This document provides information about various radiographic procedures involving the gastrointestinal tract, including barium meal follow through (BMFT), enteroclysis, and barium enema. It describes the anatomy of the small and large intestines, indications and contraindications for the procedures, patient preparation, techniques used, and advantages and disadvantages. BMFT involves administering barium orally to visualize the small intestine, enteroclysis involves inserting a tube to infuse barium directly into the jejunum, and barium enema involves administering barium rectally to examine the large intestine. The document provides detailed information on performing each procedure.
Barium meal ppt presentation is very important for radiology resident , radiologist and radiographers. this slide contents lots of barium image and technique, position, indication and modification and lots of information. this presentation help alot thanks .
Barium meal ppt presentation is very important for radiology resident , radiologist and radiographers. this slide contents lots of barium image and technique, position, indication and modification and lots of information. this presentation help alot thanks .
Learn Barium Meal & Follow Through for the beginners from a Radiology Resident.For some image description please go through the text book "David Sutton" because i have described these image during my presentation Verbally..There are many animations used inside this presentation so to see all the pictures which are placed layer by layer with the help of animations you simple need to download this presentation first.... Thanx.
Learn Barium Meal & Follow Through for the beginners from a Radiology Resident.For some image description please go through the text book "David Sutton" because i have described these image during my presentation Verbally..There are many animations used inside this presentation so to see all the pictures which are placed layer by layer with the help of animations you simple need to download this presentation first.... Thanx.
IVU is the radiographic examination of urinary tract including renal parenchyma, calyces and pelvis after intravenous injection of contrast media. Study was carried out at UCMS, Bhairawa, Nepal.
Similar to Barium meal follow through (BMFT), Enteroclysis and Barium enema (BE) (20)
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Barium meal follow through (BMFT), Enteroclysis and Barium enema (BE)
1. Barium meal follow through (BMFT), Enteroclysis
& Barium enema
KHURSHEED AHMAD GANIE
MRIT 3rd SEM.
MODERATER:- NITISH SIR
2. Contents
• Anatomy
• Clinical indication
• Contraindication
• Patient preparation
• Contrast media & dosage
• Equipment used
• Technique
• Filming
• After care
3. Anatomy of small & large intestine.
Small intestine
- Extends from pyloric sphincter to the
ileocaecal junction avg. length 4.5- 5.5m.
- Diameter varies from 3.8cm at proximal
aspect & 2.5cm at distal aspect.
- Wall consist of 4 layers-serosa, muscularis,
sub-mucosa & mucosa.
- Divided into 3 parts i.e; duodenum,
jejunum & ileum as in fig. 13-4.
4. DUODENUM (RUQ & LUQ)
- Begins at pylorus curves around head
of pancreas as “C” & join with jejunum
to form duodeno-jejunal flexure.
- 25cm long and widest part.
- Consists of four portions:-
a. Superior- duodenal blub.
b. Second descending portion.
c. Horizontal portion.
d. Ascending portion.
5. Jejunum (LUQ & LLQ)
- 2/5th of the remaining aspect of small
intestine.
- Numerous mucosal folds which produces
feathery appearance to the jejunum.
Ileum (RLQ & LLQ)
- Distal 3/5th of the remaining aspect of
small intestine .
- Terminal ileum joins to the caecum to
form ileocaecal junction in the RLQ.
6. Large intestine
- Begins in RLQ about 1.5m long &
6cm in diameter.
- Divided into four parts:-
a. Cecum.
b. Colon.
c. Rectum.
d. Anal canal.
7. a. Caecum
- Proximal end of large intestine 6cm long and 7.5cm broad.
- Large blind pouch located 2.5cm below the ileocaecal valve called
appendix.
b. Colon
- The open end of the cecum merges
with a long tube called the colon
- Divided into 5 parts i.e;
. ascending colon 20cm length.
. Transverse colon 45cm.
8. . Descending colon 30cm long.
. Sigmoidal colon 40cm .
c. Rectum
- Begins at the level of S3 & is about 12cm
long.
- Rectal ampulla is the dilated portion of
rectum anterior to the coccyx.
d. Anal canal
- The final 2.5-4cm of large intestine constrict
to form anal canal which leads in to anus.
