5)barium enema
TRANSCRIPT
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BARIUM ENEMABARIUM ENEMA
• Double contrast
• Single contrast
METHODSMETHODS
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INDICATIONSINDICATIONS
• Changes in bowel habit
• Colitis
• Ulcerative colitis
• Pain
• Mass
• Melaena/anaemia
• Diverticulum
• Intussusception (single contrats)
• Neoplasm
• Volvulus
• Obstruction
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CONTRAINDICATIONCONTRAINDICATION
• Toxic megacolon
• Pseudomembranous colitis
• Rectal biopsy
• Incomplete bowel preparation
• Recent barium meal
• Patient frailty
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CONTRAST MEDIACONTRAST MEDIA
• Positive CM:
– Barium sulfate
– Amount : 500 ml
• Negative CM:
– Double Contrast Barium Enema (DCBE)
– Carbon dioxide, room air
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EQUIPMENTEQUIPMENT
• Fluoroscopy unit with spot film device
• Miller disposable enema tube
• Barium enema bag
• Clamp/forceps
• Lubricant
• Plaster
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PATIENT PREPARATIONSPATIENT PREPARATIONS
• Bowel preparation → 2 days
– 1st day →low residual diet
– 2nd day →fluid only & laxative
• LMP / ? Pregnant
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FILMS: preliminaryFILMS: preliminary
• AXR
→assess bowel preparation
→necessary when toxic megacolon is suspected
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TECHNIQUE: DCBETECHNIQUE: DCBE• Pt lies in lateral position
• Catheter is inserted into rectum gently & taped firmly in position
• Hand pump is connected
• i.v of Buscopan (20mg) / Glucagon (1mg) is given
• Pt lies in prone position
• Infusion of barium is commenced. Intermittent screening is required
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• Infusion is terminated once the barium reaches hepatic flexure
• The barium is turn back out by either lowering the infusion bag or tilting the table erect
• Air is gently pumped into the bowel, forcing the barium round toward caecum & producing double contrast effect
• From prone position, pt rolls onto left side & over into RAO position so that barium coats the bowel mucosa
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FILMS: spotFILMS: spotSpot films of rectum &
sigmoid (table horizontal)
• RAO• Prone• LPO• Left lat. of rectum
Spot films of hepatic flexure (table erect)
• LAO• RAO• Right lat. of the rectum
Spot films of caecum (table horizontal)
• Supine; slightly on right side (slightly LAO) ; head down
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• Overcouch – AP SUPINE
– PA PRONE
– HAMPTOM :- prone with tube angle 45° caudad & center about 5cm above PSIS
– RIGHT LATERAL DICUBITUS
– LEFT LATERAL DICUBITUS
FILMS: post FILMS: post procedureprocedure
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AFTER CAREAFTER CARE• Warn pt that bowel motion will
be white for a few days
• Laxative is given to avoid barium impaction
• Pt must not leave the department until blurring vision has resolved
• Advise pt to increase intake of fluid, fruits & vegetables
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COMPLICATIONSCOMPLICATIONS
• Perforation of the bowel
• Transient bacteraemia
• Cardiac arrhytmia due to rectal distension
• Side effect of pharmacological agents used
• Venous intravasation
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