Barium Enema

views updated May 23 2018

Barium Enema

Definition

A barium enema (or BE), also known as a lower GI (gastrointestinal) series, is a radiographic exam used to view the large intestine. There are two types of barium enemas: the single-contrast technique where just barium sulfate is injected into the rectum to outline the large intestine; and the double-contrast (or "air contrast") technique in which barium and air are injected into the rectum.

Purpose

The purpose of a barium enema is to demonstrate the anatomy and morphology of the large intestine. The large intestine frames the abdomen and is divided into six sections. These include the rectum, sigmoid colon, descending colon, transverse colon, ascending colon, and cecum.

A barium enema may be performed for a variety of reasons, including abdominal pain or a change in bowel habits such as diarrhea or constipation, as well as a change in the caliber (size) of the stools. This exam is also requested when parasites, blood, mucus, or pus are found in the stools. Occult (hidden) blood found in the stools and anemia may be an indication of intestinal bleeding due to ulcers, inflammatory disease, or a cancerous lesion. Doctors may also order this exam as a screening tool for patients with a history of polyps (pre-cancerous growths extending outward from a mucous membrane) or a family history of colorectal cancer.

A barium enema may also be requested when the large intestine was not completely visualized during a colonoscopy (examination of the large intestine with a fiber-optic tube) or when a sigmoidoscopy is done, which only partially visualizes the colon. Sometimes a barium enema may be used as a treatment for intussusception (telescoping of one section of the bowel into another causing obstruction). This is a rare disorder occuring most often in young children, but when it occurs immediate action must be taken.

A barium enema may also be done to evaluate the remaining colon on colostomy patients. The barium is injected into the stoma (external drainage opening in the abdominal wall) instead of the rectum. A barium enema may be done if obstruction, perforation, or fistula formation is suspected.

Precautions

As with any radiographic procedure there is the risk of radiation. The x-ray technologist must always make sure there is no risk of pregnancy and that the least amount of films as possible are done. No lead shielding can be used since all the abdominal area must be visualized on the films.

Description

All patients must be changed into a hospital gown. All clothing is removed, including shoes and socks, since some leakage of the barium mixture can occur. In some departments disposable slippers are supplied. The x-ray technologist may take one preliminary view of the abdomen to determine how well the patient's bowel has been cleansed. Any retained fecal material can create false filling defects and mucosal abnormalities on the films. A single-contrast enema would usually be done on patients with a poor bowel preparation. After the films are taken and the patient has evacuated as much of the barium as possible air may be introduced into the large intestine and further films taken. This method takes longer and gives more radiation to the patient.

The patient will be instructed to lie on the left side on the x-ray table, and the radiography technologist will insert a lubricated enema tip into the rectum. The enema tips contain a small balloon which may be inflated to help the patient retain the barium. The patient may remain on their left side or turned prone (face-down) depending on the procedure and routine of the radiologist.

For a single-contrast barium enema, the barium sulphate solution is a thinner consistency but a larger amount is needed to completely fill the large intestine. High kilovoltage (100-125kvp) is used to get a good penetration of the barium filled colon, and it is important to take the films as quickly as possible since the patients are very uncomfortable when the bowel is completely distended. Routine films for a single contrast study include a supine and prone abdomen film as well as both obliques to see the hepatic and spenic flexures of the large bowel. The patient will completely evacuate the bowel and one more film, the post-evacuation film (PE) usually done AP (anteroposterior or front-to-back) supine will be taken.

In a double-contrast barium enema, a fine coating of thick barium is needed to outline the mucosal lining of the bowel. The patient will be placed prone so that gravity can assist the air in distributing the liquid around the large bowel. The patient is asked to turn over 360 degrees a few times during the exam to aid in the coating of the bowel. The patient is then placed upright, and more air is injected into the bowel so gravity again can assist in visualizing the large intestine. Patients may develop spasms of the bowel during this exam, so the radiologist may give the patient a glucagon injection to relax the large bowel. This injection should not be given to patients with a history of glaucoma and can cause temporary double-vision in these patients.

The radiologist will take spot-films under fluoroscopy of each segment of the bowel but most of the films will be made following the procedure by the x-ray technologist. Since less barium is used along with some air, less kilovoltage (90-100kvp) is needed to achieve a high contrast x ray of the large intestine. The usual AP and PA (posteroanterior) abdomen films will be done as well as the two oblique views of the abdomen. An upright film may be done as well depending on the routine of the radiologist. The most important films for the double-contrast exam are the two lateral decubitus films. The patient is placed on a large cushion or sponge and turned completely onto one side. A stationary grid is placed next to the patient and the x-ray tube is turned 90 degees. This film allows the air to rise to the upper surface of the abdomen so that the air along with the thin coating of barium creates a detailed visualization of the intestinal lining. This is extremely important when looking for small polyps, cancers, and ulcerations of the bowel. Films of both sides are always taken.

Preparation

In order to conduct the most accurate barium enema test, the patient must follow a prescribed diet and bowel preparation prior to the test. This includes a diet of tea, coffee (black), clear soups, and gelatin 24 to 48 hours before the barium enema. Laxatives and cathartics such as magnesium citrate (X-Prep) or Dulcolax tablets may also be required as part of the bowel preparation. Each radiology department has their own specific requirements. A rectal suppository or cleansing enema may also be necessary on the morning before the exam. Patients must drink as much fluids as possible to prevent dehydration. Patients with heart disease, diabetes, or kidney disorders should consult their physician for an alternate bowel preparation. Children are usually placed on a clear liquid diet on the day before their examination.

A barium enema may be done in a hospital or a certified x-ray clinic and will take 30 minutes to one hour depending on what type of exam has been ordered and the physical ability of the patient.

Aftercare

Patients should follow several steps immediately after undergoing a barium enema, including:

  • Drinking plenty of fluids to help counteract the dehydrating effects of the bowel preparation.
  • Taking time to rest. A barium enema and the bowel preparation taken before it can be exhausting.
  • A cleansing enema or laxative may be given to eliminate any remaining barium. White stools containing barium are normal for two or three days following a barium enema.

