lower GI

safety concerns during all barium enema processes

1. review the patient's chart 2. never forced animal tip into the rectum 3. height of animal bag should not exceed 60 cm or 24 in above the table 4. verify the water temperature of contrast media. water that is too hot or too cold may injure the patient or compromise the procedure. 5. Escort the patient to the restroom after completion of the study. some patients may faint during or after evacuation of barium.

list of small bowel procedures

1. upper GI, small bowel combination 2. small bowel only series 3. enteroclysis-double-contrast small bowel procedure 4. intubation method - single-contrast study

barium enema prep

Coldwater can lead to colon spasms. room temperature water between 85 and 90 degrees Fahrenheit is recommended. hot water is never used. to minimize spasming during the barium enema lidocaine maybe added to the contrast medium. patient should be in the Sims position which is on their left side with right leg bent over towards the front. insert the tip on exertion 1-1.5", then angle superiorly and slightly anteriorly to follow the normal curvature of the rectum. The total insertion of the tip should not exceed 3-4 inches

barium enema procedure patient prep

NPO for 8 hours no gum chewing or smoking. The goal is to have the section of the alimentary canal empty. thorough cleansing of the entire large bowel is very important for a satisfactory contrast media study of the large intestine.

patient prep for small bowel series and upper GI

NPO for at least 8 hours, a low residue diet for 48 hours before the procedure and no use of tobacco or nicotine products or chewing gum during the NPO period. The patient should be asked to void before the procedure.

annular carcinoma (adenocarcinoma)

One of the most typical forms of colon cancer, may form an "apple-core" or "napkin-ring" appearance

sectional differences of the small intestine

The C shaped duodenum is fairly fixed in position immediately distal to the stomach. The internal lining of the second and third portions of the duodenum is gathered into tight circular folds formed by the mucosa of the small intestine which contains numerous small finger-like projections termed villi, resulting in a feathery appearance when filled with barium. the mucosal folds of the distal duodenum are found in the jejunum as well. although there is no abrupt end to the circular feathery folds, the ilium tends to not have this appearance. another observable difference in the three sections of the small intestine is that the internal diameter gets progressively smaller from duodenum to ilium.

diverticulosis

The condition of having numerous diverticula that are inflamed and can cause bleeding. if the diverticulum perforates the mucosal wall, fecal matter may escape.

large versus small intestine characteristics

The internal diameter of the large intestine is usually greater than the diameter of the small bowel. the mucosal portion of the intestinal wall contains three external bands of longitudinal muscle fibers of the large bowel that form three bands of muscle called the taeniae coli, which tend to pull the large intestine into pouches. each of these pouches or sacculations , is called a haustrum. most of the large intestine, except for the rectum, possesses haustra the third differentiation is the relative positions of the two structures. The large intestine extends around the periphery of the abdominal cavity whereas the small intestine is more centrally located.

barium enema, (lower GI series) or BE

The purpose is to demonstrate radiographically the form and function of the large intestine to detect any abnormal conditions. both single and double contrast barium studies can be done.

barium and air

When a person is supine, air rises to fill the structures that are most anterior such as the transverse colon and loops of the sigmoid colon. When a patient is prone, barium and air reverse positions. air rises to fill the rectum, ascending colon, and descending colon

Meckel diverticulum

a common birth defect caused by the persistence of the yolk sac resulting in a sac like out pouching of the intestinal wall that is seen in the ileum

celiac disease

a form of male absorption disease that affects the proximal small bowel, especially the proximal duodenum. involves the insoluble protein gluten.

Whipple disease

a rare disorder of the proximal small bowel whose causes unknown. symptoms include dilation of the intestine, edema, male absorption, deposit of fat in the bowel wall and mesenteric nodules. best diagnosed with a small bowel series which shows the distorted loops of the small intestine

ilius

an obstruction of the small intestine where the proximal jejunum is expanded with air. A dynamic or paralytic ileus is due to the cessation (absence) of peristalsis and the bowel is unable to propel its contents forward. mechanical ileus obstruction is a physical blockage of the bowel that may be caused by tumors, adhesions, or hernia. The loops of intestine proximal to the site of obstruction are dilated with gas and produces a circular staircase or herringbone pattern look in barium exams.

digestive functions of intestines

digestion, absorption, reabsorption and elimination

giardiasis

dilation of intestine, with thickening circular folds is often spread by contaminated food and water. symptoms include non-specific gastrointestinal discomforts, mild to profuse diarrhea, nausea, anorexia, and weight loss. The presence of this flagellate protozoan usually affects the duodenum and jejunum with spasms, irritability and increased secretions.

