The Alimentary System
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- Buck Abner Little
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1 The Alimentary System Contrast Medium: 1. Barium Examinations of different parts of the GI tract require different densities of Barium suspension. The escape of Barium into the peritoneal cavity is extremely serious. Complete bowel obstruction is contraindicated. 2. Water-soluble e.g. Gastrografin, Conray Pulmonary edema if aspirated, suspected perforation is contraindicated. Pharmacological Agents: 1. Buscopan Reduced bowel peristalsis Anticholineric side-effects e.g. blurring of vision, tachycardia, etc.. It is contraindicated in glaucoma and cardiovascular disease. 2. Glucagon It is expansive. Hypersensitivity reactions. Phaeochromocytoma and insulinoma are contraindicated. 3. Maxalon Increased gastric peristalsis. Extrapyramidal side-effects. Barium Swallow 1. Dysphagia 2. Pain 3. Assessment of tracheo-esophageal fistula in children 4. Assessment of heart enlargement 5. Preoperative assessment Contraindication: Page 1 of 5
2 150% w/v (E-Z HD) The patient holds a mouthful of barium solution and is positioned Spot films are taken while asking the patient to swallow the barium solution 1. RAO 2. RPO 3. Lateral 4. AP Barium Meal Dyspepsia 不良 3. Weight loss 4. Assessment of site of perforation 5. Gastrointestinal haemorrhage 6. Upper abdominal mass Complete large bowel obstruction 250% w/v (E-Z HD) Nil orally for 6 hours Stop smoking on the day of examination, as smoking causes increased gastric motility Page 2 of 5
3 A gas-producing agent is swallowed The patient then drinks the barium and lying on left side The patient is positioned as the desired position and spot films are taken. Buscopan etc. is injected as required. For the stomach, 1. RAO 2. Supine 3. LAO 4. Left lateral 5. Erect For the duodenum, 1. Prone with compression 2. RAO 3. LAO 4. Supine 5. Erect Drink more water than usual to avoid barium impaction The patient should be warned that his bowel motions will be white for a few days Barium Follow Through 1. Pain 2. Diarrhoea 3. Bleeding 4. Partial obstruction 1. Complete obstruction 2. Suspected perforation 100% w/v (E-Z HD) Page 3 of 5
4 A laxative on the evening prior to the examination Maxalon given 20 minutes before the examination (optional) Preliminary film: AXR The patient is lying on the right side after bowel has been ingested Prone AXR films are taken every 20 minutes during the first hour, and subsequentially every 30 minutes until the colon is reached Same for barium meal Barium Enema 1. Change in bowel habit 2. Pain 3. Mass 4. Melaena 5. Obstruction 1. Toxic megacolon 2. Pseudomembranous colitis 3. Rectal biopsy within the previous 3 days 4. Incomplete bowel preparation 5. Recent barium study 125% w/v (enema kit) Nil orally 6 hours before the examination Bowel preparation Page 4 of 5
5 Preliminary film: AXR The patient lies on the left side on an incontinence sheet The enema tube is inserted gently Barium is than injected through the tubing and the infusion stops when the barium has reached the splenic flexure Air is then pumped gently through the tube The patient then lies prone and rolls onto the left and over into an RAO position Buscopan is then given Spot films: For the rectum and sigmoid colon, RAO Prone LPO Left lateral of the rectum For the hepatic flexure and splenic flexure, Erect LAO (to open out the splenic flexure) Erect RAO (to open out the hepatic flexure) Overcouch films: Supine (KUB) Prone (KUB) Prone caudal (CP: midway at the level of 5cm above the PSIS with 45 tube tilting caudally) Cross-table Lateral rectum (CP: midway at the level of 5cm anterior to the sacrum) Both sides decubitus (AXR) Erect (AXR) Same for barium meal Page 5 of 5
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