Complications

While a barium enema is considered a safe screening test used on a routine basis, it can cause complications in certain patients. The following contraindications should be kept in mind before a barium enema is performed:

  • Those who have a rapid heart rate, severe ulcerative colitis, toxic megacolon, or a presumed perforation in the intestine should not undergo a barium enema.
  • The test can be cautiously performed if the patient has a blocked intestine. Gastrograffin, an iodinebased contrast, will be used instead of the barium in case emergency surgery is needed following the barium enema.

Results

A normal result indicates no structural or filling defects of the large intestine. Radiologists look for any enlargement or narrowing of the large bowel as well as variations in the mucosal lining. The walls of the intestine should collapse normally after the post-evacuation film, and the bowel should have normal haustral markings (undulations of the colon wall).

Abnormal results may include colorectal polyps, diverticulosis (multiple abnormal sacs bulging through the intestinal wall), ulcerative colitis, abscesses, or tumors visualized on the walls or adjacent to the large intestine. Further evaluation such as a biopsy or CT scan may be necessary to determine the extent of any positive findings.

Health care team roles

It is the responsibility of the radiography technologist to prepare the barium, insert the enema tip, and take the overhead films after the radiologist has filled the entire colon with either the barium or a combination of barium and air. In some departments an interventional radiology technologist will perform the complete exam. He or she will have had additional education and training by the radiologists to complete this duty.

The x-ray technologist must work closely with the nurses to make sure all hospital patients follow the bowel preparation. Since the preparation is physically exhausting for the patient, care is taken to complete the exam as soon as possible so the patient may resume a normal diet.

Patient education

Since a good preparation is the most important step in a barium enema, all patients should receive detailed information on the reasons and requirements for the cleansing treatment. The x-ray technologist must explain the procedure in detail before starting the exam. The patient must be informed that the barium enema can sometimes cause cramps and that the urge to have a bowel movement is completely normal. Some leakage of the barium may occur and the patient should not feel embarrassed if this happens because it occurs fairly often, especially in elderly patients. Care should be taken when inserting the enema tip because the rectum is already irritated, due to the multiple bowel movements during the preparation. The x-ray technologist must take note of any history of glaucoma in case an injection of glucagon is needed. Patients should be completely covered at all times and care taken when placing the patient in the upright position since many patients are weak after undergoing the bowel preparation.

The x-ray technologist should also explain to the patient the need to drink plenty of fluids after the barium enema and that white stools following a barium enema are normal.

All radiography technologists must be certified, having completed a two to four year program depending on where the course was completed. All x-ray technologists must be registered with the A.S.R.T. and earn continuing education credits to remain registered.

KEY TERMS

Barium sulfate— A barium compound used during a barium enema to block the passage of x rays during the exam,allowing visualization of the intestinal lining.

Colonoscopy— An examination of the large colon performed with a colonoscope.

Diverticula (plural of diverticulum)— A sac or pouch in the colon walls which is usually asymptomatic (without symptoms) but may cause difficulty if it becomes inflamed.

Diverticulitis— A condition of the diverticula of the intestinal tract, especially in the colon, where inflammation may cause and pain.

Diverticulosis— A condition of the colon characterized by the presence of diverticula.

Glaucoma— A disease of the eye characterized by increased ocular pressure resulting in damage to the retina and optic nerve if not treated.

Sigmoidoscopy— A visual examination of the rectum and sigmoid colon using a fiberoptic sigmoidoscope.

Ulcerative colitis An ulceration or erosion of the mucosa of the colon.

Resources

BOOKS

Eisenberg, Ronald. Clinical Imaging, Atlas of Differential Diagnosis, 3rd Ed. Philadelphia: Lippincott, Williams, and Wilkins, 1996.

Segen, Joseph C., and Joseph Stauffer. "Barium Enema (lower GI series)." In The Patient's Guide To Medical Tests: Everything You Need To Know About The Tests Your Doctor Prescribes. New York, NY: Facts On File, Inc., 1998, pp. 44-45.

PERIODICALS

Friedenberg, Richard M.D. "The Supertechnologist." Radiology Review (June 2000): 630-633.

ORGANIZATIONS

American Cancer Society. 1599 Clifton Road NE, Atlanta, GA 30329-4251. (800) ACS-2345. 〈http://www.cancer.org/〉.

OTHER

Health Discovery. 〈http://www.healthdiscovery.com/diseasesandconditions〉.

Barium Enema

views updated May 09 2018

Barium enema

Definition

A barium enema (or BE), also known as a lower GI (gastrointestinal) series, is a radiographic exam used to view the large intestine. There are two types of barium enemas : the single-contrast technique where just barium sulfate is injected into the rectum to outline the large intestine; and the double-contrast (or “air contrast”) technique in which barium and air are injected into the rectum.

Purpose

The purpose of a barium enema is to demonstrate the anatomy and morphology of the large intestine. The large intestine frames the abdomen and is divided into six sections. These include the rectum, sigmoid colon, descending colon, transverse colon, ascending colon, and cecum.

A barium enema may be performed for a variety of reasons, including abdominal pain or a change in bowel habits such as diarrhea or constipation , as well as a change in the caliber (size) of the stools. This exam is also requested when parasites, blood, mucus, or pus are found in the stools. Occult (hidden) blood found in the stools and anemia may be an indication of intestinal bleeding due to ulcers, inflammatory disease, or a cancerous lesion. Doctors may also order this exam as a screening tool for patients with a history of polyps (pre-cancerous growths extending outward from a mucous membrane) or a family history of colorectal cancer .

A barium enema may also be requested when the large intestine was not completely visualized during a colonoscopy (examination of the large intestine with a fiber-optic tube) or when a sigmoidoscopy is done, which only partially visualizes the colon. Sometimes a barium enema may be used as a treatment for intussusception (telescoping of one section of the bowel into another causing obstruction). This is a rare disorder occuring most often in young children, but when it occurs immediate action must be taken.

A barium enema may also be done to evaluate the remaining colon on colostomy patients. The barium is injected into the stoma (external drainage opening in the abdominal wall) instead of the rectum. A barium enema may be done if obstruction, perforation, or fistula formation is suspected.

Precautions

As with any radiographic procedure there is the risk of radiation. The x-ray technologist must always make sure there is no risk of pregnancy and that the least amount of films as possible are done. No lead shielding can be used since all the abdominal area must be visualized on the films.

