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A DIAGNOSTIC TEST PRESENTATION ON LOWER GI SERIES/BARIUM ENEMA

Presented to the faculty of School of Nursing

Adventist Medical Center College

Brgy. San Miguel, Iligan City

In partial fulfilment of the requirements for the Degree

BACHELOR OF SCIENCE AND NURSING

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

causes the barium-filled colon to show up clearly on the X-ray picture.

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

caused by ulcerated polyps or shallow ulcerations of inflammatory disease.

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,

mucus or pus in the stool.

 After colostomy or ileostomy

Indications for double contrast barium enema

 Rectal bleeding- gross or occult

 Polyps or carcinoma – suspected or unknown

 IBD – suspected or unknown

 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

the etiology of anemia, weight loss

Indications for single contrast barium enema

 Pt under 40 y/o with abdominal signs or symptoms not suggestive for polyps, colitis, or bleeding

(i.e pain only, bloating only)

 Bowel not prepared but limited exam requested to verify or exclude obstruction, volvulus,

appendicitis, fistula and etc.

 Uncooperative, disabled, very old or very ill patient unable to tolerate or perform the

maneuvers required for a double contrast study

Contraindications

 Patients with tachycardia, toxic megacolon, pseudomembranous colitis, recent biopsy within the

previous 5 days

 Patients with incompetent bowel preparation and recent Ba meal or swallow


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 Pregnant patients

 Allergy to iodinated contracted material

 Generalized peritonitis, complete colonic obstruction, paralytic ileus

 Difficulty to pass tube in rectum like in inflamed piles, growth etc.

 Recent polypectomy or colonoscopy

 Acute diverticulitis or other acute IBD. In these pt, Ba enemas should be delayed until medical

management has had time to quiet the inflammation

 A suspected abscess or fistula ( an iodinated water-soluble contrast material should be used

instead of barium.)

 Patients with fulminant ulcerative colitis associated with systemic toxicity and megacolon

Equipment used and procedure

 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

the barium on an x-ray screen.

 Sometimes a small amount of air is delivered into the colon to expand it. This allows for even

clearer images. This test is called a double contrast barium enema.

 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

for a few seconds so the images will not be blurry.

 The enema tube is removed after the x-rays are taken.

 You are then given a bedpan or helped to the toilet, so you can empty your bowels and remove

as much of the barium as possible. Afterward, 1 or 2 more x-rays may be taken


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Nursing Responsibilities

Pretest

 Explain to the patient that the barium enema test permits examination of the large intestine

through x-rays taken after barium enema.

 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.

Administer a bowel preparation supplied by the radiography department. (A GoLYTELY

prepation is not recommended because it leaves the bowel too wet for the barium to coat the

walls of the bowel)

 Advise the patient to administer prescribed enemas until return is clear.

 Tell the patient not to eat break fast before the procedure, if the test is scheduled for late

afternoon, he may have clear liquids.

 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

or broth, gelatin, sports drink, strained fruit juices and water)

During the procedure

 Let the patient wear gown

 Ask the patient to remove eyewear, jewelry or removable dental devices

 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

a retaining balloon may be inserted.

 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

and instruct to expel as much barium as possible.


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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

health care facility.

 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

 Perforation of the colon

 Water intoxication

 Barium granulomas

 Intraperitoneal and extraperitoneal extravasation of barium

 Barium embolism

 Allergic reactions to barium

 Constipation or obstruction due to hardened barium that remains in the colon


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Normal values

Barium should fill the colon evenly, showing normal bowel shape and position and no blockages.

In a single contrast enema

 Intestine is uniformly filled with barium

 Colonic haustral markings are clearly apparent

 The intestinal wall collapse as the barium is expelled

 Mucosa has a regular, feathery appearance on postevacuation film

In a double contrast enema

 The intestine uniformly distend with air and have a thin layer of barium providing excellent

detail of the mucosal pattern

 As the patient is assisted to various positions, the barium collects on the dependent walls of the

intestine by the force of gravity.


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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

that any abnormalities can be examined more thoroughly, biopsied or removed.


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Drug Study
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Validity of the test

 the test may be inaccurate if the barium leaks.

 intestinal gas may hinder the accuracy of test results


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Latest study

Published online 2015 May 14. Mizue Matsuura, Masahiko Inamori, Atsushi Nakajima, Hepatology and

Gastroenterology, Yokohama City University Hospital, Yokohama 236-0004, Japan

“Effectiveness of therapeutic barium enema for diverticular haemorrhage”

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

every 20 min for 3 h.

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

where the active bleeding site cannot be identified by colonoscopy.


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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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A DIAGNOSTIC TEST PRESENTATION ON CT (COMPUTERIZED TOMOGRAPHY) SCAN

Presented to the faculty of School of Nursing

Adventist Medical Center College

Brgy. San Miguel, Iligan City

In partial fulfilment of the requirements for the Degree

BACHELOR OF SCIENCE AND NURSING

Kea R. Alinas

November 5, 2017
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