This essay has been submitted by a student. This is not an example of the work written by our professional essay writers.
Barium enema is given in the examination use to diagnose pathologic condition of the colon or the lower GI tract.Barium is choose to become solution in this procedure because barium solution allow rapid flow, allow good adhesion to the mucosa, provide adequate radiographic density in a thin layer,have plastic coating and also lack foam and artifact in the solution.There are two types of barium enemas,single contrast and double contrast.
Anatomy of lower gastrointestinal tract
A lower gastrointestinal series also calle the barium enema is a type of procedure that are used to examined and diagnose the problem relating with the human colon (large intestine).
Before the x-ray are taken,a liquid or contrast called barium sulphate is placed in the rectum.Then,x-ray pictures are taken while the barium sulphate fill the colon via the rectum.This contrast will highlight specific area on the body and will create clearer image because x-ray cannot pass through the barium.Then the barium will be transport out from the body with the stools.
Purpose and indication
Barium enma is used to detect any abnormalities of the colon or the rectum of patient such as tumors,inflammatory disease and other changes in the large intestinenes and also the rectum.
Barium enemas are used to check bowel health and also diagnose the inflammatory of the bowel disease such as ulcerative colitis,crohn disease and irritable bowels syndrome (IBS).Polyps also can been seen through the colonoscopy.
The other problem such as diverticulosis (small pounches form on the colon wall that become inflamed on the colon).The other problem such as acute appendicitis or twisted loop of the bowel can also being seen.Annular pancrease,hirschprungs disease also the indication of this examination.
The normal indication for doing barium enema is change in bowel habit ,pain, mass, anaemia and obstruction.
The contraindication of this procedure include the toxic megacolon(double contrast barium enema is said to be no better than clinical judgement in this situation and is clearly more dangerous),pseudomembranous colitis, rectal biopsy with seven days and flexible endoscope within 24 hours, incomplete bowel preparationrecent barium meal and it is advice to wait for 7-10 days,imminent abdominal bowel surgery,patient fraility,Rectal bopsy via flexible edoscope within previous 24 hours and rigid endoscope within previous 5 days.
TYPE OF BARIUM ENEMAS
In single contrast,the colon is filled with barium which outline the intestine and reveals most of the large abnormalities.Single contrast is used for the children since it usually not necessary to demonstrate mucosal pattern and also to reduce of an intussusceptions.It is used to incate colon configuration, gross pathology, suspected fistula, suspected acute appendicitis or diverticulitis and also volvulus or to evaluate obstruction.The uses of single contrast is not recommended because barium is run slowly in GI tract.
In Double contrast,the colon is first filled with barium an then the barium is drained out from inside of the body leaving only thin layer of barium on the wall of colon.Then the colon is filled with air top rovide detail image of inner surface of colon.This is done to see the abnormalities of the lower GI tract.It is especially indicated in diarrhea and high risk cases for example patient with polyps,family history of colorectal cancer,or bleeding.The use of double contrast has become routine compare to single contrast.
Before doing the procedure of barium enema,history of the patient must be known such as patient is pregnant or not,patient are allergic latex or barium or the patient had an upper digestive barium taste (upper GI or barium swallow ) recently.The colon must be clearly completely of the stool and gas.Event small amount stool can affect the result of the test.
For 1 to 3 days before the test,Patient must have clear liquid diet.make sure the diet is low residue diet (no milk, tomato soup, crackers, or another solid food.On the day of examination,patient should drink large amount of noncarbonated clear liquids,patient also should take laxatives (magnesium citrate) to empty the intestines and take tap water to clean the remaining stool in the colon.
While doing the procedure,it is important patient understand the need to keep the tip firmly in the rectum, relax the abdominal muscles to reduce intaabdominal pressure, and make deep oral brathing to prevent spasm and cramps during this examination.
The equipment should be well prepared before doing this procedure,miller disposable enema tube is used if the patient is incontinent,it is permissible to use atube with an inflatable cuff.However,it is use should be confined to such cases resulting to the increased risk of perforation.Prepared the equipment such as fluoroscopy unit, overcouch tube, y-shaped connector, disposable incontinence sheets, stationary gid, cassettes, barium renal catheter, forceps and also clips.
Contrast media preparation
The contrast media that are used are pollibar 115% w/v 500 ml, air, and buscopan/ glucagoninjection.
Spot film are taken over lateral rectum,splenic fleure and also hepatic flexure.Overcouch views taken for lateral decubitis AP, PA 30-40.
While doing this procedure,radiation protection shoul be apply to reduce patient dose.Firstly,minimize fluoroscopy time and current,collimate x-ray beam to minimize the size of interested area.The sensitive organ should be should be protected using shield gonads.
For the machine,install moder image intensifier with sensitive photocathode and digital image processing .Replace the use of cine camera by use video recorder during fluoroscopy.Use spot film photofluoroscopy with modern image intensifier and 100 mm camera.its better to used pulsed system with image storage device in fluoroscopy.Lastly,introduce QA programme to make regular check on and to optimized staff and equipment performance.
This procedure can take up into an hour.The test is done on hospital at the clinical department.Patient will lies on the x-ray table and a preliminary film is taken to asses preparation,exposure and also the anatomy.The patient lies on their left side while a lubricated enema tube is inserted to the rectum of the patient.As the enema enter the patient body,the patient may have sensation that their stomach is being filled with barium.Barium is a radioopaque contrast medium will show up on x-ray.The flow of the barium is monitored by the radiographer through the fluoroscopy screen like TV monitor.