Description

All patients must be changed into a hospital gown. All clothing is removed, including shoes and socks, since some leakage of the barium mixture can occur. In some departments disposable slippers are supplied. The x-ray technologist may take one preliminary view of the abdomen to determine how well the patient's bowel has been cleansed. Any retained fecal material can create false filling defects and mucosal abnormalities on the films. A single-contrast enema would usually be done on patients with a poor bowel preparation. After the films are taken and the patient has evacuated as much of the barium as possible air may be introduced into the large intestine and further films taken. This method takes longer and gives more radiation to the patient.

The patient will be instructed to lie on the left side on the x-ray table, and the radiography technologist will insert a lubricated enema tip into the rectum. The enema tips contain a small balloon which may be inflated to help the patient retain the barium. The patient may remain on their left side or turned prone (face-down) depending on the procedure and routine of the radiologist.

For a single-contrast barium enema, the barium sulphate solution is a thinner consistency but a larger amount is needed to completely fill the large intestine. High kilovoltage (100–125kvp) is used to get a good penetration of the barium filled colon, and it is important to take the films as quickly as possible since the patients are very uncomfortable when the bowel is completely distended. Routine films for a single contrast study include a supine and prone abdomen film as well as both obliques to see the hepatic and spenic flexures of the large bowel. The patient will completely evacuate the bowel and one more film, the post-evacuation film (PE) usually done AP (anteroposterior or front-to-back) supine will be taken.

In a double-contrast barium enema, a fine coating of thick barium is needed to outline the mucosal lining of the bowel. The patient will be placed prone so that gravity can assist the air in distributing the liquid around the large bowel. The patient is asked to turn over 360 degrees a few times during the exam to aid in the coating of the bowel. The patient is then placed upright, and more air is injected into the bowel so gravity again can assist in visualizing the large intestine. Patients may develop spasms of the bowel during this exam, so the radiologist may give the patient a glucagon injection to relax the large bowel. This injection should not be given to patients with a history of glaucoma and can cause temporary double-vision in these patients.

The radiologist will take spot-films under fluoroscopy of each segment of the bowel but most of the films will be made following the procedure by the x-ray technologist. Since less barium is used along with some air, less kilovoltage (90–100kvp) is needed to achieve a high contrast x ray of the large intestine. The usual AP and PA (posteroanterior) abdomen films will be done as well as the two oblique views of the abdomen. An upright film may be done as well depending on the routine of the radiologist. The most important films for the double-contrast exam are the two lateral decubitus films. The patient is placed on a large cushion or sponge and turned completely onto one side. A stationary grid is placed next to the patient and the x-ray tube is turned 90 degees. This film allows the air to rise to the upper surface of the abdomen so that the air along with the thin coating of barium creates a detailed visualization of the intestinal lining. This is extremely important when looking for small polyps, cancers, and ulcerations of the bowel. Films of both sides are always taken.

Preparation

In order to conduct the most accurate barium enema test, the patient must follow a prescribed diet and bowel preparation prior to the test. This includes a diet of tea, coffee (black), clear soups, and gelatin 24 to 48 hours before the barium enema. Laxatives and cathartics such as magnesium citrate (X-Prep) or Dulcolax tablets may also be required as part of the bowel preparation. Each radiology department has their own specific requirements. A rectal suppository or cleansing enema may also be necessary on the morning before the exam. Patients must drink as much fluids as possible to prevent dehydration . Patients with heart disease , diabetes, or kidney disorders should consult their physician for an alternate bowel preparation. Children are usually placed on a clear liquid diet on the day before their examination.

A barium enema may be done in a hospital or a certified x-ray clinic and will take 30 minutes to one hour depending on what type of exam has been ordered and the physical ability of the patient.

Aftercare

Patients should follow several steps immediately after undergoing a barium enema, including:

  • Drinking plenty of fluids to help counteract the dehydrating effects of the bowel preparation.
  • Taking time to rest. A barium enema and the bowel preparation taken before it can be exhausting.
  • A cleansing enema or laxative may be given to eliminate any remaining barium. White stools containing barium are normal for two or three days following a barium enema.

Complications

While a barium enema is considered a safe screening test used on a routine basis, it can cause complications in certain patients. The following contraindications should be kept in mind before a barium enema is performed:

  • Those who have a rapid heart rate, severe ulcerative colitis, toxic megacolon, or a presumed perforation in the intestine should not undergo a barium enema.
  • The test can be cautiously performed if the patient has a blocked intestine. Gastrograffin, an iodine-based contrast, will be used instead of the barium in case emergency surgery is needed following the barium enema.

Results

A normal result indicates no structural or filling defects of the large intestine. Radiologists look for any enlargement or narrowing of the large bowel as well as variations in the mucosal lining. The walls of the intestine should collapse normally after the post-evacuation film, and the bowel should have normal haustral markings (undulations of the colon wall).

Abnormal results may include colorectal polyps, diverticulosis (multiple abnormal sacs bulging through the intestinal wall), ulcerative colitis, abscesses,

or tumors visualized on the walls or adjacent to the large intestine. Further evaluation such as a biopsy or CT scan may be necessary to determine the extent of any positive findings.

Caregiver concerns

It is the responsibility of the radiography technologist to prepare the barium, insert the enema tip, and take the overhead films after the radiologist has filled the entire colon with either the bariumor a combination of barium and air. In some departments an interventional radiology technologist will perform the complete exam. He or she will have had additional education and training by the radiologists to complete this duty.

The x-ray technologist must work closely with the nurses to make sure all hospital patients follow the bowel preparation. Since the preparation is physically exhausting for the patient, care is taken to complete the exam as soon as possible so the patient may resume a normal diet.

Patient education

Since a good preparation is the most important step in a barium enema, all patients should receive detailed information on the reasons and requirements for the cleansing treatment. The x-ray technologist must explain the procedure in detail before starting the exam. The patient must be informed that the barium enema can sometimes cause cramps and that the urge to have a bowel movement is completely normal. Some leakage of the barium may occur and the patient should not feel embarrassed if this happens because it occurs fairly often, especially in elderly patients. Care should be taken when inserting the enema tip because the rectum is already irritated, due to the multiple bowel movements during the preparation. The x-ray technologist must take note of any history of glaucoma in case an injection of glucagon is needed. Patients should be completely covered at all times and care taken when placing the patient in the upright position since many patients are weak after undergoing the bowel preparation.

