Small Intestine Examinations and Barium Follow-Through

Small Intestine Examinations

• The small intestine (SI) extends from the stomach's pyloric sphincter to the iliocecal valve.
• It's divided into three parts: duodenum, jejunum, and ileum.
• Examinations can be performed by oral barium follow-through, direct injection, or complete reflux with a large volume barium enema.

Barium Follow-Through

• This radiographic technique assesses the SI after oral barium administration.
• Methods: Single contrast or with an effervescent agent.
• Indications: Abdominal pain, diarrhea, anemia/GI bleeding, or abdominal mass.
• Contraindications: Complete obstruction or suspected perforation.
• Contrast Media: Barium sulfate (100% w/v 300 ml) mixed with Gastrografin (10 ml) to speed transit time.
• Patient Preparation: Two-day low-residue diet, cleansing enema to clear the colon and SI, and emptying the bladder before and after to avoid compression.

Technique and Films

• Technique: Single column of barium and patient drinking the barium.
• Films: Prone (PA view) every 20 minutes the first hour and 30 minutes thereafter, to separate small intestinal loops. Spot film of terminal ileum (supine AP) taken 20 minutes after barium ingestion.
• Positions (PA or AP): Film size 14x17 lengthwise, patient in prone or supine position, mid-sagittal plane centered to the grid. CR is perpendicular at L2 level (2 inches above iliac crest).
• Additional Positions: Oblique, head-down tilt, or tube angled to pelvis to separate loops; erect (fluid level) for diverticula.

Barium Follow-Through - Additional Notes

• Slow Transit: Administer ice water or dry meal. Metoclopramide (20 mg orally 20 minutes before) may enhance gastric emptying.
• Time Marker: Essential.
• Fluoroscopy: Performed when barium reaches ileocecal region while showing the small bowel progressively filling. Exam complete when barium reaches cecum.
• Criteria for Good Images: Entire SI, stomach( initial images), well-placed time markers, centered vertebral column without rotation, good barium penetration, and total completion with barium in the cecum.