enteroclysis-double-contrast small bowel procedure

double contrast method that is used to evaluate the small bowel. The injection of a nutrient or medicinal liquid into the bowel. the study requires the patient to be intubated under fluoroscopic control using a guide wire with a special catheter passed over it. The catheter is passed through the stomach into the duodenojejunal junction. a tube is placed into the terminal duodenum and is held with a retention balloon. Barium is injected through the catheter air or methylc.ellulose is injected into the bowel to distend it which provides the double contrast effect. the double contrast dilates the loops of the small bowel while enhancing the visibility of the mucosa. disadvantages include increased patient discomfort and the possibility of a small bowel perforation during catheter placement.

rectum

extends from the sigmoid colon to the anus. begins at the level of S3 and is about four and a half inches long. The final one to one and a half inches is constricted to form the anal canal which terminates as an opening to the exterior and is called the anus. rectal ampulla- Is a dilated portion of the rectum located anterior to the coccyx. The initial direction of the rectum along the sacrum is inferior and posterior. A second abrupt change and direction occurs in the region of the anal canal which is directed inferiorly and posteriorly. because of this the rectum presents to anteriopostwrior curves and must be remembered when inserting an enema tip.

flatus

gas expelled through the anus to help break down proteins to amino acids

contradictions to laxatives

gross bleeding, severe diarrhea, obstruction, and inflammatory conditions such as appendicitis. a laxative is a substance that produces frequent soft or liquid bowel movements and increase peristalsis in the large bowel and occasionally the small bowel by irritating sensory nerve endings in the intestinal mucosa.

small intestine or small bowel

if stretched out would be about 23 ft in length. during life, with good muscle tone, the actual length of the small intestine is 15 to 18 ft. beginning at the pyloric valve of the stomach, the three parts of the small intestine are the duodenum (RUQ, LUQ), jejunum (LUQ, LLQ) and ilium (RUQ, RLQ, LLQ).

contradictions for small bowel series

if the patient is suspected you have a perforated hollow viscous (intestine or organ) or perforated bowel they should not receive barium sulfate. they should use a water soluble, identated contrast. Care must be taken because The water soluble, I donated contrast can cause dehydration. Barium sulfate by mouth is contraindicated and patients with a possible large bowel obstruction.

CR positioning for most barium enema projections

iliac crest

colitis

inflammation of the large intestine. Maybe caused from bacterial infection, diet, stress, and other environmental conditions. intestinal mucosa may appear rigid and thick and lack haustral markings along the involved segment. The intestinal wall has a sawtooth or jagged appearance..

enteritis

inflammation of the small intestine. When the stomach is also involved this condition is called gastroenteritis. chronic irritation may cause the lumen of the intestine to become thickened, irregular, and narrowed

regional enteritis, segmental enteritis, or Crohn's disease

inflammatory bowel disease of unknown origin involving any part of the gastrointestinal tract but commonly involving the terminal ilium. leads to scarring and thickening of the bowel all and produces a cobblestone appearance visible during small bowel series

types of laxatives

irritant laxatives, such as castor oil sailing laxatives such as magnesium citrate or magnesium sulfate

large intestine

large bowel. begins in the right lower quadrant and it connects to the small intestine. extends around the periphery of the abdomen cavity to end at the anus. The large intestine is about 5 ft long and about 2 and 1/2 in in diameter. begins in the RLQ and it's just lateral to the ileocecal valve. The large intestine consists of four major parts- cecim, rectum, and anal canal. The final segment in the large intestine is the rectum. The distal rectum contains the anal canal which ends in the anus

cecum

located at the proximal end of large intestine. It is a large blind pouch located inferior to the level of the ileocecal valve. the cecum Is the widest portion of a large intestine and is fairly free to move about the RLQ. The ileocecal valve acts as a sphincter to prevent the contents of the ilium from passing too quickly into the cecum. the second function of the ileocecal valve is to prevent reflux or a backward flow of large intestine contents back into the ilium.

ilium

located primarily in the RUQ, RLQ, and LLQ makes up the distal 3/5 of the remaining aspect of the small intestine and is the longest portion of the small intestine. The terminal ilium joins the large intestine at the ileocecal valve (or sphincter or fold) in the RLQ. The ilium possesses a thinner wall and has fewer mucosal folds. at the point of the ileocecal valve, the inner lumen of the ilium is nearly smooth.

jejunum

located primarily to the left of the midline in the LUQ and LLQ, making up about 2/5 of the remaining aspect of the small intestine. it's inner diameter is approximately 2.5 cm and contains numerous mucosal folds (plicae circulares). these mucosal folds produce the feathery appearance of the jejunum. the jejunum begins at the duodenojejunal flexure, slightly to the left of midline in the LUQ.

barium enema

lower GI series of the colon, or study of large intestine. this radiographic procedure is to study the large intestine

lymphoma and adenocarcinoma

malignant tumors of the small intestine that are demonstrated in a small bowel series as the stack of coin symbol. caused by thickening, coarsening and possible hemorrhage of the mucosal wall. other segments of the intestine may become narrowed and ulcerative. produce a short and sharp napkin ring defect within the lumen which may lead to complete obstruction. The most common sites are the duodenum and the proximal jejunum.