KEY TERMS

Barium sulfate —A barium compound used during a barium enema to block the passage of x rays during the exam, allowing visualization of the intestinal lining.

Diverticula (plural of diverticulum) —A sac or pouch in the colon walls which is usually asymptomatic (without symptoms) but may cause difficulty if it becomes inflamed.

Sigmoidoscopy —A visual examination of the rectum and sigmoid colon using a fiberoptic sigmoidoscope.

Ulcerative colitis —An ulceration or erosion of the mucosa of the colon.

The x-ray technologist should also explain to the patient the need to drink plenty of fluids after the barium enema and that white stools following a barium enema are normal.

All radiography technologists must be certified, having completed a two to four year program depending on where the course was completed. All x-ray technologists must be registered with the A.S.R.T. and earn continuing education credits to remain registered.

Resources

BOOKS

Eisenberg, Ronald. Clinical Imaging, Atlas of Differential Diagnosis, 3rd Ed. Philadelphia: Lippincott, Williams, and Wilkins, 1996.

Segen, Joseph C., and Joseph Stauffer. “Barium Enema (lower GI series).” In The Patient's Guide To Medical Tests: Everything You Need To Know About The Tests Your Doctor Prescribes. New York, NY: Facts On File, Inc., 1998, pp. 44–45.

PERIODICALS

Friedenberg, Richard M.D. “The Supertechnologist.” Radiology Review (June 2000): 630–633.

ORGANIZATIONS

American Cancer Society. 1599 Clifton Road NE, Atlanta, GA 30329-4251. (800) ACS-2345. http://www.cancer.org/.

OTHER

Health Discovery. http://www.healthdiscovery.com/diseasesand conditions.

Lorraine K. Ehresman

Barium Enema

views updated May 29 2018

Barium enema

Definition

A barium enema, also known as a lower GI (gastrointestinal) exam, is a diagnostic test using x-ray examination to view the large intestine (colon and rectum). There are two types of this test: the single-contrast technique, in which barium sulfate solution is injected into the rectum to gain a profile view of the large intestine; and the double-contrast (or air contrast) technique, in which air and barium sulfate are injected into the rectum.

Purpose

A barium enema may be performed to assist in diagnosing or detecting:

  • colon or rectal cancer (colorectal cancer)
  • inflammatory diseases such as ulcerative colitis
  • polyps (small benign growths in the tissue lining of the colon and rectum)
  • diverticula (pouches pushing out from the colon)
  • structural changes in the large intestine

The double-contrast barium enema is more accurate than the single-contrast technique for detecting small polyps or tumors, early inflammatory disease, and bleeding caused by ulcers because it gives a better view of the intestinal walls.

The decision to perform a barium enema is based on the patient's history of altered bowel habits. These alterations may include diarrhea , constipation, lower abdominal pain, blood, mucus or pus in the stool. It is also recommended that this exam be used every five to 10 years beginning at age 50 to screen healthy people for colon cancer , the second most deadly type of cancer in the United States. Those who have a close relative with colon cancer or who have had a precancerous polyp are considered to be at an increased risk for the disease and should be screened more frequently to detect abnormalities.

Precautions

Although the barium enema is an effective screening method and may lead to a timely diagnosis of a variety gastrointestinal diseases, the test may not detect all abnormalities present in the colon and rectum. In addition, the barium enema visualizes only the large intestine; the small intestine may also require examination with an upper GI series to rule out abnormalities in that area of the digestive tract. Another drawback is that intestinal gas may hinder the accuracy of test results.

As of 2001, numerous studies have shown that a colonoscopy performed by an experienced gastroenterologist is a more accurate initial diagnostic tool for detecting early signs of colorectal cancer than a barium enema. Colonoscopy allows a physician to examine the entire colon and rectum for polyps. In addition, if abnormalities such as polyps are observed during the procedure, these often-precancerous growths may be removed during the procedure and later examined (biopsy ). One additional difference between a barium enema and a colonoscopy is that a colonoscopy almost always involves conscious sedation, while the barium enema is an unsedated procedure. Some physicians use flexible sigmoidoscopy (proctosigmoidoscopy) plus a barium enema instead of colonoscopy. However, sigmoidoscopy only visualizes the rectum and the portion of the colon immediately above it (sigmoid colon) and does not allow the physician to remove polyps but only to obtain tissue or stool samples.

Description

To begin a barium enema, the patient lies flat on his or her back on a tilting radiographic table in order to have x rays of the abdomen taken. After being assisted to a different position, a well-lubricated rectal tube is inserted through the anus. This tube allows the physician or assistant to slowly administer the barium sulfate into the intestine. While this filling process is closely monitored, it is important for the patient to keep the anus tightly contracted against the rectal tube to help maintain its position and prevent the barium from leaking. This step is important because the test may be inaccurate if the barium leaks. A rectal balloon may also be inflated to help retain the barium. The table may be tilted or the patient moved to different positions to aid in the filling process.

As the barium fills the intestine, x rays of the abdomen are taken to distinguish significant findings. There are many ways to perform a barium enema. One way is that shortly after filling, the rectal tube is removed and the patient expels as much of the barium as possible. Upon completing this expulsion, an additional x ray is taken, and a double-contrast enema exam may follow. If this procedure is done immediately, a thin film of barium will remain in the intestine, and air is then slowly injected to expand the bowel lumen (space in the intestine). Sometimes no x rays will be taken until after the air is injected. The entire test takes about 20-30 minutes.

Preparation

In order to conduct the most accurate barium enema test, the large intestine must be empty. Thus, patients must follow a prescribed diet and bowel preparation instructions prior to the test. This preparation commonly includes restricted intake of dairy products and a liquid diet for 24 hours prior to the test, in addition to drinking large amounts of water or clear liquids 12-24 hours before the test. Patients may also be given laxatives and asked to give themselves a cleansing enema.

In addition to the prescribed diet and bowel preparation prior to the test, the patient can expect the following during a barium enema:

  • The patient will be well draped with a gown and secured to a tilting x-ray table.
  • As the barium or air is injected into the intestine, the patient may experience cramping pains or the urge to defecate.
  • The patient will be instructed to take slow, deep breaths through the mouth to ease any discomfort.

