Barium Enema Past Paper PDF

Barium Enema  Methods 1. Double contrast—to demonstrate mucosal pattern 2. Single contrast- (a) Localization of an obstructing colonic lesion (b) Children- not necessary to demonstrate mucosal pattern (c) Reduction of an intussusception  Indicat...

Barium Enema  Methods 1. Double contrast—to demonstrate mucosal pattern 2. Single contrast- (a) Localization of an obstructing colonic lesion (b) Children- not necessary to demonstrate mucosal pattern (c) Reduction of an intussusception  Indication For suspected large bowel pathology, colonoscopy is the investigation of choice allowing tissue diagnosis. CT colonography is the alternative colon examination of choice and has superseded barium enema where facilities and expertise exist If a tight stricture is demonstrated, only run a small volume of barium proximally to define the upper margin, the barium may impact. CTC avoids the risks of barium impaction.  Contraindications  Absolute 1. Toxic megacolon 2. Pseudomembranous colitis 3. Recent biopsy via: (a) rigid endoscope within previous 5 days (b) flexible endoscope within previous 24 h  Relative 1.Incomplete bowel preparation. If the patient can have extra preparation to return later that day or the next day. 2.Recent barium meal. It is advised to wait for 7–10 days. 3.Patient frailty.  Contrast Medium 1. Polibar 40 % w/v 500 mL 2. Air Equipment Disposable enema tube and pump. Patient Preparation For 3 days prior to examination Low-residue diet. On the day prior to examination 1. Fluids only 2. Picolax On the day of the examination To place diabetics first on the list.  Aftercare 1. The patient must not drive until any blurring of vision produced by Buscopan has resolved, usually within 30 min. 2. Patients should be warned that their bowel motions will be white for a few days after the examination. They may eat normally and should drink extra fluids to avoid barium impaction. Antibiotic Prophylaxis in Barium Enema This is not routinely required, but barium enema is identified as the only lower GI intervention with a significant risk of endocarditis in those patients with specific risk factors. Offer antibiotic prophylaxis to those with: previous infective endocarditis acquired valvular heart disease with stenosis or regurgitation valve replacement structural congenital heart disease hypertrophic cardiomyopathy Complications (All Are Rare) 1.Cardiac arrhythmias induced by Buscopan or the procedure itself. This is the most frequent cause of death after barium enema. 2.Perforation of the bowel (often related to manipulation of the rectal catheter balloon)is the second most common cause of death after barium enema. 3.Transient bacteraemia. 4.Side effects of the pharmacological agents used. 5.Intramural barium. 6.Venous intravasation. This may result in a barium pulmonary embolus, which carries an 80% mortality risk. The Instant Enema Indications 1.To identify/confirm the level of suspected large bowel obstruction and to assess the degree of narrowing. 2.Rarely, to show the extent and severity of mucosal lesions in active ulcerative colitis. Contraindications 1. Toxic megacolon 2. Rectal biopsy (as for barium enema) 3.Chronic ulcerative colitis -- Optical colonoscopy to detect dysplasia and neoplasia in this high-risk group is preferred 4.Crohn’s colitis—Assessment in this situation is unreliable Contrast Medium Water soluble contrast(e.g.Urografin150).(Omnipaque) Preliminary Image Plain abdominal film-to exclude: 1. Toxic megacolon 2. Perforation Technique 1.The contrast medium is run until it flows into an obstructing lesion or dilated bowel loops. 2. Air insufflation is not required. Images Images are obtained as required, generally to include views of pathology encountered, but may include prone, left lateral decubitus and erect films as necessary.  Air enema Very rarely used. Indications Demonstrate extent of ulcerative colitis. Technique 1.Insert 14–16-F Foley catheter into rectum and inflate balloon (10–20 mL). 2.Take preliminary over couch AP film of abdomen. 3.View film and without the patient moving give relaxant (e.g.Buscopan) and then inflate air (gentle puffs) into catheter lumen. 4. Take AP film of abdomen.