Small Intestinal Series (SIS) and Small Bowel Series (SBS) PDF

SMALL INTESTINAL SERIES (SIS) Luisa T. Cruz, RRT  SMALL BOWEL SERIES (SBS) Radiographic study of the small intestine Done at timed intervals Small Bowel Follow-Through (SBFT): when SI is studied in combination of UGIS-SBS radiologic examination of the...

SMALL INTESTINAL SERIES (SIS) Luisa T. Cruz, RRT  SMALL BOWEL SERIES (SBS) Radiographic study of the small intestine Done at timed intervals Small Bowel Follow-Through (SBFT): when SI is studied in combination of UGIS-SBS radiologic examination of the small bowel with the administration of barium suspension. Purposes: To study the form and function of the three components of the Small Intestine To detect any abnormal conditions ANATOMY (SMALL INTESTINE) 1. Duodenum - the 1st part, shortest, widest - 8-10” (20-25 cm) - located Right Upper Quadrant & Left Upper Quadrant 2. ILEUM - Right Lower Quadrant & Left Lower Quadrant - longest portion of Small Intestine - 2.5 cm diameter 3. Jejunum - Left Upper Quaddrant & Left Lower Quadrant - 3-3.5 cm diameter PATHOLOGIC INDICATIONS ENTERITIS ADENOCARCINOMA GARDIASIS Sprue ( Malabsorption ILEUS Syndrome) ADYNAMIC OR PARALYTIC Celiac Disease MECHANICAL OBSTRUCTION Whipple’s Disease MICKEL’S DIVERTICULUM NEOPLASM ADENOMAS and LEIOMYOMAS CARCINOID TUMOR LYMPHOMA and ADENOCARCINOMA PATHOLOGIC INDICATIONS 1.Enteritis inflammation of the intestine, primarily the small intestines. 2.GASTRO-ENTERITIS stomach involve 3.REGIONAL ENTERITIS ( SEGMENTAL ENTERITIS or CROHNS’S DISEASES Inflammatory bowel disease of unknown origin, involving the GIT “cobblestone” appearance PATHOLOGIC INDICATIONS 4. GARDIASIS –infection in the lumen of the small intestines that is caused by the FLAGELLATE PROTOZOAN (Gardia lamblia) PATHOLOGIC INDICATIONS 5. ILEUS Obstruction of the small intestine, proximal jejunum PATHOLOGIC INDICATIONS 6.ADYNAMIC OR PARALYTIC due to cessation of peristalsis PATHOLOGIC INDICATIONS 7.MECHANICAL OBSTRUCTION – physical blockage of the bowel that may caused by tumors, adhesions and hernia. PATHOLOGIC INDICATIONS 8.MICKEL’S DIVERTICULUM common birth defect caused by persistence of yolk sac (umbilical vesicle) resulting in saclike out pouching of the intestinal wall, 10-12 cm in diameter, 50-100 cm proximal to the ileocecal valve. PATHOLOGIC INDICATIONS 9.NEOPLASM new growth 10.ADENOMAS and LEIOMYOMAS common benign tumors of the SI and usually found in the JEJUNUM and ILEUM. 11.CARCINOID TUMOR common tumors of the small bowel, 12.LYMPHOMA and ADENOCARCINOMA malignant tumor “ stacked-coin” sign 13.ADENOCARCINOMA “ napkin ring” sign  PATHOLOGIC INDICATIONS 14.Sprue ( Malabsorption Syndrome) condition in which the GIT is unable to process and absorb certain nutrients.  PATHOLOGIC INDICATIONS 15.Celiac Disease form of sprue or malabsorption disease that affects the PROXIMAL SMALL BOWEL, esp. The PROXIMA DUODENUM PATHOLOGIC INDICATIONS 16.Whipple’s Disease Rare disorder of the PROXIMAL SMALL BOWEL whose cause is unknown. Diagnosed with SBS which shows distorted loops of small intestines.  CONTRAINDICATIONS Pre-surgical patients Patients with perforated hollow viscus (intestine or organ) BaSO4 should not be used CM used: water-soluble iodinated Care must be taken to young or dehydrated patients Possible large bowel obstruction  SMALL BOWEL SERIES (SBS) PROCEDURE Performed by: Upper Gastro Intestinal-Small Bowel combination (Mouth) Complete reflux filling Large volume Barium Enema Enteroclysis/small bowel enema Direct injection into bowel through an intestinal tube Difficult to performed: Intubation Method Barium Enema & Enteroclysis: used when oral method fails to provided conclusive information  PATIENT PREPARATION Soft residue diet for 2 days NPO after evening meal of the day before the examination NPO (breakfast) on the day of the study Cleansing enema/cathartics - Purpose: to clear the colon Bladder should be empty before and during the procedure - Rationale: to avoid displacing and compressing the ileum  PRELIMINARY FILM Plain AP Abdomen (KUB)  POSITION OF THE PATIENT Supine/prone Purpose of Supine: To take advantage of the superior and lateral shift of the barium- filled stomach For visualization of retrogastric portions of the duodenum and jejunum To prevent possible compression overlapping loops of the intestine Purpose of Prone: To compress the abdominal contents Increases radiographic quality To separate the various loops of bowel Creates higher degree of visibility  POSITION OF THE PATIENT Trendelenburg Position: For final radiograph in asthenic patient Purpose: To unfold