Aftercare

Patients should follow several steps immediately after undergoing a barium enema, including:

  • Drinking plenty of fluids to help counteract the dehydrating effects of bowel preparation and the test.
  • Taking time to rest because a barium enema and the bowel preparation taken before it can be exhausting.
  • Administering a cleansing enema may help to eliminate any remaining barium. Light-colored stools will be prevalent for the next 24-72 hours following the test.

Risks

Although a barium enema is generally considered a safe screening test , it can cause complications in certain people. For example, patients with a rapid heart rate, severe ulcerative colitis, toxic megacolon (acute dilation of the colon that may progress to rupture), or a presumed perforation in the intestine should not undergo a barium enema. Patients with a known blocked intestine, diverticulitis, or severe bloody diarrhea may be tested with caution on the advice of a physician. Also, administering a barium enema to a pregnant woman is not advisable because of radiation exposure to the fetus.

Although the barium enema may cause minor stomach or abdominal discomfort in some people, more serious complications include:

  • severe cramping
  • nausea and vomiting
  • perforation of the colon
  • water intoxication
  • barium granulomas (inflamed nodules)
  • allergic reactions

These complications, however, are all very rare.

Normal results

When the patient undergoes a single-contrast enema, the intestine is steadily filled with barium to differentiate the colon's markings. A normal result displays uniform filling of the colon. As the barium is expelled, the intestinal walls collapse. A normal result on the x ray after the barium is expelled shows an intestinal lining with a standard, feathery appearance and no abnormalities.

The double-contrast enema expands the intestine, which is already lined with a thin layer of barium; however, the addition of air displays a detailed image of the mucosal pattern. Varying positions taken by the patientallow the barium to collect on the dependent walls of the intestine by way of gravity.

Abnormal results

A barium enema visualizes abnormalities appearing on a series of x rays, thus aiding in the diagnosis of a variety of gastrointestinal disorders and the early signs of cancer. However, most colon cancers occur in the rectosigmoid region, or upper part of the rectum and adjoining portion of the sigmoid colon, and are better detected with flexible sigmoidoscopy or colonoscopy.

Abnormal findings on a barium enema examination may include polyps, lesions or tumors, diverticulae, inflammatory disease, such as ulcerative colitis, obstructions, or hernias. Structural changes in the intestine, gastroenteritis, and the size, position, and motility of the appendix may also be apparent.

Resources

BOOKS

Fischbach, Frances Talaska. A Manual of Laboratory and Diagnostic Tests, 6th ed. Philadelphia: Lippincott Williams and Wilkins, 2000.

Pagana, Kathleen Deska, and Timothy James Pagana. Mosby's Manual of Diagnostic and Laboratory Tests. St. Louis, Mo: Mosby, 1998.

Schull, Patricia, ed. Illustrated Guide to Diagnostic Tests, 2nd ed. Springhouse, PA: Springhouse Corporation, 1998.

Segen, Joseph C., and Joseph Stauffer. "Barium Enema (lower GI series)." In The Patient's Guide To Medical Tests: Everything You Need To Know About The Tests Your Doctor Prescribes. New York, NY: Facts On File, Inc., 1998: 44-45.

PERIODICALS

Fletcher, Robert H. "The End of Barium Enemas?" The New England Journal of Medicine 342 (June 15, 2000): 1823-1824.

Winawer, Sidney J., R. H. Fletcher, L. Miller, et al. "Colorectal Cancer Screening Clinical Guidelines and Rationale." Gastroenterology 112 (1997):594-642.

Winawer, Sidney J., Edward T. Stewart, Ann Zauber et al. "AComparison of Colonoscopy and Double-Contrast Barium Enema for Surveillance After Polypectomy." The New England Journal of Medicine 342 (June 15, 2000): 1766-1772.

Zoorob, Roger, Russell Anderson, Charles Cefalu, and Modamed Sidari. "Cancer Screening Guidelines." American Family Physician 63 (March 15, 2001): 1101-1112.

ORGANIZATIONS

American Cancer Society. 1599 Clifton Road, NE, Atlanta, GA 30329-4251. Phone: 1-800-ACS-2345. <http://www.cancer.org>.

American College of Gastroenterology. 4900 B South 31st Street, Arlington, VA 22206. Phone: 703-820-7400. Health Hotline: 1-800-978-7666. <http://www.acg.gi.org>.

American College of Radiology, <http://www.acr.org>.

Beth Kapes

KEY TERMS

Barium sulfate

A barium compound used during a barium enema to block the passage of x rays during the exam.

Colonoscopy

An examination of the upper portion of the rectum performed with a colonoscope or elongated speculum.

Diverticula

A diverticulum of the colon is a sac or pouch in the colon walls which is usually asymptomatic (without symptoms) but may cause difficulty if it becomes inflamed.

Diverticulitis

A condition of the diverticulum of the intestinal tract, especially in the colon, in which inflammation may cause pain and distended sacs extending from the colon.

Sigmoidoscopy

A visual examination of the rectum and sigmoid colon using an instrument called a sigmoidoscope.

Ulcerative colitis

An ulceration or erosion of the mucosa (lining) of the colon.

QUESTIONS TO ASK THE DOCTOR

  • How long will the test take?
  • Will the test be painful?
  • Is barium safe?
  • Can I take my usual medications the day before the test?
  • How many days will the barium be in my system?
  • When will I get the test results?

Barium Enema

views updated Jun 27 2018

Barium Enema

Definition

A barium enema, also known as a lower GI (gastrointestinal) exam, is a test that uses x-ray examination to view the large intestine. There are two types of this test: the single-contrast technique where barium sulfate is injected into the rectum in order to gain a profile view of the large intestine; and the double-contrast (or "air contrast") technique where air is inserted into the rectum.

Purpose

A barium enema may be performed for a variety of reasons, including to aid in the diagnosis of colon and rectal cancer (or colorectal cancer ), and inflammatory disease. Detection of polyps (a benign growth in the tissue lining of the colon and rectum), diverticula (a pouch pushing out from the colon), and structural changes in the large intestine can also be established with this test. The double-contrast barium enema is the best method for detecting small tumors (such as polyps), early inflammatory disease, and bleeding caused by ulcers.