double contrast barium enema

more effective demonstrating polyps in diverticula than single contrast studies. The use of air and barium are introduced into the large bowel. a clean large bowl is essential and a much thicker barium mixture is required. usually the ratio is a 1:1 mix. two stage procedure is where the barium and air are injected at different times with barium first and air second. the air and gas combination moves the main bolus of barium forward. single stage procedure -still a double contrast procedure, but barium and air are instilled in a single procedure that reduces time and radiation exposure to the patient.

carcinoid tumors

most common tumors of the small bowel, have a benign appearance but may become malignant

neoplasm

new growth. Maybe benign or malignant. common benign tumors of the small intestine include adenomas and leiomyomas. narrow segments of the intestine look like an apple core or napkin ring sign

colon

not the same as a large intestine. The colon consists of four sections and two flexures and does not include the cecum and rectum. The four sections are the ascending colon, the transverse colon the descending colon and the sigmoid colon. The right (or hepatic) and left (or splenic) colic flexures are also included as part of the colon.

diverticulum

out pouching of the mucosal wall that may result from a herniation of the inner wall of a colon. most common among adults older than 40 years of age

small bowel only series

patient typically in just two cups of barium. Time is noted and depending on protocol additional radiographs are taken in 15 or 30 minute intervals after the barium has been ingested. radiographs are generally taken every half hour for 2 hours or until the barium reaches the cecum or ascending colon. most of the time this procedure takes 2 to 3 hours but varies among patients.

small bowel series

radiographic examination specifically of the small intestine. this examination is often combined with an upper GI and under these conditions may be termed a small bowel follow through

polyps

sack like projections similar to diverticula except they project inward into the lumen rather than outward.

contradictions for a barium enema

same as the small bowel series. It is also important to review the patient's chart to determine whether they had a recent sigmoidoscopy or colonoscopy before undergoing the barium enema. if a biopsy of a colon was performed during these procedures the involved section may be weakened and may lead to perforation during the barium enema. this procedure is generally not performed in cases of acute appendicitis.

ulcerative colitis

severe form of colitis that is most common among young adults. often leads to development of coin like ulcers within the mucosal wall. along with Crohn's disease it is one of the most common forms of inflammatory bowel disease. can create a cobblestone appearance along the mucosa and may develop stove pipe colon in which haustral markings and flexures are absent.

duodenum

shortest, widest, and most fixed portion of the small bowel that is located primarily in the RUQ but also extends into the LUQ where it joins the jejunum at a point called the duodenojejunal flexure. It is the shortest part of the small intestine and averages 20 to 25 cm

types of lower GI examinations

single contrast barium enema double contrast barium enema evacuative proctography (defecogram)

lower digestive functions

small intestine = digestion duodenum / jejunum = absorption and reabsorption large intestine= defecation or elimination

Movements of the digestive tract

small intestine includes peristalsis and rhythmic segmentation large intestine includes peristalsis, haustral churning, mass peristalsis and defecation

diverticula

small, barium-filled circular defects that project outward from the colon during a very minimal

intubation method - single-contrast media study

sometimes referred to as a small bowel enema. with this technique a nasogastric tube is passed through the patient's nose, through the esophagus, stomach, and duodenum into the jejunum. this procedure is performed for both diagnostic and therapeutic purposes. therapeutic innovation is performed often to relieve post-operative distention or to decompress a small bowel obstruction

intussusception

telescoping of one part of the intestine into another. most common in infants younger than two but can occur in adults. A barium enema or an air gas and a may play a therapeutic role in re-expanding the involved bowel. creates a mushroom shaped dilation which marks the point of obstruction

spur and mal absorption syndromes

thickening of mucosal folds and poor definition of normal feathery appearance. gastrointestinal tract is unable to process and absorb certain nutrients. this is often experienced by patients with lactose in sucrose sensitivities

vulvulus

twisting of the intestine on itself, causing an obstruction. More likely to occur than men in women in this most common in adults between 20 and 50 years old. The classic sign is a beak sign or a tapering narrowing of the vulvas demonstrated during a barium enema

upper GI and small bowel combination

upper GI is performed first and after the stomach study is completed, progress of the barium is followed through the entire small bottle. patient generally should ingest one full cup of barium sulfate mixture. The time the barium ingested by the patient should be noted. additional images are taken at specific time ranges such as 15 minutes or 30 minutes apart up to 2 hours and then 1 hour after or until the barium passes through the ileocecal valve.

appendix

vermiform appendix. long narrow, worm shaped tube that extends from the cecum. The second has a blind ending and infectious agents we enter the appendix which cannot empty itself.