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Contrast Media and Pharmacological Agents for GIT Exams

Contrast Media and Pharmacological Agents for GIT Exams. Barium Sulfate: BaSO 4. Why Barium sulphate ? Many patients do not like endoscope. Endoscopes cannot: See outside the bowel lumen (masses, calssification ) 2. Bypass tight strictures 3. Determine the length of the lession .

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Contrast Media and Pharmacological Agents for GIT Exams

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  1. Contrast Media and Pharmacological Agents for GIT Exams

  2. Barium Sulfate: BaSO4 • Why Barium sulphate? • Many patients do not like endoscope. • Endoscopes cannot: • See outside the bowel lumen (masses, calssification) 2. Bypass tight strictures 3. Determine the length of the lession. 4. Reach some parts of the bowel. • Barium provides a road map (see the site and the nature of the lesion). • High atomic number. • Not soluble in water = suspension • Produces good mucosal coatings. • Completely innert and non toxic.

  3. Barium Sulfate: BaSO4 • Relatively cheap. • Body cannot metabolize. • Supplied in different thicknesses: 1. Thin barium Contains one part BaSO4 to one part water (thin milkshake). Used to study the entire GI tract (UGI, Small Bowel, Lower GI). 2. Thick barium Contains three or four parts of BaSO4 to one part water. (cooked cereal). Used to study the esophagus (Esophogram).

  4. Contraindications • Perforations of GI tract. • BaSO4 are contraindicated if any chance exists that the mixture might escape into peritoneal cavity. precautions • adequate hydration post examination.

  5. Gastrografin or Hypaque • High atomic # • Each 100ml vial has 37gm of Iodine • Water soluble • Similar usage as Barium • Water soluble, safe in the abdominal cavity • Safe to use if perforation is suspected • Very harmful to the lung tissue • Do not use if aspiration is possible

  6. Gastrografin (water soluble CM for oral use) • Can be used for CT scan of the abdomen and pelvis. • For GIT evaluation in case of : • Suspected perforation • Suspected anastomotic leakage. • Suspected intestinal obstruction. • Definition of Anastomosis: - Communication between vessels by collateral channels. - Surgical, traumatic, or pathologic formation of an opening between two normally distinct spaces or organs

  7. Double contrast • Used to enhance diagnosis in upper GI. • Both radiolucent (air CO2 and radiopaque BaSO4 were used in double contrast technique. • Carbon dioxide gas is created when the patient ingests gas producing crystals (calcium and magnesium citrate). • On reaching the stomach, these crystals form a large gas bubble. • The gas mixes with the barium and forces the barium sulphate against the stomach mucosa, providing better coating and visibility of the mucosa and its pattern.

  8. Double contrast used for the stomach and colon as a standard.The mucosa is coated by barium.The lumen is distended by introducing air. A short acting muscle relaxant may be used. • Colon examination: Ulcerative colitis imaging.

  9. Post exam elimination (Defecation) • One of the normal functions of the large intestine is the absorption of water. • Any barium sulfate mixture remaining in the large intestine may become hardened and difficult to evacuate. • Some patients may require a laxative or mineral oil until the stools are free from all traces of the white barium.

  10. Pharmacological agents • Buscopan • Glucagon • Maxalon • Why are they given?

  11. Pharmacological agents • Buscopan (20mg iv) & Glucagon (0.3mg iv) both relax smooth muscle (Glucagon more potent & can be used on patients with glaucoma & cardiovascular disease). • Useful in barium enema examinations. • Maxalon (20mg iv/oral) increases gastric peristalsis (useful in follow through examinations) • Peristalsis is a radially symmetrical contraction and relaxation of muscles which propagates in a wave down the muscular tube, in an anterograde fashion. • In humans, peristalsis is found in the contraction of smooth muscles to propel contents through the digestive tract.

  12. Terminology of the GI tract exams • Antegrade studies (with the normal flow) • esophagus, stomach, small bowel • contrast • barium • barium + air • oral iodine solution BaSO4 Only BaSO4 + Air

  13. Retrograde studies (against the flow Barium Enema) • colon • contrast • barium • barium + air BaSO4 Only BaSO4 + Air

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