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Trisha C. Mangubat
November 5, 2017
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Definition
Barium enema also called lower GI examination is the radiographic examination of the large
intestine after rectal instillation of barium sulphate (single contrast technique) or barium sulphate and air
( double contrast technique). A barium enema typically takes between 30 and 60 minutes and is
performed at a hospital or specialized testing facility. You’ll change into a hospital gown and remove any
jewelry or other metal from your body. Metal can interfere with the X-ray process. The test is used to help
find diseases and other problems that affect the large intestine including the rectum, the colon is filled
with a contrast material that contains barium so that the intestine can be seen on an X-ray. This is done
by pouring the contrast material through a tube inserted into the anus, the barium blocks X-rays which
The single-contrast technique provides a profile view of the large intestine; the double-contrast
technique provides profile and frontal views. The latter technique best detects small intraluminal tumors
(especially polyps), the early mucosal changes of inflammatory disease, and subtle intestinal bleeding
Although barium enema clearly outlines most of the large intestine, proctosigmoidoscopy
provides the best view of the rectosigmoid region. Barium enema should precede the barium swallow and
upper GI and small bowel series because barium ingested in the latter procedure may take several days
to pass through the GI tract and thus may interfere with subsequent X-ray studies.
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Indications
Patients with histories of altered bowel habits, lower abdominal pain or the passage of blood,
Pt over 40 y/o who can cooperate and turn over w/o assistance
Pt with a family hx of colon neoplasi, in pt suspected or known to have IBD and in the search for
Pt under 40 y/o with abdominal signs or symptoms not suggestive for polyps, colitis, or bleeding
Bowel not prepared but limited exam requested to verify or exclude obstruction, volvulus,
Uncooperative, disabled, very old or very ill patient unable to tolerate or perform the
Contraindications
Patients with tachycardia, toxic megacolon, pseudomembranous colitis, recent biopsy within the
previous 5 days
Pregnant patients
Acute diverticulitis or other acute IBD. In these pt, Ba enemas should be delayed until medical
instead of barium.)
Patients with fulminant ulcerative colitis associated with systemic toxicity and megacolon
You lie flat on your back on the x-ray table. An x-ray is taken.
You then lie on your side. The health care provider gently inserts a well-lubricated tube (enema
tube) into your rectum. The tube is connected to a bag that holds a liquid containing barium
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sulfate. This is a contrast material that highlights specific areas in the colon, creating a clear
image.
The barium flows into your colon. X-rays are taken. A small balloon at the tip of the enema tube
may be inflated to help keep the barium inside your colon. The provider monitors the flow of
Sometimes a small amount of air is delivered into the colon to expand it. This allows for even
You are asked to move into different positions. The table is slightly tipped to get different views.
At certain times when the x-ray pictures are taken, you are told to hold your breath and be still
You are then given a bedpan or helped to the toilet, so you can empty your bowels and remove
Nursing Responsibilities
Pretest
Explain to the patient that the barium enema test permits examination of the large intestine
Describe the test, including who will perform it and when and where it will take place.
Because residual fecal material in the colon obscures nomal anatomy on X-ray, instruct patient
to carefully follow the prescribed bowel preparation, which may include diet, laxative, or an
enema. However, in certain conditions, such as ulcerative colitis and active GI bleeding, their use
may be prohibited.
Stress that accurate test results depend on the patient’s cooperation with prescribed dietary
restrictions and bowel preparation. A common bowel preparation technique includes restricted
intake of dairy products and maintenance of a liquid diet for 24 hrs before the test. The patient
is encouraged to drink five 8 oz glasses of water or clear liquids 12-24 hrs before the test.
prepation is not recommended because it leaves the bowel too wet for the barium to coat the
Tell the patient not to eat break fast before the procedure, if the test is scheduled for late
Tell the patient that he will be placed on a tilting X-ray table and adequately draped. Assure him
that he will be secured to the table and will be assisted to various positions.
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Tell the patient that he may experience cramping pains or the urge to defecate as the barium or
air is introduced into the intestine. Instruct him to breathe deeply and slowly through his mouth
to ease discomfort.
Tell the patient to keep his anal sphincter tightly contracted against the rectal tube, this holds
the tube in position and helps prevent leakage of barium. Stress the importance of retaining the
barium enema, if the intestinal walls are not adequately coated with barium, test results may be
inaccurate.
Assure the patient that the barium enema is fairly easy to retain because of its cool
temperature.