9. Barium Meal Follow Through (BMFT)
BMFT is the radiographic examination of GIT ( up to ileocecal junction)
after administration of oral contrast media.
- May be done separately or in continuation with Barium meal.
Methods
- single contrast BMFT
- with the addition of effervescent agent.
- Addition of Pneumocolon technique.
12. Contraindications
- Colonic obstruction.
- Suspected perforation.
- Paralytic ileus.
Patient preparation
- Low residue diet for 48 before contrast study is conducted.
- NPO 12 hours before the study is performed.
- Take laxative agent on the evening prior to contrast study.
- Remove jewelry or any other thing that may cause artifact.
- Metoclopramide 20mg orally 20 min before or during examination.
- Ask patient to void before the start of procedure.
13. Contrast media & dosage
- BaSo4 solution 100% W/V 300ml (150ml if performed immediate after Barium
meal).
- Addition of 10ml gastrografin reduces transit time BaSo4 sol. Through small
bowel.
- 3-4ml/kg is suitable in childrens.
- Non ionic water soluble contrast media is used in case barium is contraindicated.
Equipment used
- Fluoroscopic equipment with II TV system.
- Over-couch X-ray tube.
- Tilting x- ray table.
- Spot filming device.
14. Preliminary film
- AP full abdomen.
Technique & Filming
> Single contrast study
- Aim to obtain continuous column of barium from duodenum to
ileocecal junction.
- Give dry food if transit time is slow.
- ask the patient to drink Barium suspension as rapidly as possible.
- Place the patient at right side dependent position.
- after 15-20 min PA prone image is taken to determine jejunum &
proximal ileum.
- subsequent images are taken after every 15-30 min till ileocaecal
junction is opacified.
15. - Spot films are taken in supine right side up for ileocaecal junction.
- Compression pad is used to displaces overlying loops of intestine.
* Always empty bladder before spot film.
** If BMFT is combined with Barium meal glucagon is used instead
of Buscopan for duodenal cap view ( short time action + not interfere
transit time).
Additional films
1. To separate loops of small bowel:
a. oblique films.
b. 30 ̊̊ caudal angled view of pelvis
c. with the patient tilted head down.
16. 2. To demonstrate diverticula:
erect - this position will reveal any fluid levels caused by contrast
medium retained within the diverticula.
Double contrast BMFT examination
- Same as single contrast study.
- Gas producing agent is given when head of Barium column reaches
the caecum. This should generate about 750-1000 ml of gas.
- Pt is placed on the left side slightly head down to allow the gas to
leave the stomach & enter the small bowel.
17. - Compression radiographs with patient in supine or oblique positions
are taken.
A. BMFT B. Spot film of terminal ileum
18. Per oral Pneumocolon
- It is the double contrast radiographic examination of terminal ileus
and right colon in which air is insufflated through rectum in conjunction
with BMFT.
- It is performed when terminal ileus is suspicious.
- Colonic preparation similar to Barium enema.
Technique
- Baso4 suspension is administered orally.
- Air is insufflated rectally when Barium reaches at right colon &
proximal transverse colon.
19. - spot films of different areas of small bowel are taken especially
suspicious terminal ileus.
- Compression may be used.
A. Conventional spot film ( poor demonstrated terminal ileum) B. peroral Pneumocolon ( well demonstrated)
20. After care
- patients should warned about the white bowel motion for few days.
- advice intake of large water to avoid barium impaction.
- patient should not leave the department till the blurred vision
produced may not resolved.
Advantages of BMFT
- Easily performed.
- No discomfort/intubation to the patient unlike in Enteroclysis.
- It is a physiological process hence transmit time can be assessed.
21. Disadvantages
- Overlapping of barium filled bowel loops in the pelvis.
- Poor distension of bowel loops.
- Inappropriate timing for visualization of partial (or) intermittent
small bowel obstruction.
- Operator dependence.
- Time consuming.
Complications
- leakage of Barium from unsuspected perforation.
22. - Conversion of partial obstruction large bowel into complete
obstruction by barium impaction.
- Aspiration of Barium.
- Barium appendicitis if barium impacted in the appendix.
- Side effects of pharmacological agents used.
23. ENTEROCLYSIS/ SMALL BOWEL ENEMA
The radiographic examination of small bowel from jejunum to the ileocaecal
junction in which contrast media is directly installed in to the proximal jejunum
through nasogastric tube.
