Large Intestine Barium Enema PREPARED BY SHARA C

Large Intestine Barium Enema PREPARED BY: SHARA C. ALOJADO 53 B

Large Intestine 1. 5 metres in length n Consists of n n Caecum n Appendix n Ascending colon n Transverse colon n Descending colon n Sigmoid colon n Rectum n Anus

Large Intestine

What is Lower GI Tract X-ray Radiography (Barium Enema)? • Lower gastrointestinal (GI) tract radiography, also called a lower GI or barium enema, is an x-ray examination of the large intestine, also known as the colon. • This examination evaluates the right or ascending colon, the transverse colon, the left or descending colon, the sigmoid colon and the rectum. The appendix and a portion of the distal small intestine may also be included.

Barium Enema examinations Some Indications n Change in bowel habits n Mass (eg mass right iliac fossa) n Appendicitis / diverticulitis n Polyp / cancer Volvulus Signs / Symptoms n Right / left lower quadrant pain Fever / elevated wbc’s Distension / obstruction Weight loss Melena (Is darkening of the feces by blood pigments)

Barium Enema examinations contraindications Perforated hollow viscus • Large bowel obstructions • recent biopsy • toxic mega colon • Pseudo membranous colitis Relative: • incomplete bowel preparation • recent Ba meal •

Barium enema examinations Double contrast – demonstrates mucosal pattern n Barium sulphate + air n Single contrast – Paediatrics, reduction of an intussusceptions (Intussusceptions occurs ( when part of the bowel or intestine is wrapped around itself producing a mass like object on the right side of the abdomen) n

Patient Preparation n n n n Low residual diet ( 3 days before) Laxative and fluids only (1 day before ) Amoxicillin or Vancomycin prior and after the procedures ( dose and type as instructed Females – 10 day rule applies Preliminary film taken in certain circumstances full explanation of procedure Catheter (miller) introduced Muscle relaxant may be given Drip stand, and hand pump for introducing air

Barium enema - Technique n Patient lies on one side & catheter is inserted gently into the rectum n Connections are made to the barium bag

Barium enema - Technique

Barium enema - Technique n Patient lies on one side & catheter is inserted gently into the rectum n Connections are made to the barium bag n i. v. injection of Buscopan / glucagon is given n The barium is infused slowly as far as the hepatic flexure under fluoroscopic control. n The column of barium within the sigmoid colon is run back out n Air is gently pumped into the bowel, forcing the column of barium round towards the caecum (double contrast effect) n The patient position is adjusted under fluoroscopic control as the complete colon is visualised as the barium travels round to the caecum n From a prone position, the patient rolls onto the left side and over into an RAO position

ENEMA INSERTION

Barium enema - film series • • Spot films of rectum and sigmoid colon: - RAO, prone, LPO, left lateral of the rectum • Spot films of splenic flexure LAO • Spot films of hepatic flexure RAO • Spot film of caecum with compression • Over couch film supine abdomen • Over couch film prone abdomen • Right and left lateral decubitus films • Prone caudal angled sigmoid view • Post evacuation supine film

Barium enema Patient aftercare & complications n n n Encourage patient to drink plenty of fluids Inform patients where & when to obtain results Warning of the side effects against the muscle relaxant that may have been given during the examination complications n n barium impaction reaction to the rubber of the cuff Cardiac arrhythmias due to rectal distension Perforation of the bowel

Barium Enema (1) caecum (2) ascending colon, (3) transverse colon (4) descending colon (5) rectum (6) right colic flexure (hepatic flexure) (7) left colic flexure (splenic flexure)

IMAGES OF LARGE INTESTINE WITH ABNORMALITIES DIVERTICULOSIS

POLYPS

Sigmoid Carcinoma

COLITIS

References • Radiographic procedures: By Stephen Chapman • Positioning in Radiography: By k. C. Clarke. • Text book of radiographic positioning and related anatomy; bykenneth L. Bontrager. • GOOGLE Websites • http: //www. e-radiography. net/