sulphate is (40-45F). If we use the hot water may scald the mucosal lining of the colon bocose of the barium sulphate produces a colloidal suspension, shaking the enema bag before tip insertion is important to prevent separation of the barium sulfate water.
BARIUM ENEMA PREPARATION
To obtain an accurate x-ray image of the contours of the colon, fecal material must be cleared. This is achieved by the cleansing enema.
Also, a laxatives 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.
It is vital that the patient has an empty bowel for this examination and so a strict cleansing regime must be commenced prior to the procedure. An example of this regimen would be a low-residue diet for 2 days prior to the procedure, then on the day before, a powerful aperients, example Picolax, should be taken and then restrict to clear fluids only, but each centre will their own specific regime for bowel preparation.
If the patient is a women of childbearing age, the radiographer will ask if there is any possibility you are pregnant. Because this examination exposes the pelvic area to radiation, it is important that you tell radiographer the date of your last menstrual period and whether there is a chance that you may be pregnant.
DURING THE PROCEDURE
Intestines must be completely empty. Typically, patient will be asked to follow a restricted diet for two days prior to the examination. This may include a soft diet or a liquid diet.
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 of fluids. They will also make sure that you bowel has been prepared adequately (by cleansing enema or laxative or both).
Before patient examination, radiographer will explain the procedure to the patient and answer any questions patient might has.
You will remain awake throughout the barium enema procedure. The contrast material (barium) will be put into the rectum through a plastic tube. A side from that discomfort, you may feel the pressure of the liquid that is being administered. Otherwise, pain should be minimal.
Prior to performing your barium enema examination, the radiographer will gave the patient a hospital gown to wear. This gown has no metal snaps on it, because metal can interfere with the accuracy of the image. It is important that everything underneath this gown be removed, including jewelry and underwear.
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Several x-ray 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.
Once the films are complete, the radiographer will show you the toilet facilities do you can expel the barium. After you have expelled the barium, the radiographer may take another x-ray to assess wheter any barium remains.
AFTER THE PROCEDURE
Most people have a short recovery time and go home after the procedure. The images are read by a qualified 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 barium will make your stools white for few days. This is normal. If the patient experience constipation following the examination, tell the doctor. He or she may advise you to take a laxative. You also should increase your water consumption in the days following the examination.
After you leave the hospital or surgical center, expect your next bowel movement to contain the contrast material. You should watch for abdominal pain, cramping, or vomiting. Call your or seek medical attention at the nearest medical facility if you have severe symptoms.
WHEN TO SEEK MEDICAL CARE
Call your doctor if you have any of these problems:
-moderate to severe abdominal pain
-moderate to severe abdominal bloating
-inability to take food or fluids
Also you should see 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.
If you pass dark material or have fresh bleeding in your stools, go to a hospital's emergency department. In additional, any severe abdominal pain, bloating, and cramping needs evaluation in a hospital.
FILMS WHICH ARE TAKEN WHILE PROCEDURES
There are grate variation in views recommended, and the following it is only the scheme used in the department.
1. spot films of the rectum and sigmoid colon (lying)
RAO/Prone /LOP/Left lateral of the rectum
2. spot film of the hepatic flexure, splenic flexure and rectum (erect)
-LAO to open out the splenic flexure
-RAO to open out the hepatic flexure
-Right lateral of the rectum
3. spot film of the caecum (lying). Positioning of the patient supine.
4. over couch films (usually with a ceiling tube) to demonstrated all of the large bowel (lying)
Supine/Prone/ Left lateral decubitis /Right lateral decubitis/ prone, with the tube angled 45 degree caudad and centered 5cm above the posterior supine iliac spines.
5. The post-evacuation film of the caecum when the other films have failed.
6. Extra spot films of any regions of abnormality are taken as required.
Computer Tomography (CT scan) and ultrasound are the present day tests of choice for the initial evaluation of abdominal masses and colonoscopies are becoming the standard for routine colon screening for those with the history of polyps or colon cancer, although the use of barium enema test after a colonoscopy for further evaluation. Barium enema test remains useful for identifying anatomical abnormalities in patients with strictures of the colon that are too small for a colonoscope to pass through for examination purposes.