Air is introduced into the colon of patient to provide the better image.This is called double contrast examination by coating the bowel wall and distending the bowel with the air.The pump of the air under fluoroscopic control and will stop until the barium reach the hepatic flexure.The air will continous travel even the air pumping is stop due to the residual pressure.If the air is not stop pumping,this will make patient become pain.
The position of the patient is adjusted under fluoroscopic examination as the complete colon is visualized as the barium travel to the cecum.A series of film is taken as the air is runback as much as possible.
Lastly,whe the examination is complete,the tube is removed and the patient will be sent to the rest room so that patient can use the toilet for the complete bowel evacuation.
If the patient are suspected to have bowel perforation,a water soluble contrast is used to replace the barium.The study is very similar to barium but the image produce is not good.
The radiologist may used an intravenous smooth muscle relaxant to reduce or stop the movement of peristalsis.This is done to improve visualition of the image of the bowel.
Fewer film may be taken to reduce radiation dose and cost.The sequence of positioning enable the bariu to flow proximally to reach caecal pole.Air is pumped to distend the colon.
Firstly we used spot film of the rectum and sigmoid colon while patient is lying. RAO ,prone,LPO, left lateral of the rectum.Then,we used spot film of the hepatic flexure ,splenic flexure and rectum while patient in erect position. Patient in Lao to open out splenic flexure and patient in RPO to open out hepatic flexure and right lateral of the rectum.
The next film is for spot film of the cecum. Position patient supine, lying slightly on the right side and with aslight head down tilt will usually give a double contrast effect in the cecum.Some compression are placed at the abdominal of the patient to persuade a stubborn pool of barium out of the caecal pole.
Overcouch film usually with ceiling tube to demonstrate all of the large bowel.Patient is lying and be position in supine, prone, left lateral decubitis, right lateral decubitis, and prone with the tube angled 45 caudad and centerd 5cm above the posterior superior iliac crest (PSIS).This view will separate overlying loops of sigmoid colon.
The post evacuation films is not taken routinely but may allow to improved assessment of the cecum when the other film is failed.Extra spot film of any region at the lower GI are taken as required.Below are some example typical film from image series:
Spot film of recto sigmoid region
Pre evac overcouch decubitis film
Patient should be warned that their bowel motionmay be become white for a few days after this examination, and to keep the bowel open with laxatives to avoi barium impaction which are very painful.To flush away this barium is difficult.
The patient must not leave the department as the examination complete until any blurring of the vision produced by buscapon has resolved.
Advise patient to drink the enough volume of water to avoid barium effct or constipation.Laxatives may be taken if required.
After the examination,patient may resume on their regular meal and medication.
When doing this procedure,there are a few complication regarding to the patient,patient will become a bit uncomfortable,embrassing when doing this procedure,unable to retain the barium and insertion of catheter not more than 8-10 cm and do not force it that will cause pain to the patient.Some patient can experience discomfort as the bowel become expand with air and the radiologist will reduce air volume for this case.
Damage to the rectal wall from improper use of balloon catheter is the most common complication in bariumenema.Baloon should not overinflated and contraindicated in case if the rectal narrowing.Breaks in the gastrointestinal mucosa due to trauma or disease also complication in this procedure.Disease condition such as cancer and diverciculitis can create assymptomatic perforation that can blow out under pressure.
Then peritonitis or venous emboli may cause serious complication and cause death, fibrosis, or barium granuloma.In addition,allergic reaction to latex tips and cuffs are also be reported.
The other complication may be rectal perforation,leakage of barium into the peritoneum with unsuspected perforation and also barium impaction.The perforation of the bowel are increased on infant and the elderly, obstructing neoplasm ulceration of the bowel wall, inflation of the foley catheter balloon in colostomy or the rectum, patient on steroid theraphy, and also hypothyroidism. Transient bacteraemia, side-ffects of the pharmacological agents used ,cardiac arrhythmia due to rectal distention ,intramural barium and venous intavasation.
The radiation exposure is less when doing barium enema.However,a more serious risk is a bowel perforation which is very rare.
The vision of the patient will be blured after this examination,this is because,the radiologist used intravenous smooth muscle to reduce activity of peristalsis.
Patient will notice chalky stools for a several days.A high fiber diet is advice to patient and increase intake liquid to prevent constipation.
Some patient experience mild colic as the smooth muscle relaxant effect the dissipates but,by walking around or lying decubitis may assist this problem.It will take several day to fully evacuate the barium.
If the patient is pregnant,the dose may be harmful to an unborn child especially in the early stage of pregnancy.Some patient information is collected such as the intake of the pill,have been sterilized or had a hysterectomy, have been fitted with a coil (IUD),last menstrual period, and also partner have vasectomy.
If patient are pregnant,they are not to have x-rays and this will cause damage to the unborn child.Patient should be tell the doctor if they coul have chance to be pregnant.
If the patient is diabetic,do not come on yourself,bring a responsible person to accompany.Patient should bring the medication regarding their disease.
In recent years,the use of barium enema is less as ore the common test to lok inside the colon is with flexible telescope (colonoscopy). However, There are place for a barium enema enema to help and diagnose various condition of the gut.
Besides the colonoscopy,CT scans and ultrasound are using to evaluate the abdominal mass through the colon screening for the patient age above 50 or with familiar history of polyps or colon cancer.