Barium Enema

1. Midterm Barium Enema

2. Large Intestine • It begins in right iliac region when it joins the ileum of the small intestine. • The length is approximately 5 ft. (152cm) long and is greater in diameter than the small bowel (2.5 in diameter).

3. Large Intestine Anatomy • CECUM  • COLON  • RECTUM • ANAL

4. Colon subdivision • Ascending • Transverse • Descending • Sigmoid

6. *Rectum and Anal Canal* • Rectal Ampulla • Anal canal • Anus

8. Barium Enema (BE or Lower GI series) • It is a Radiographic study of the large intestine. • Purpose: • to study radiographically the form and function of the large intestine, as well as to detect any abnormal conditions.

10. Clinical Indications

11. Colitis • caused by many factors including bacterial infection, diet, stress, and other environmental conditions. • Diverticulum • outpouching of the mucosal wall resulting from herniation of the inner wall of the colon. • Neoplasm • tumors in large intestine. • Volvulus • twisting of a portion of the intestine on its own mesentery.

12. Intussusceptions • telescoping of one part of the bowel into another. • Polyps • A polyp is an abnormal growth of tissue projecting from a mucous membrane.

17. Contraindications to Cathartics • Gross bleeding • Severe diarrhea • Obstruction • Inflammatory lesions (appendicitis) • Pregnancy

18. Preparation of the Patient • The final objective is that the section of alimentary canal to be examined must be empty. 2 – classes of Cathartics • Irritant cathartic – castor oil • Saline cathartic – magnesium citrate or sulfate

19. Irritant Cathartic Saline Cathartic

20. Contrast media

21. Contrast Media • High – density Barium Sulfate • It is excellent for use in double-contrast studies of the alimentary tract in which uniform coating of the lumen is required. • Air contrast • Carbon dioxide may also be used because it is more rapidly absorbed than nitrogen of air when evacuation.

22. Mixture of Barium suspensions • Single contrast 12 % - 25% weight / volume • Double contrast 75% - 95% weight / volume

23. Barium Containers • Closed system type enema • Open system type enema

24. Closed system type Open system type

25. Enema Tips • 3 – common enema tips • Plastic disposable • Rectal retention • Air contrast retention

26. “Prior to any special procedure a scout film should be taken first.”

27. Enema tips insertion •  Sims position – relaxes the abdominal muscles and decreases pressure within the abdomen.

28. Sims Position

29. Summary of Enema tip insertion • Describe the tip insertion to pt. • Place pt. in sims position. (pt. should lie on the left side, with the right leg flexed at the knee and hip • Shake and inspect the enema container to provide good mixture. Allow the barium to flow through the tubing and from tip to remove any air in the system

30. Continuation… • Wearing gloves, coat enema tip with water-soluble lubricant.(KY jelly or any sterile lubricant) • On expiration, direct enema tip toward the umbilicus proximally 1 to 1.5 inches • After initial insertion, advance up superiorly and slightly anteriorly. Do not force enema tip.

31. Continuation… • Tape tubing in place to prevent slippage. Do not inflate unless directed by radiologist • Ensure IV pole/enema bag is no more than 24 inches (60cm) above the table. Ensure tubing stopcock is in the closed position and no barium flows into the pt.

32. Procedures • 3 – Types of Examinations of Colon • Single – contrast Ba. Enema • Double – contrast Ba. Enema • Defecogram

33. Single Contrast Ba. Enema

34. Double Contrast Ba. Enema

35. Cont… • Single – contrast • utilizes only a positive contrast medium. • Double – contrast • Difference is that in an examination there is both air and barium.

36. 2  - Approaches of Double-contrast Administering

37. Two-stage procedure described “by Welin” •  In which the entire colon is filled with a barium suspension. • Patient evacuates the barium and immediately returns to the fluoroscopic table for injection of air or other gaseous contrast into the colon.

38. Single-stage double contrast examination • The barium and the air are instilled in a single procedure as compared to the two-stage which reduces time and radiation to patient.

39. 7 – pump method (by Miller) • 7 pumps, left lateral position • 7 pumps, LAO position(left PA-oblique) • 7 pumps, prone position • 7 pumps, RAO position • 7 pumps, right lateral position • 7 pumps, RPO position • +7 pumps, supine position

40. 10 – Miller’s Routine Sequence of Radiographs • AP – to include flexures • Left lateral rectum • AP – 15 – 25 degs. Cephalic(CR) to include rectum. • 15 – 25 degs.RPO – to include Left colic • Right lateral – to include rectum

41. Cont… • Prone PA – to include flexures • Prone PA with 15 – 25 degs caudal angulation (Angle Prone)– to include rectum. • 15 – 25 degs LPO- to include the right colic flexure. • Supine – AP tightly collimated ileocecal region proj. taken in 2 – 3 degs obliquity. • Using horizontal central ray, upright proj. of both flexures and lateral rectum.

42. Usually used in the hospital Modification of Positions for Barium Enema

48. AP – Single Contrast

49. Double Contrast

50. Splenic Flexure