The decision to perform a barium enema is based on a person's history of altered bowel habits. These can include diarrhea, constipation, any lower abdominal pain they are currently exhibiting, blood, mucus, or pus in their stools. It is also recommended that this exam be used every five to 10 years to screen healthy people for colorectal cancer, the second most deadly type of tumor in the United States. Those who have a close relative with colorectal cancer or have had a precancerous polyp are considered to be at an increased risk for the disease and should be screened more frequently to look for abnormalities.

Precautions

While barium enema is an effective screening method in the detection of symptoms and may lead to a timely diagnosis of several diseases, it is not the only method to do this. As of 1997, some studies have shown that the colonoscopy procedure performed by experienced gastroenterologists is a more accurate initial diagnostic tool for detecting early signs of colorectal cancer. A colonoscopy is the most accurate way for the physician to examine the entire colon and rectum for polyps. If abnormalities are seen at this time the procedure is accompanied by a biopsy. Some physicians use sigmoidoscopy plus a barium enema instead of colonoscopy.

KEY TERMS

Barium sulfate A barium compound used during a barium enema to block the passage of x rays during the exam.

Bowel lumen The space within the intestine.

Colonoscopy An examination of the upper portion of the rectum performed with a colonoscope or elongated speculum.

Diverticula A diverticulum of the colon is a sac or pouch in the colon walls which is usually asymptomatic (without symptoms) but may cause difficulty if it becomes inflamed.

Diverticulitis A condition of the diverticulum of the intestinal tract, especially in the colon, where inflammation may cause distended sacs extending from the colon and pain.

Ulcerative colitis An ulceration or erosion of the mucosa of the colon.

Proctosigmoidoscopy A visual examination of the rectum and sigmoid colon using a sigmoidoscope.

Description

To begin a barium enema, the patient will lie with their back down on a tilting radiographic table in order to have x rays of the abdomen taken. After being assisted to a different position, a well-lubricated rectal tube is inserted through the anus. This tube allows the physician or assistant to slowly administer the barium into the intestine. While this filling process is closely monitored, it is important for the patient to keep the anus tightly contracted against the rectal tube to help maintain its position and prevent the barium from leaking. This step is emphasized to the patient due to the inaccuracy that may be caused if the barium leaks. A rectal balloon may also be inflated to help retain the barium. The table may be tilted or the patient moved to a different position to aid in the filling process.

As the barium fills the intestine, x rays of the abdomen are taken to distinguish significant findings.There are many ways to perform a barium enema. One way is that shortly after filling, the rectal tube is removed and the patient expels as much of the barium as possible. Upon completing this, an additional x ray is taken, and a double-contrast enema may follow. If this is done immediately, a thin film of barium will remain in the intestine, and air is then slowly injected to expand the bowel lumen. Sometimes no x rays will be taken until after the air is injected.

Preparation

In order to conduct the most accurate barium enema test, the patient must follow a prescribed diet and bowel preparation instructions prior to the test. This preparation commonly includes restricted intake of diary products and a liquid diet for 24 hours prior to the test, in addition to drinking large amounts of water or clear liquids 12-24 hours before the test. Patients may also be given laxatives, and asked to give themselves a cleansing enema.

In addition to the prescribed diet and bowel preparation prior to the test, the patient can expect the following during a barium enema:

  • They will be well draped with a gown as they are secured to a tilting x-ray table.
  • As the barium or air is injected into the intestine, they may experience cramping pains or the urge to defecate.
  • The patient will be instructed to take slow, deep breaths through the mouth to ease any discomfort.

Aftercare

Patients should follow several steps immediately after undergoing a barium enema, including:

  • Drink plenty of fluids to help counteract the dehydrating effects of bowel preparation and the test.
  • Take time to rest. A barium enema and the bowel preparation taken before it can be exhausting.
  • A cleansing enema may be given to eliminate any remaining barium. Lightly colored stools will be prevalent for the next 24-72 hours following the test.

Risks

While a barium enema is considered a safe screening test used on a routine basis, it can cause complications in certain people. The following indications should be kept in mind before a barium enema is performed:

  • Those who have a rapid heart rate, severe ulcerative colitis, toxic megacolon, or a presumed perforation in the intestine should not undergo a barium enema.
  • The test can be cautiously performed if the patient has a blocked intestine, ulcerative colitis, diverticulitis, or severe bloody diarrhea.
  • Complications that may be caused by the test include perforation of the colon, water intoxication, barium granulomas (inflamed nodules), and allergic reaction. These are all very rare.

Normal results

When the patient undergoes a single-contrast enema, their intestine is steadily filled with barium to differentiate the colon's markings. A normal result displays uniform filling of the colon. As the barium is expelled, the intestinal walls collapse. A normal result on the x ray after defecation will show the intestinal lining as having a standard, feathery appearance.

Accordingly, the double-contrast enema expands the intestine which is already lined with a thin layer of barium, but with air to display a detailed image of the mucosal pattern. Varying positions taken by the patient allow the barium to collect on the dependent walls of the intestine by way of gravity.

Abnormal results

A barium enema allows abnormalities to appear on an x ray that may aid in the diagnosis of several different conditions. Although most colon cancers occur in the rectosigmoid region, or upper part of the rectum and adjoining portion of the sigmoid colon, and are better detected with a different test called a proctosigmoidoscopy, an enema can identify other early signs of cancer.

Identification of polyps, diverticulosis, inflammatory disease, such as diverticulitis and ulcerative colitis is attainable through a barium x ray. Structural changes in the intestine, gastroenteritis, and some cases of acute appendicitis may also be apparent by viewing this x ray.

Resources

ORGANIZATIONS

American Cancer Society. 1599 Clifton Rd., NE, Atlanta, GA 30329-4251. (800) 227-2345. http://www.cancer.org.

Barium Enema

views updated Jun 27 2018

Barium Enema

Definition
Purpose
Description
Preparation
Aftercare
Risks
Normal results

Definition

A barium enema, also known as a lower GI (gastrointestinal) exam, is a test that uses x-ray examination to view the large intestine. There are two types of tests: the single-contrast technique, where barium sulfate is injected into the rectum to gain a profile view of the large intestine, and the double-contrast (or “air contrast”) technique, where air and barium are inserted into the rectum.