Indications
- Partial small bowel obstruction.
- Crohn’s disease- to know its extent.
- Malabsorption.
- Tumors of small intestine.
- Occult GIT bleeding.
- Equivocal BMFT but strong clinical suspicious.
24. Contraindications
- Complete colonic obstruction.
- Suspected perforation.
- Massive dilatation of the small bowel.
- Duodenal obstruction and gastrojejunostomy.
- Paralytic ileus.
Patient preparation
- Low residue- diet for 2 days before the examination.
- NPO 6 hours prior to study.
- laxative should be taken at the bed time before examination.
25. - If the patient is taking any antispasmodic drugs, they must be
stopped 1 day prior to examination.
- Immediately before the examination, the pharynx is anaesthetised
with lignocaine jelly.
Contrast media & dosage
- Single contrast Enteroclysis:- barium suspension 70%w/v is diluted
to prepare 1500ml barium suspension 20% w/v .
- Double contrast Enteroclysis:- Barium suspension 200-250% w/v is
ideal. We can use 95% Microbar by diluting it to 70% to decrease
viscosity. 600ml of 0.5% Carboxyl- methyl cellulose (CMC) after 500ml
of Barium suspension 70% w/v.
26. Contrast Dose in infants
3-5 Months age 200 ml, 5-8 Months 300 ml, 8-11 Months 400 ml,
1-3 Years 500 ml
Equipment used
- Same as that in BMFT.
- Two types of tubes are used for administration of CM viz..
* Bilbao-Dotter tube with guide wire.
** Silk tube (10F, 140cm long) with a tungsten-filled guide-tip. It is
made of polyurethane and the stylet and the internal lumen of the
tube are coated with a water-activated lubricant to facilitate the
smooth removal of the stylet after insertion.
27. Preliminary film
Supine AP full abdomen plain radiograph.
Technique
> single contrast study
- Single lumen tube is introduced into the proximal jejunum after
anaesthetization of pharynx.
- RAO position aids in passage of tube by gastric peristalsis from
stomach to duodenum.
- barium suspension 20%w/v is infused through the tube @
75ml/min.
28. - Spot films are taken of the Barium column & follow under
fluoroscopy until colon reaches.
- Fluoroscopy is performed during infusion
& images are recorded using 100/105 mm
films or full radiograph as required.
Enteroclysis
29. Double contrast study
- 150-500ml High density BaSo4 suspension is injected @ 100ml/min
through the tube.
- Air or CMC is injected @ 75-120ml/min.
- Spot-films should be taken when Barium reaches ileocaecal junction
than again for double contrast.
- ileocaecal junction is well seen in double contrast immediate after
defecation & spot films may be taken.
30. After care
- Nil orally for 5 h after the procedure.
- patient should be warned that diarrhoea may occur as a result of
the large volume of fluid.
Disadvantages
- Intubation may be unpleasant for the patient.
- It is more time-consuming for the radiologist.
- Higher radiation dose to the patient (screening the tube position).
31. Barium enema
It is the radiographic examination of large bowel after administration
of BaSo4 suspension through the rectum to determine form & function
of large bowel and to detect any abnormal conditions.
Indications
- benign tumors (such as polyps).
- Ulcerative colitis (inflammatory bowel disease).
- Chronic diarrhea.
- Blood in stools.
- Constipation.
- Irritable bowel syndrome.
32. - Unexplained weight loss.
- Change in bowel habits.
- Suspected blood loss.
- Abdominal pain.
Contraindications
Absolute
- Toxic megacolon
- Pseudomembranous colitis
- Rectal biopsy via: a. rigid endoscope within previous 5 days.
b. flexible endoscope within previous 24 h.
33. Relative
- Incomplete bowel preparation
- Recent barium meal - it is advised to wait for 7-10 days
- Patient frailty.
Patient preparation
Many regimes of bowel preparation exists a suggested regime is as
follows:
- low residue diet for 3 days prior to study.
- Take plenty of water on the day proceeding the examination.
- Stop the iron containing medicine 2 days prior to the examination
as they make the stool adhere to mucosa.
34. - Advice laxative for two days prior to examination (Biscodyl 15-20mg,
Castor oil-30ml or Magnesium citrate – 5-10mg).
