barium in ascending and descending colon air in recto sigmoid colon and transverse colon
in the prone position where is the barium and air
air ascending and descending colonbarium in rectosigmoid and transverse colon
list the four Small bowel procedures
Upper GI/small bowel combination
SBS alone
Enteroclysis (radiographic or CT)
Intubation method
One more what are the contraindications to using barium and water soluble iodinated contrast media like gastroview
barium:
presurgical pts
pts with perforated hollow viscus
large intestine obstructions
sensitivity
Iodinated contrast:
pts with history of sever dehydration or young pts
sensitivity (allergy) to iodine
how much barium is needed for a SBS
16oz
what is the pt prep for SBS, enteroclysis and intubation procedure
NPO - 8hrs
low residue diet for 48 hrs (jello)
no gum chewing
no smoking
and ask abt pregnancy
what is the pt prep for a BE
light evening meal prior to exam - jello
bowel cleansing cathartics
NPO aftermidnight 8 hrs minimum
no gum chewing
no smoking
what are cathartics
list examples
what are the two types
substance that produces frequent soft liquid bowel movements
dulcolax mirolax
irritant (rarely used)
saline
what are the contraindications to using cathartics
gross bleeding
severe diarrhea
obstruction
inflammatory lesions
how much barium is needed for a BE single and double contrast
single 1500ml
double 500 ml
what is the position of the pt for a BE procedure
sims position lying on left side with right leg flexed to expose the rectum
what four things must we keep in mind when inserting the tip in the rectum
1.communicate with patient
2.ear gloves
3.drain air from enema tubing
4.lubricate enema tip
what barium is used for a double contrast BE
thick barium (1:1 ratio) and room air temp for air administered
what are the 5 safety concerns of a BE procedure
1. review chart history
2.never for an enema tip it should be sucked in once inserted 3.height of enema bag should be no higher than 2 in above the table
4.verify the water temp of the contrast media
5.escort pt to the restroom
what is the routine and special procedures for an SBS
routine: PA
special: Intubation method, enteroclysis
why is a pa the routine for a SBS
b/c it helps compress the intestines and spread them when pt is lying on their stomach
where is the CR for SBS pa projection for a 15-30min radiographs
and hourly radiographs?
2in above iliac crests
iliac crests
what is the routine and specials positions for a BE
pa and/or ap
RAO and LAO
LPO and/or RPO
LAt. rectum
R and L lat. decubs (double contrast study)
PA post evac
Special:
ap axial or ap axial oblique
Pa axial or pa axial oblique
where is CR for a PA and/or AP BE
iliac crest
where is the CR what is the obliquity for an RAO BE
CR to iliac crests and 1inch to left of MSP
35-45 oblique
the RAO position of a BE demonstrates what anatomy
what other position will demonstrate the right colic flexure in profile as the RAO
right hepatic flexure in profile ascending and descending colon are open w/o superimposition splenic flexure is not viewed
LPO b/c it is opposite
where is the CR what is the obliquity for an LAO BE
what other position visualizes the same thing
CR at 1-2 in above crests and 1in to the right
35-45 deg
RPO
Bag of contrast should be suspended at what height to prevent faster flow of barium into rectum causing pt discomfort
24-30in above the table
all BE radiographs except for the what 2 projections are take on a 14x17
for hypersthenic pts what must be done to include appropriate anatomy
lateral rectum and butterfly positions
2 14x17 crosswise cassettes
what are the technical factors for a single contrast and double
what is the breating
what cells should be selected when using AEC
100-125 single contrast
80-90 kvp for a double contrast
Suspend respiration and expose on expiration
all cells selected when using aec
why must we or could we use two films on an ap or pa of the colon
to make sure we include the splenic flexure b/c it is located higher up and rectal ampulla (area where feces is stored)
what structures are best shown in a PA/AP BE
transverse colon and portion of sigmoid colon BA filled
what structures are best visualized in an LAO or RPO BE
the splenic flexure should be seen w/o superimposition
where is the CR for a RPO BE
1-2in above crests and 1in to the left of MSP
where is the CR for a LPO BE
cr to level of iliac crests cr 1in to right of MSP
visualizes the right hepatic flexure as an RAO would
where is the CR for a lateral rectum
what casette would you use
CR to level of ASIS and midcoronal plane (midway between asis and posterior sacrum)
10x12 length wise
what is the alternative position to the lateral rectum
why is the position done for
ventral decub (cross table or xtable lateral)
to visualize air in the rectum in a double contrast study
what structure does the right lateral decub position show
entire colon and an air filled splenic flexure and descending colon
where is the CR for a right lateral decub BE (only for a double contrast study)
1-2 in above crests because splenic flexure is located higher in abdomen
if we are doing a single contrast BE are decubs R & L necessary
no
which position in a double contrast study visualizes the an air filled hepatic flexure and ascending colon and cecum
where is the CR for this position
left lateral decub BE
at level of crests
what size cassette is needed for a ap axial or ap axial oblique (LPO) Butterfly positions
what is the tube angle ap axial
where is the CR for the ap axial and ap axial oblique
what is the obliquity of the LPO
11x14
30-40 deg cephalad
AP axial: 2" inferior to ASIS at MSP
LPO:2'' inferior and 2in medial to right ASIS
30-40
what size cassette is needed for a pa axial or pa axial oblique (RAO) Butterfly positions
what is the tube angle for pa axial
where is the CR for the pa axial and pa axial oblique
what is the obliquity of the RAO
11x14 lengthwise
angle cr 30-40 caudal
PA: at ASIS at MSP
RAO:cr at level of asis and 2in to left of spinous process
35-45 deg
a pa post evac use what IR and where is the cr
do we need more or less penetration
14x17
cr at the crests
less penetration because there is less barium
what is the follow up care for BE
pt should increase their intake of fluids and increase fiber intake