Purpose

A barium enema may be performed for a variety of reasons. One reason may be to help in the diagnosis of colon and rectal cancer (or colorectal cancer), and inflammatory disease. Detection of polyps (benign growths in the tissue lining the colon and rectum), diverticula (pouches pushing out from the colon), and structural changes in the large intestine can also be confirmed by the barium enema. The double-contrast barium enema is the best method for detecting small tumors (such as polyps), early inflammatory disease, and bleeding caused by ulcers.

A doctor’s decision to perform a barium enema is based on a patient’s history of altered bowel habits. These can include diarrhea, constipation, lower abdominal pain, or patient reports of blood, mucus, or pus in the stools. It is recommended that healthy people have a colorectal cancer screening colonoscopy every five to 10 years, because this form of cancer is the second most deadly type in the United States. Those who have a close relative with colorectal cancer, or who have had a precancerous polyp, are considered to be at an increased risk for the disease and should be screened more frequently by their doctor for possible abnormalities.

Description

To begin a barium enema, the doctor will have the patient lie with their back down on a tilting radiographic table so that x rays can of the abdomen can be taken. The film is then reviewed by a radiologist, who assesses if the colon has been adequately cleansed of stool during the prep process. After being assisted into a different position, a well-lubricated rectal tube is inserted through the anus. This tube allows the physician or the assisting health care provider to slowly administer the barium into the intestine. While this filling process is closely monitored, the patient must keep the anus tightly contracted against the rectal tube

KEY TERMS

Barium sulfate— A barium compound used during a barium enema to block the passage of x rays during the exam.

Bowel lumen— The space within the intestine.

Colonoscopy— An examination of the colon performed with a colonoscope.

Diverticula— A diverticulum of the colon is a sac or pouch in the colon wall which is usually asymptomatic (without symptoms) but may cause difficulty if it becomes inflamed. Diverticula is the plural of diverticulum.

Diverticulitis— A condition of the diverticulum of the intestinal tract, especially in the colon, where inflammation may cause distended sacs extending from the colon and pain.

Diverticulosis— The development of diverticula.

Megacolon— Abnormally large colon associated with some chronic intestine disorders.

Proctosigmoidoscopy— A visual examination of the rectum and sigmoid colon using a sigmoidoscope, also known as sigmoidoscopy.

Sigmoidoscopy— Endoscopic examination of the lower colon.

Ulcerative colitis An ulceration or erosion of the lining of the colon.

so that the position is maintained and the barium is prevented from leaking. This step is emphasized to the patient because inaccuracy may occur if the barium leaks. A rectal balloon may also be inflated to help the patient retain the barium. The table may be tilted or the patient may be moved to different positions to aid in the filling process.

As the barium fills the intestine, x rays of the abdomen are taken to distinguish significant findings. There are many ways to perform a barium enema. One way is that shortly after filling, the rectal tube is removed and the patient expels as much of the barium as possible. Alternatively, the tube will remain in place, and the barium will move through that tube. A thin film of barium remains in the intestine, and air is then slowly injected through the rectum and to expand the bowel lumen. Usually no films will be taken until after the air is injected. Multiple films are generally obtained by a radiologist; then, additional films are made by a technologist.

Preparation

To conduct the most accurate barium enema test, the patient must follow a prescribed diet and bowel preparation instructions prior to the test. This preparation commonly includes restricted intake of diary products and a liquid diet for 24 hours prior to the test, in addition to drinking large amounts of water or clear liquids 12–24 hours before the test. Patients may also be given laxatives, and asked to give themselves a cleansing enema.

In addition to the prescribed diet and bowel preparation prior to the test, the patient can expect the following during a barium enema:

  • They will be well draped with a gown as they are placed on a tilting x-ray table.
  • As the barium or air is injected into the intestine, they may experience cramping pains or the urge to defecate.
  • The patient will be instructed to take slow, deep breaths through the mouth to ease any discomfort.

Aftercare

Patients should follow several steps immediately after undergoing a barium enema, including:

  • Drinking plenty of fluids to help counteract the dehydrating effects of bowel preparation and the test.
  • Taking time to rest. A barium enema and the bowel preparation taken before it can be exhausting.
  • A cleansing enema may be given to eliminate any remaining barium. Lightly colored stools will be prevalent for the next 24-72 hours following the test.

Risks

While a barium enema is considered a safe screening test used on a routine basis, it can cause complications in certain people. The following indications should be kept in mind before a barium enema is performed:

  • Those who have a rapid heart rate, severe ulcerative colitis, toxic megacolon, or a presumed perforation in the intestine should not undergo a barium enema.
  • The test can be performed cautiously if the patient has a blocked intestine, ulcerative colitis, diverticulitis, or severe bloody diarrhea.
  • Complications that may be caused by the test include perforation of the colon, water intoxication, barium granulomas (inflamed nodules), and allergic reaction. However, these conditions are all very rare.

Normal results

When patients undergo single-contrast enemas, their intestines are steadily filled with barium to differentiate markings of the colon markings. Normal results display uniform filling of the colon.

As the barium is expelled, the intestinal walls collapse. A normal result on the x ray after defecation will show the intestinal lining as having a standard, feathery appearance.

The double-contrast enema expands the intestine, which is already lined with a thin layer of barium, using air to display a detailed image of the mucosal pattern. Varying positions taken by the patient allow the barium to collect on the dependent walls of the intestine by way of gravity.

A barium enema allows abnormalities to appear on an x ray that may aid in the diagnosis of several different conditions. Most colon cancers occur in the rectosigmoid region, or on the upper part of the rectum and adjoining portion of the sigmoid colon. However, they can also be detected with a proctosigmoidoscopy (usually referred to as a sigmoidoscopy ). Further, an enema can identify other early signs of cancer.

Identification of polyps, diverticulosis, and inflammatory disease (such as diverticulitis and ulcerative colitis) is attainable through a barium x ray. Some cases of acute appendicitis may also be apparent by viewing this x ray, though acute appendicitis is usually diagnosed clinically, or by CT scan.

Resources

BOOKS

PERIODICALS

Gazelle, G. “Screening for Colorectal Cancer.” Radiology 327 (May 2000)

Rubesin, S. “Double Contrast Barium Enema Examination Technique.” Radiology 642 (June 2000).

ORGANIZATIONS

American Cancer Society. 1599 Clifton Rd., NE, Atlanta, GA 30329-4251. (800) 227-2345. http://www.cancer.org.