- Wash the bowel on previous night & 2 hours prior to examination.
Preparation of the Patient should not be done in
- Diarrhea.
- Total obstruction.
- Paralytic ileus.
- Children less than 8 yrs. of age.
Contrast media
- for Single contrast 15%-25% W/V barium suspension.
- For double contrast
a. Polibar 115% w/v 500 ml (or more, as required)
b. Air.
35. Equipment used
- Same as used in BMFT examination.
- Rectal tube (e.g. Miller tube) for administration of contrast
* Miller tube has three components;
a. a (wide bore) tube for administration of Barium
b. a (usually blue) tube for administration of gas
c. A small tube for inflating the balloon at the tip
- Adhesive tape to fix the tube to the patient so prevent from back out
- Enema bag & IV pole.
36. Enema tip insertion procedure
- Explain the tip insertion procedure to the patient.
- Place the patient in sims position.
- Shake the enema bag to mix Baso4 suspension well.
- Remove the air in tube.
- Wearing glove & coat the enema tip with lubricant.
- Direct the tip approx. 2.5-4cm towards umbilicus.
- Advance 3-4cm superiorly & slightly anterior.
- Tape the tube in place to prevent spillage.
- Ensure enema bag is no more than 60cm above the table.
37.
38. Double contrast barium enema
- Patient lie in sim’s position & catheter is introduced.
- Connect it with barium reservoir & hand pump for injecting air.
- IV injection Buscopan (20mg) or glucagon (1mg) is given.
- Patient lie in prone or left side down oblique position & high density
barium is allowed to flow up to splenic flexure.
- Roll the patient from prone to left lateral than RAO to coat bowel
with Barium.
- Install air/Co2 in the bowel in prone position.
- Air must push barium forward not passed through it.
39. - install air till it outlines ileocaecal junction.
- Take spot films of junction & flexures.
Single contrast barium enema
- Infuse low density barium 15-25% w/v in left lateral position.
- Clamp the catheter after rectum is full & take spot film.
- Place pt. prone with Continue infusion take frontal view of rectum.
- Prone right side down oblique position & take spot films of recto-
sigmoidal curve.
- Prone oblique left side down to open splenic flexure & take spot
film.
40. - Turn pt. right side down oblique position to follow barium
towards hepatic flexure & take spot film.
- As refluxes seen in ileocaecal junction
clamp the tube & take spot films.
- Take film of entire colon.
- Remove the catheter & take Post
evacuation film.
Normal single contrast BE
41.
42.
43. Filming
- Spot film for rectum & sigmoid colon (lying);
a. RAO
b. Prone.
c. LPO.
d. Left lateral of rectum.
- Spot films for flexures & rectum (erect);
a. LAO to open out splenic flexure.
44. b. RAO to open out hepatic flexure.
c. Right lateral of rectum.
- Spot films of caecum (lying)
supine, lying slightly on the right side & with a slight head down
position.
- Over couch films to demonstration all large bowel (lying).
a. Supine
b. Prone
c. Left lateral decubitus.
45. d. Right lateral decubitus.
e. Prone with tube angled 45 ̊ caudal angulation to separate the
overlying loops of sigmoidal colon.
- Extra spot film of any abnormal area if required.
46. After care
- Patient should be warned about the white bowel motion for few
days.
- Advice laxative to prevent barium impaction.
- Patient must not leave the department until any blurred vision
produced by Buscopan will not resolve.
Complications
- Bowel perforation.
- Transient Bacteraemia.
- Side effects of pharmacological agents.
47. - Cardiac arrhythmia due to rectal distension.
- Venous intravasation.
Advantages of Double Contrast Over Single Contrast
• Better surface details.
• Surface lesions can be demonstrated to the best effect.
• Easy unraveling of the colon as it is possible to look through loops.
Disadvantages of Double Contrast Over Single Contrast
• Difficult in uncooperative patients.
• Fistulae/sinuses can be missed.
48. References
• A guide to radiological procedures by Stephen chapman and Richard
Nakielyn (4th edition).
• Dr. Bhushan N Lakhkar Radiological procedures (3rd edition).
• Text book of Radiographic positioning and Related Anatomy by
Kenneth L. Bontrager & John P. Lampignano (8th edition).
• Different internet sources.