Drink plenty of clear liquids for 1-3 days before the test ( i.e. clear coffee or tea, fat-free bouillon
Assist the patient to sim’s position and apply lubricant to the tube to be inserted to the anus. If
the patient has anal sphincter atony or severe mental or physical debilitation, a rectal tube with
During barium administration, tilt table or assist patient in supine, prone or lateral decubitus
position.
The patient will be instructed to take slow, deep breaths through the mouth to ease any
discomfort
After overhead films of the abdomen are taken, escort patient to the CR or provide a bedpan
Posttest
One or two more X-ray pictures (post-evacuation films) will then be taken.
Make sure further studies have not been ordered before allowing the patient food and
fluids. Encourage extra fluid intake because bowel preparation and the test itself can cause
dehydration.
Because barium retention after this test can cause intestinal obstruction or fecal impaction,
administer a mild cathartic or an enema. Tell the patient his stool will be light colored (pale
or whitish) for 24-72 hours. Record and describe any stool passed by the patient in the
Some patients may feel abdominal bloating or cramping after a barium enema and the
procedure may also lead to constipation. Patients are therefore advised to drink plenty of
fluids and eat plenty of fruit and vegetables. Mild laxatives may also help.
Inform the patient that rectum and anus may be sore from the procedure. If you have
difficulty or pain with bowel movements, fever, or rectal bleeding, call your doctor. If you do
not have a bowel movement for two days after the exam or are unable to pass gas, call your
doctor.
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Possible Complications
Water intoxication
Barium granulomas
Barium embolism
Normal values
Barium should fill the colon evenly, showing normal bowel shape and position and no blockages.
The intestine uniformly distend with air and have a thin layer of barium providing excellent
As the patient is assisted to various positions, the barium collects on the dependent walls of the
Significant results/Interpretations
Negative result. A barium enema exam is considered negative if the radiologist detects no abnormalities
in the colon.
Positive result. A barium enema exam is considered positive if the radiologist detects abnormalities in
the colon. Depending on the findings, you may need additional testing — such as a colonoscopy — so
Drug Study
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Latest study
Published online 2015 May 14. Mizue Matsuura, Masahiko Inamori, Atsushi Nakajima, Hepatology and
AIM: To evaluate the effectiveness of barium impaction therapy for patients with colonic diverticular
bleeding.
METHODS: We reviewed the clinical charts of patients in whom therapeutic barium enema was
performed for the control of diverticular bleeding between August 2010 and March 2012 at Yokohama
Rosai Hospital. Twenty patients were included in the review, consisting of 14 men and 6 women. The
median age of the patients was 73.5 years. The duration of the follow-up period ranged from 1 to 19 mo
(median: 9.8 mo). Among the 20 patients were 11 patients who required the procedure for re-bleeding
during hospitalization, 6 patients who required it for re-bleeding that developed after the patient left
the hospital, and 3 patients who required the procedure for the prevention of re-bleeding. Barium
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(concentration: 150 w%/v%) was administered per the rectum, and the leading edge of the contrast
medium was followed up to the cecum by fluoroscopy. After confirmation that the ascending colon and
cecum were filled with barium, the enema tube was withdrawn, and the patient’s position was changed
RESULTS: Twelve patients remained free of re-bleeding during the follow-up period (range: 1-19 mo)
after the therapeutic barium enema, including 9 men and 3 women with a median age of 72.0 years. Re-
bleeding occurred in 8 patients including 5 men and 3 women with a median age of 68.5 years: 4
developed early re-bleeding, defined as re-bleeding that occurs within one week after the procedure,
and the remaining 4 developed late re-bleeding. The DFI (disease-free interval) decreased 0.4 for 12 mo.
Only one patient developed a complication from therapeutic barium enema (colonic perforation).
CONCLUSION: Therapeutic barium enema is effective for the control of diverticular hemorrhage in cases
Reference
Internet
https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.slideshare.net%2Fraiamajustin%2Fbariu
m-series-70624119&h=ATM1Wl-kQhPnA_DGY-
8SQJ3cl_QeeZUdlTsvDSHlS3BGD6RQuExrDNbfhTfk8DIcUQIpwPWKGFXc8d5iRHngSLrvYAbT7mzP
J2KZZxjz6wD67aIzZ2x7q4L8U2UtLEjWirEtZ-g4Z5_8
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4427678/
https://www.mayoclinic.org/tests-procedures/barium-enema/basics/results/prc-20019174
Books
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Diagnostic test
Drug study
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Kea R. Alinas
November 5, 2017
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