small and large intestine

3 ways barium can be administered

oral

reflux filling via enema

enteroclysis

prep for small intestine exam

Soft or low-residue diet for 2 days before study
 Food and fluid withheld after evening meal on day before examination
 Breakfast withheld on day of examination
 Cleansing enema for colon may be administered

termed small bowel series because

several identical images are produced at timed intervals

each image in small bowel identified with

time marker indicating interval since ingestion of barium

images for small bowel obtained with pt in

supine or prone

position that take advantage of superior and lateral shift of stomach, which improves visualization of duodenum and jejunum

supine

supine also used to prevent

compression of overlapping loops of intestine

prone position used to

compress abdomen and increase image quality

first image usually taken

immediately after ingestion of barium

next interval for small intestine

15-30 minutes

when barium reaches ileocecal region, use

fluoro to obtain compression radiographs

examination complete when

barium seen in cecum (2 hours after ingestion)

patient given __ to relax intestine

glucagon

__ may also be given to diminish patient discomfort

diazepam (valium)

large amount of barium used to

fill colon and small intestine

the injection of nutrient or medicinal liquid into bowel

enteroclysis

contrast medium can be injected into

duodenum

contrast injected through a special catheter usually a

Bilbao

Selink tube

specially designed tube is inserted through nose and passed into stomach

intubation

intubation can be used to

Prevent or relieve post-op distention or to deflate or decompress the small intestine

double-lumen, single-balloon tube can be used to intubate the small intestine.

miller-abbott

gas and fluids are withdrawn through the

aspiration lumen and liquids injected through

single contrast large intestine

barium or water soluble contrast

colon is examined with barium, evacuated, and then examined with air or other gaseous media

two stage double contrast large intestine

barium and gas are selectively administered by the radiologist simultaneously

single stage double contrast large intestine

The positive contrast enables visualization of the

anatomy and the tonus of the colon, as well as most abnormalities

The gaseous medium distends the lumen of the bowel and enables visualization of

all parts of the barium-coated mucosal lining and any small intraluminal lesions, such as polyps

2 types of colonoscopy

CT colonography

virtual colonoscopy

virtual colonoscopy is primary screening tool for

colorectal cancer or after failed conventional colonoscopy

virtual colonoscopy combines

helical CT with virtual reality software

virtual colonoscopy creates 3D and multiplanar images of

colonic mucosa

finely divided barium particles that resist precipitation

colloidal preparations

contain suspending or dispersing agent

flocculation resistant preparations

most commonly used, absorb greater percentage of radiation, allows
for uniform coating of the lumen

high density barium

usually the gaseous medium used

air

can be used, more rapidly absorbed than the nitrogen in the air

carbon dioxide

Water-soluble, iodinated contrast media-used when

leak or perforation is suspected

can be administered orally when

retrograde is contraindicated

disadvantage of water soluble iodine contrast media

evacuation is often insufficient for mucosal pattern visualization

advantages of wayer soluble iodine contrast media

practically nonabsorbable from mucosa so outlines large bowel, not subject to drying or flaking like barium

in order to allow all parts of the inner wall to be visible.

tract must be completely empty

Retained fecal matter can simulate the appearance of

polypoid or other tumor masses

preliminary prep of patients with severe diarrhea, gross bleeding, or symptoms of obstruction is

limited

preliminary preparation for intestinal tract

clear liquids and bowel cleaning regimen

methods of bowel cleaning

Complete intestinal tract cleansing kit
 Gastrointestinal lavage preparation
 Cleansing enema

commercially available in different sizes

disposable and soft plastic enema tips

have replaced older retention catheters such as the Bardex or Foley catheter.

disposable rectal retention

retention tip is

dual lumen with balloon at its distal end

is recommended to limit the air capacity to approximately 90 ml.

a reusable squeeze inflator

One complete squeeze of the inflator should give

adequate distension of the balloon without overinflation.

most enema bags have a capacity of ___ when fully distended

3 quarts (3000 ml)

tubing is usually approximately

6 ft long

single contrast, recommended weight/volume

12-25%

double contrast _ weight/volume is common

80-100%

with water soluble contrast, __ density is required

60-76%

let pt know that since all portions of colon are being filled, abdomen may be

palpated or compressed and body rotation may be necessary

instruct pt during enema

Keep anal sphincter contracted to hold tip in place and prevent leakage
 Relax abdominal muscles to prevent pressure
 Concentrate on deep oral breathing to reduce spasms and cramps

position for enema tip

sims

enema bag no higher than

24” above level of anus

__ prior to insertion of tip

clear bag of air

anal sphincter most relaxed during

expiration

direct tip anteriorly __ and slightly superiorly

no more than __

1-1 ½”

4”

single stage double contrast procedure

Barium with density of 80-100%
 Barium and air instilled in a single procedure. Patient rotated to coat
mucosal lining.

general term for the surgical procedure of forming an artificial opening to the intestine, usually through the abdominal wall, for fecal passage.

enterostomy

other terms for enterostomy

colostomy, cecostomy, ileostomy, jejunostomy

most common site of disease in the large intestine

colon

Loop colostomy diverts the fecal column (can be temporary or permanent) from areas of

diverticulitis or ulcerative colitis

most colostomy studies are performed for

malignancies of lower bowel and rectum

if a tumor is present

bowel may be resected with the end of the remaining bowel brought to the surface through the abdominal wall

Adequate cleansing of bowel crucial to show

polyps and intraluminal lesions

sterile technique not required because

stoma is part of intestinal tract

Performed on patients with defecational dysfunction

defecography

defecography also called

evacuation proctography and dynamic rectal examination.