Beth A. Kapes

Lee A. Shratter, M.D.

Barium swallow seeUpper GI exam

Beating heart surgery seeMinimally invasive heart surgery

Beclomethasone seeCorticosteroids

Bedside monitors seeCardiac monitor

Barium Enema

views updated May 21 2018

Barium enema

Definition

A barium enema, also known as a lower GI (gastrointestinal) exam, is a test that uses x-ray examination to view the large intestine. There are two types of tests: the single-contrast technique, where barium sulfate is injected into the rectum to gain a profile view of the large intestine, and the double-contrast (or "air contrast") technique, where air and barium are inserted into the rectum.


Purpose

A barium enema may be performed for a variety of reasons. One reason may be to help in the diagnosis of colon and rectal cancer (or colorectal cancer), and inflammatory disease. Detection of polyps (benign growths in the tissue lining the colon and rectum), diverticula (pouches pushing out from the colon), and structural changes in the large intestine can also be confirmed by the barium enema. The double-contrast barium enema is the best method for detecting small tumors (such as polyps), early inflammatory disease, and bleeding caused by ulcers.

A doctor's decision to perform a barium enema is based on a patient's history of altered bowel habits. These can include diarrhea, constipation, lower abdominal pain, or patient reports of blood, mucus, or pus in the stools. It is recommended that healthy people have a colorectal cancer screening colonoscopy every five to 10 years, because this form of cancer is the second most deadly type in the United States. Those who have a close relative with colorectal cancer, or who have had a precancerous polyp, are considered to be at an increased risk for the disease and should be screened more frequently by their doctor for possible abnormalities.


Description

To begin a barium enema, the doctor will have the patient lie with their back down on a tilting radiographic table so that x rays can of the abdomen can be taken. The film is then reviewed by a radiologist, who assesses if the colon has been adequately cleansed of stool during the prep process. After being assisted into a different position, a well-lubricated rectal tube is inserted through the anus. This tube allows the physician or the assisting health care provider to slowly administer the barium into the intestine. While this filling process is closely monitored, the patient must keep the anus tightly contracted against the rectal tube so that the position is maintained and the barium is prevented from leaking. This step is emphasized to the patient because inaccuracy may occur if the barium leaks. A rectal balloon may also be inflated to help the patient retain the barium. The table may be tilted or the patient may be moved to different positions to aid in the filling process.

As the barium fills the intestine, x rays of the abdomen are taken to distinguish significant findings. There are many ways to perform a barium enema. One way is that shortly after filling, the rectal tube is removed and the patient expels as much of the barium as possible. Alternatively, the tube will remain in place, and the barium will move through that tube. A thin film of barium remains in the intestine, and air is then slowly injected through the rectum and to expand the bowel lumen. Usually no films will be taken until after the air is injected. Multiple films are generally obtained by a radiologist; then, additional films are made by a technologist.


Preparation

To conduct the most accurate barium enema test, the patient must follow a prescribed diet and bowel preparation instructions prior to the test. This preparation commonly includes restricted intake of diary products and a liquid diet for 24 hours prior to the test, in addition to drinking large amounts of water or clear liquids 1224 hours before the test. Patients may also be given laxatives , and asked to give themselves a cleansing enema.

In addition to the prescribed diet and bowel preparation prior to the test, the patient can expect the following during a barium enema:

  • They will be well draped with a gown as they are placed on a tilting x-ray table.
  • As the barium or air is injected into the intestine, they may experience cramping pains or the urge to defecate.
  • The patient will be instructed to take slow, deep breaths through the mouth to ease any discomfort.

Aftercare

Patients should follow several steps immediately after undergoing a barium enema, including:

  • Drinking plenty of fluids to help counteract the dehydrating effects of bowel preparation and the test.
  • Taking time to rest. A barium enema and the bowel preparation taken before it can be exhausting.
  • A cleansing enema may be given to eliminate any remaining barium. Lightly colored stools will be prevalent for the next 2472 hours following the test.

Risks

While a barium enema is considered a safe screening test used on a routine basis, it can cause complications in certain people. The following indications should be kept in mind before a barium enema is performed:

  • Those who have a rapid heart rate, severe ulcerative colitis, toxic megacolon, or a presumed perforation in the intestine should not undergo a barium enema.
  • The test can be performed cautiously if the patient has a blocked intestine, ulcerative colitis, diverticulitis, or severe bloody diarrhea.
  • Complications that may be caused by the test include perforation of the colon, water intoxication, barium granulomas (inflamed nodules), and allergic reaction. However, these conditions are all very rare.

Normal results

When patients undergo single-contrast enemas, their intestines are steadily filled with barium to differentiate markings of the colon markings. Normal results display uniform filling of the colon.

As the barium is expelled, the intestinal walls collapse. A normal result on the x ray after defecation will show the intestinal lining as having a standard, feathery appearance.

The double-contrast enema expands the intestine, which is already lined with a thin layer of barium, using air to display a detailed image of the mucosal pattern. Varying positions taken by the patient allow the barium to collect on the dependent walls of the intestine by way of gravity.

A barium enema allows abnormalities to appear on an x ray that may aid in the diagnosis of several different conditions. Most colon cancers occur in the rectosigmoid region, or on the upper part of the rectum and adjoining portion of the sigmoid colon. However, they can also be detected with a proctosigmoidoscopy (usually referred to as a sigmoidoscopy ). Further, an enema can identify other early signs of cancer.

Identification of polyps, diverticulosis, and inflammatory disease (such as diverticulitis and ulcerative colitis) is attainable through a barium x ray. Some cases of acute appendicitis may also be apparent by viewing this x ray, though acute appendicitis is usually diagnosed clinically, or by CT scan.


Resources

books

periodicals

Gazelle, G. "Screening for Colorectal Cancer." Radiology 327 (May 2000)

Rubesin, S. "Double Contrast Barium Enema Examination Technique." Radiology 642 (June 2000).

organizations

American Cancer Society. 1599 Clifton Rd., NE, Atlanta, GA 30329-4251. (800) 227-2345. <http://www.cancer.org>.


Beth A. Kapes

Lee A. Shratter, M.D.

barium enema

views updated Jun 08 2018

barium enema (bair-iŭm) n. see enema.