MOD 4 - Exams of the GI System

contrast media purpose

to alter the radiographic appearance of an area by altering the resultant radiographic contrast of a body part to help enhance visualization of structures

types of contrasts

• positive contrast

• negative contrast

• water-soluble contrast

positive contrast

• barium sulphate

• does impede the passage of x-rays, thus appearing white on image (radiopaque)

• can be ingested orally or administered via the rectum

  • Insoluble

  • Non-toxic

positive contrast examples

• EZHD

• Ultra R

• Polibar 

negative contrast

does not hamper the passage of x-rays, thus appearing black on image

negative contrast examples

• For UGIs double-contrast enemas

• Arthrography

Complications of contrast

• aspiration pneumonia: Ba ending up in lungs

• Perforation (hole)

• Barium peritonitis: Ba leakage into peritoneal cavity

water soluble contrast

solution that can be absorbed (unlike Ba), and used when barium is contraindicated

water soluble contrast indications

• Water-Soluble, instead of using barium

• Used for CT exams to differentiate bowel

• Used if suspected bowel perforation or obstruction

Upper GI Exam

1. pt drinks Ba Sulphate while fluoro is used

2. takes look at ES&D

Contraindications UGI and SBFT

• Bowel or esophagus perforation

• Bowel obstruction or severe constipation

• Pregnancy

• Severe swallowing difficulty such that aspiration (entry of substances into the lungs) of barium is likely

PT Prep for UGI

• Esoph and UGI Exam: NPO after midnight

• SB follow-through: mild laxative and NPO after the evening meal, emptied bladder during the exam

• removal of FB

Significance of NPO

• food prior to these exams can give false information

• Fluids prior to the exam can affect the ability of the barium to adhere to the walls of the stomach

Tech Role for UGI

prep room:

• put table in upright to start

• prep of Ba mixture

UGI Exam Procedure

• gas pills: fizz up quickly in contact with moisture, thus pt should swallow quickly with little water, dont burp the gas out

• LPO position moves the patient’s esophagus off of the spine for better visualization

Positions that demonstrate certain parts the best

• AP: Ba within fundus and Air in the stomach body

• RT LAT: Air within fundus and Ba in the body pylorus

• RAO: Air within the fundus and Ba within the body

• PA: Air within the fundus and Ba within the body

• LPO: Ba within the fundus and Air within the body

Post Procedure Care UGI and SBFT

• pts should drink plenty of water to clear Ba out

• advise pts of chalky stools

• constipation may occur with insufficient fluid

• may resume normal diet

Small Bowel Follow Through (SBFT)

• routinely follows an Upper GI exam or can stand alone as a procedure

• pt drinks 16-20oz of thin barium then images are taken at timed intervals

Contraindications SBFT

similar to UGI

• Bowel or esophagus perforation

• Bowel obstruction or severe constipation

• Pregnancy

• Severe swallowing difficulty such that aspiration (entry of substances into the lungs) of barium is likely

SBFT Images

1. 15 min post-ingestion: entire stomach

2. 30 min post-ingestion: centered at crest to see Ba in SB

3. 50 min post-ingestion: Ba seen in the right lower quadrant

4. 70 min post-ingestion: barium in the cecum and ascending colon, ready for spot imaging fluoro

what images can be obtained once the barium reaches the terminal ileum

spot images of the small bowel and ileocecal valve

Other Small Bowel Procedures 

• Complete Reflux: via the rectum

• Enteroclysis: via NG tube

• Intubation: Miller-Abbott tube

Barium Enema (BaE)

• takes a look at the lower gastrointestinal (GI) tract (large intestine, rectum)

• fills colon with barium sulfate using single or double contrasts for the use of fluoro

Single Contrast Enema

• only one type of contrast media: Barium sulphate, Hypaque, or Air

Double Contrast Enema

• Barium sulphate is introduced first and then drained, then air or carbon dioxide is introduced to the colon to inflate the colon and outline its edges

BaE Contraindications

• history of heart condition – may increase BP

• acute bowel condition

• pregnancy

• suspected bowel perforation

• failed bowel prep

• exam refusal after explanation

• 6 months post radiation therapy

Pt Prep

• Fasting (NPO)

• Ingesting Laxatives

• Suppositories

• Cleansing enema that may be self-administered prior to the procedure

Buscopan

antispasmodic drug designed to relieve muscle spasms (cramps) in the stomach and intestines by relaxing the smooth muscle temporarily

Glucagon

bowel relaxant to ensure minimal peristalsis during the procedure

Side effect of buscopan

May cause temporary blurry vision

Enema Bag Height when instilling barium into the bowel

24-30 inches

Enema Tip Insertion

1. place pt in LAO

2. ensure pt is draped and inform them of procedure

3. apply clean gloves

4. Lubricate the enema tip

5. Instruct the patient to exhale slowly as the tip is inserted

6. insert 3-4 inches or until it passes the anal sphincter in an anterior-superior direction towards the patient's belly button

7. once in place, secure it by inflating the balloon and clamping it in place

Post Procedural Care Barium Enema

• assist pt to washroom to relieve pressure from enema and evacuate their bowel

• pt lies on left side to clear out Ba into bag with gravity

• pt should drink plenty of fluid

• Patients may resume their normal diet

• advise pt patients may experience cramping and unexpected urgent bowel movements, "chalky" stool

• constipation may occur with insufficient fluid