Barium Enema

Midterm

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).

CECUM  COLON RECTUMANAL                            

AscendingTransverseDescendingSigmoid

Rectal AmpullaAnal canalAnus

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.

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.

Intussusceptions telescoping of one part of the bowel into another.

Polyps A polyp is an abnormal growth of tissue projecting from a mucous membrane.

Gross bleedingSevere diarrheaObstructionInflammatory lesions (appendicitis)

Pregnancy

The final objective is that the section of alimentary canal to be examined must be empty.

2 – classes of CatharticsIrritant cathartic – castor oil Saline cathartic – magnesium

citrate or sulfate

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.

Single contrast12 % - 25% weight / volume

Double contrast75% - 95% weight / volume

Closed system type enema

Open system type enema

Closed system type

Open system type

3 – common enema tipsPlastic disposableRectal retentionAir contrast retention

 Sims position – relaxes the abdominal muscles and decreases pressure within the abdomen.

1. Describe the tip insertion to pt. 2. Place pt. in sims position. (pt.

should lie on the left side, with the right leg flexed at the knee and hip

3. 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

4. Wearing gloves, coat enema tip with water-soluble lubricant.(KY jelly or any sterile lubricant)

5. On expiration, direct enema tip toward the umbilicus proximally 1 to 1.5 inches

6. After initial insertion, advance up superiorly and slightly anteriorly. Do not force enema tip.

7. Tape tubing in place to prevent slippage. Do not inflate unless directed by radiologist

8. 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.

3 – Types of Examinations of ColonSingle – contrast Ba. Enema

Double – contrast Ba. Enema

Defecogram

Single – contrastutilizes only a positive contrast medium.

Double – contrastDifference is that in an examination there is both air and barium.

A. In which the entire colon is filled with a barium suspension.

B.Patient evacuates the barium and immediately returns to the fluoroscopic table for injection of air or other gaseous contrast into the colon.

The barium and the air are instilled in a single procedure as compared to the two-stage which reduces time and radiation to patient.

1)7 pumps, left lateral position2)7 pumps, LAO position(left PA-

oblique)3)7 pumps, prone position4)7 pumps, RAO position5)7 pumps, right lateral position6)7 pumps, RPO position7)+7 pumps, supine position

1)AP – to include flexures2)Left lateral rectum3)AP – 15 – 25 degs.

Cephalic(CR) to include rectum.

4)15 – 25 degs.RPO – to include Left colic

5)Right lateral – to include rectum

6) Prone PA – to include flexures7) Prone PA with 15 – 25 degs caudal

angulation (Angle Prone)– to include rectum.

8) 15 – 25 degs LPO- to include the right colic flexure.

9) Supine – AP tightly collimated ileocecal region proj. taken in 2 – 3 degs obliquity.

10)Using horizontal central ray, upright proj. of both flexures and lateral rectum.

Usually used in the hospital

Position and film used

Structure Shown

Central Ray

• AP (recto sigmoid area)

• Film: 10x12cm crosswise

• AP view of the Rectum & Sigmoid should be included

• 5-7 cm above the level of the pubic symphysis

• Left/Right position of the recto sigmoid area

• Film: 10x12cm lengthwise

• True lateral position of the Recto sigmoid

• 5-7 cm above the level of the pubic symphysis in the midaxillary plane

• AP (Single Contrast)

• Film: 14x17cm

• An Entire colon filled with contrast media should be demonstrated including the splenic flexure and the rectum.

• At the level of the L4 or at the level of the iliac crest

Position and film used

Structure Shown

Central Ray

• AP Double Contrast• Film: 14x17cm

lengthwise

• An Entire colon filled with positive and negative contrast media should be demonstrated including the splenic flexure and the rectum.

• At the level of the L4 or at the level of the iliac crest

• RAO Position (optional)

• Film: 14x17cm lengthwise

• Entire colon should be included

• Right colic (hepatic) flexure should be less superimposed or open when compared to the PA

• At the level of the L4 or at the level of the iliac crest

• LPO Position (optional)

• Film: 14x17cm lengthwise

• Entire colon should be included

• Left colic (splenic) flexure should be less superimposed or open when compared to the PA

• At the level of the L4 or at the level of the iliac crest

Position and film used Structure Shown Central Ray

• Right Lateral Decubitus

• Film: 14x17cm lengthwise

• Best demonstrate the “up”, medial side of the ascending colon and the lateral side of the descending colon, when the colon is inflated with air.

• At the level of the L4 or at the level of the iliac crest

• Left Lateral Decubitus

• Film: 14x17cm lengthwise

• Best demonstrate the “up”, medial side of the descending colon and the lateral side of the ascending colon, when the colon is inflated with air.

• At the level of the L4 or at the level of the iliac crest

Position and film used

Structure Shown

Central Ray

• Ventral Decubitus• Film: 10x12cm

lengthwise

• A cross table view of the recto sigmoid area

• Demonstrate the air-fluid level of the recto sigmoid area

• 5-7 cm above the level of the pubic symphysis in the midaxillary plane

• PA Axial position (Angle Prone)

• Film: 10x12cm or 11x14cm crosswise

• Rectosigmoid area must be less superimposition than in the PA projection because of the angulation of the CR

• Center it the midline of the body with an angulation of 30-400 caudad at approximate level of the anterior superior iliac spines.

Position and film used

Structure Shown

Central Ray

• Supine position • Film: 14x17cm

lengthwise

• A postevacuation radiograph view of the colon is taken after the procedure is done

• If inadequate satisfactory delineation of the mucus the patient may be given hot beverage (tea/coffee) to stimulate evacuation

• At the level of the L4 or at the level of the iliac crest

• After care• Patient is advised to drink plenty of water, or laxative is taken

to remove excess barium sulfate.