Podcast
Questions and Answers
Perforation of the bowel is often related to manipulation of the rectal catheter ______.
Perforation of the bowel is often related to manipulation of the rectal catheter ______.
balloon
Venous intravasation may result in a barium pulmonary ______, which carries an 80% mortality risk.
Venous intravasation may result in a barium pulmonary ______, which carries an 80% mortality risk.
embolus
Toxic megacolon is listed as one of the contraindications for ______.
Toxic megacolon is listed as one of the contraindications for ______.
barium enema
The primary purpose of using an air ______ is to demonstrate the extent of ulcerative colitis.
The primary purpose of using an air ______ is to demonstrate the extent of ulcerative colitis.
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For the contrast medium, water soluble contrast such as ______ is commonly used.
For the contrast medium, water soluble contrast such as ______ is commonly used.
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Double contrast is used to demonstrate the ______ pattern.
Double contrast is used to demonstrate the ______ pattern.
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Colonoscopy is the investigation of choice for suspected large bowel ______.
Colonoscopy is the investigation of choice for suspected large bowel ______.
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A tight stricture may require a small volume of barium to define the upper ______.
A tight stricture may require a small volume of barium to define the upper ______.
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The absolute contraindications include toxic megacolon and ______ colitis.
The absolute contraindications include toxic megacolon and ______ colitis.
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For patient preparation, a low-residue diet is recommended for ______ days prior to the examination.
For patient preparation, a low-residue diet is recommended for ______ days prior to the examination.
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Patients should be warned that their bowel motions will be ______ for a few days after the examination.
Patients should be warned that their bowel motions will be ______ for a few days after the examination.
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Antibiotic prophylaxis is not routinely required but is recommended for patients with previous infective ______.
Antibiotic prophylaxis is not routinely required but is recommended for patients with previous infective ______.
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Complications of barium enema can include cardiac ______ induced by Buscopan.
Complications of barium enema can include cardiac ______ induced by Buscopan.
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Study Notes
Barium Enema
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Methods:
- Double contrast: Used to show the mucosal lining.
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Single contrast:
- Locating an obstruction in the colon.
- Assessing children (doesn't need mucosal pattern)
- Reducing intussusception (a condition where a part of the intestine slides or telescopes into another part)
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Indications:
- Colonoscopy is the preferred investigation for large bowel issues, showing tissue samples.
- CT colonography is an alternative, replacing barium enema in facilities with the required expertise.
- If a tight stricture is found, use a small volume of barium to define the upper margin, preventing barium impactation. CT avoids this risk.
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Contraindications (Absolute):
- Toxic megacolon (a condition causing a large colon)
- Pseudomembranous colitis (inflammation of the colon)
- Recent biopsy via rigid endoscope (within 5 days) or flexible endoscope (within 24 hours).
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Contraindications (Relative):
- Incomplete bowel preparation. If the patient can have additional preparation to return later that day, or the next, the examination can proceed.
- Recent barium meal. Wait 7-10 days after a meal with barium.
- Patient frailty (weakness).
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Contrast Medium:
- Polibar 40% w/v 500 mL.
- Air.
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Equipment:
- Disposable enema tube and pump.
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Patient Preparation:
- 3 days before: Low-residue diet.
- Day before: Fluids only, Picolax.
- Day of: Diabetics first.
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Aftercare:
- Do not drive until Buscopan-induced vision blurring resolves (usually within 30 minutes).
- Bowel movements may be white for a few days.
- Drink extra fluids to prevent barium impaction..
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Antibiotic Prophylaxis:
- It is not routinely needed.
- However, barium enema carries a significant endocarditis risk in patients with specific risk factors.
- Offer antibiotics to those with:
- Previous infective endocarditis.
- Acquired valvular heart disease (stenosis or regurgitation).
- Valve replacement.
- Structural congenital heart disease.
- Hypertrophic cardiomyopathy.
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Complications (Rare):
- Cardiac arrhythmias: Induced by Buscopan or the procedure itself; most frequent cause of death after barium enema.
- Bowel perforation: Often linked to rectal catheter balloon manipulation; second most frequent cause of barium enema-related death.
- Transient bacteremia.
- Side effects: From the pharmacological agents used.
- Intramural barium.
- Venous intravasation: Can cause barium pulmonary embolus, carries an 80% mortality risk.
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Instant Enema:
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Indications:
- Identifying/confirming large bowel obstruction level.
- Assessing narrowing extent.
- Showing extent and severity of mucosal issues in active ulcerative colitis.
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Contraindications:
- Toxic megacolon.
- Rectal biopsy.
- Chronic ulcerative colitis (optical colonoscopy preferable).
- Crohn's colitis (unreliable assessment).
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Indications:
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Contrast Medium (Instant Enema):
- Water-soluble contrast (e. g., Urografin 150, Omnipaque)
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Preliminary Images: Plain abdominal films to rule out toxic megacolon and perforation
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Technique: Run contrast medium until it reaches obstructing lesion or dilated bowel loops. Air insufflation is unnecessary.
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Images: Obtained as needed; should include views of the identified pathology. Prone, left lateral decubitus, and erect views might be necessary.
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Air Enema:
- Very rarely performed.
- Indications: Demonstrating ulcerative colitis extent.
- Technique: Inserts a 14-16 F Foley catheter into the rectum, inflates the balloon (10-20 mL). Take preliminary AP film, relax patient (e.g. Buscopan). Inflate air into catheter lumen and take AP films of the abdomen.
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Description
Test your knowledge on colonoscopy and related bowel conditions with this comprehensive quiz. It covers various contraindications, preparation requirements, and potential complications. Perfect for medical students and healthcare professionals looking to refresh their understanding.