low lying and superimposed loops of the ileum To separate overlapping loops of ileum  UPPER GSATRO INTESTINAL-SMALL BOWEL COMBINATION (BONTRAGER) Routine Upper Gastro Intestinal first (UGI) Barium: 1 full cup (8 oz); time noted Second cup: after routine Gastro Intestine; time noted 30-minute PA radiograph -IR centered high for proximal Small Bowel 30-minute interval radiographs -IR centered to iliac crest Finished: when barium reaches ileocecal valve (usually 2 hours) 1-hour interval radiographs If more time is needed after 2 hours  UPPER GSATRO INTESTINAL-SMALL BOWEL COMBINATION (BONTRAGER) Routine Upper Gastro Intestinal first (UGI) Barium: 1 full cup (8 oz); time noted Second cup: after routine Gastro Intestine; time noted 30-minute PA radiograph -IR centered high for proximal Small Bowel 30-minute interval radiographs -IR centered to iliac crest Finished: when barium reaches ileocecal valve (usually 2 hours) 1-hour interval radiographs If more time is needed after 2 hours  SMALL BOWEL SERIES ONLY (BONTRAGER) Scout: Plain abdomen radiograph Barium: 2 cups (16 oz); noting time First radiograph: 15-30 minute radiograph – IR centered high for proximal Small Bowel Second radiograph: half hour interval radiograph – IR centered to iliac crest Finished: when barium reaches ileocecal valve (usually 2 hours) 1-hour interval or continuous half-hour interval radiographs – If more time is needed after 2 hours  COMPLETE REFLUX EXAMINATION Administer Barium Enema To demonstrate colon and small bowel Preparation before exam: Glucagon Barium suspension: Rationale: 15% +/- 5% weight/volume To relax intestine 4500 mL: required to fill the colon – Diazepam/Valium and small intestine Rationale: Allowed to flow until observed in To diminish patient discomfort duodenal bulb Materials: Enema bag is lowered Retention tip enema Radiographs are taken Enema bag  ENTEROCLYSIS (BONTRAGER) Injection of a nutrient or medicinal liquid into the bowel Material: special enteroclysis catheter (Bilbao/Sellink tube) Site: duodenojejunal junction (ligament of Treitz) Double contrast method – Barium Rate: 100 mL/minute Air or methylcellulose Purpose: used to distend the lumen of bowel  ENTEROCLYSIS (BONTRAGER) Indication: patient with – History of small bowel ileus – Regional enteritis (Crohn’s Disease) – Malabsorption syndrome Advantages: – Enhances the visibility of the mucosa (double contrast effect) – Increases the accuracy of the study Disadvantages: – Increased patient discomfort – Increased possibility of bowel perforation during catheter placement  ENTEROCLYSIS PROCEDURE (BONTRAGER) Preparations: – Colon must be thoroughly cleansed Enemas not recommended – Rationale: enema fluid may retain in the small intestine Special catheter advanced to duodenojejunal junction (near ligament of Treitz) – Under fluoroscopic control Thin mixture of barium sulfate instilled – Rate: 100 mL/minute Air or methycellulose instilled Fluoroscopic spot images and conventional radiographs taken CT may be performed Iodinated CM or tap water must be used ENTEROCLYSIS PROCEDURE (BONTRAGER) GASTROINTESTINAL INTUBATION METHOD The procedure in which a long, specially designed tube is inserted through the nose and passed into the stomach Small bowel enema Single-contrast small bowel series For diagnostic & therapeutic purposes  GASTROINTESTINAL INTUBATION METHOD Materials: Nasogastric tubes Single-lumen tube Site: proximal jejunum Patient: RAO position (gastric peristalsis more active) – Aid in passage of tube Miller-Abbott (M-A) tube -A double-lumen tube -For therapeutic intubation Site: proximal jejunum GASTROINTESTINAL INTUBATION METHOD  INTUBATION METHOD PROCEDURE Therapeutic intubation Purposes: -To relieve postoperative distention -To decompress a small bowel obstruction INTUBATION METHOD PROCEDURE (Bontrager) Single-lumen catheter advanced to proximal jejunum Double lumen: used for therapeutic intubation Water-soluble iodinated CM or thin mixture of BaSO4 instilled (time noted) Conventional radiograph of fluoroscopic spot images taken (at specific time intervals) INTUBATION METHOD PROCEDURE  SMALL BOWEL SERIES PROCEDURE (BALLINGER) First radiograph: 15 minutes – After the patient drinks the barium Second radiograph: b/n 15-30 minutes – Depends on transit time of barium Glass of ice water/food stimulant: – For patient with hypomotility – Given after 3-4 hours of administering barium Purpose: to accelerate peristalsis Alternative methods to stimulate peristalsis: – Water-soluble CM, tea or coffee – Peristaltic stimulants every 15 minutes Examination: completed in 30-60 minutes