Babeh Edi

GIT	Barium Follow Through

---

Basic Anatomy
Barium Follow Through is designed to demonstrate the small bowel from the duodenum to the ileo ceacal region encompassing the duodenum, jejunum and ileum including the junctions superiorly with  the stomach and inferiorly with the ascending colon.

         http://www.vh.org/Providers/TeachingFiles/NormalRadAnatomy/Images/

 

Indications
Abdominal pain
Diarrhoea
Bleeding
Partial obstruction
Investigations of transit time
? Mekels diverticulum
Contraindications
Obstruction
Imminent surgery and or suspected perforation require water soluble contrast media.
Contrast Media and drugs. (Typical Examples, See Contrast / Drugs Section for more information)
Baritop 100% w/v
EZHD 120 %
Buscopan / Glucagon if required
Metaclopramide 
Equipment
Fluoroscopy with rapid film capability 10 frames/second
Fluoroscopy table with 90/20 tilt.
Special "feeding" equipment may be required, i.e. straws and feeding cups.
Injection administration equipment.
Patient Preparation
Patient Identification, Check Pregnancy state,
General psychological preparation and examination outline.
* Note special preparation may be needed for diabetic patients.
Check sensitivity to drugs used.
Nil by mouth for 12 hours
Laxative preparation 12 hours before examination
Metaclopramide 20 mg orally 30 minutes before the examination
Technique
The technique should ensure a non fragmented dense column of contrast agent passes smoothly through the small bowel.
The patient should rapidly drink about 300 ml of contrast media and then lie on their right side
Typical Film Series
35 x 43 cm Films in the prone position are taken at 20 minute intervals until the contrast media passes into the colon, ensure that the early films should include the stomach, a pad under the abdomen may help to separate out the loops of bowel.
The patient may need fluoroscopic spot films of areas of interest especially the terminal ileum

Typical Film from Image Series

Radiation Protection
Define strict referral criteria to exclude clinically unhelpful examinations
Minimise fluoroscopy time and current
Introduce QA programme to make regular checks on and to optimise staff and equipment performance
Collimate X-ray beam to minimise size
Shield sensitive organs when possible
Install modern image intensifiers with sensitive (e.g. CsI) photocathodes and digital image processing
Use video recorder instead of cine camera during fluoroscopy wherever possible
Use spot film photofluoroscopy with modern image intensifier and 100mm camera instead of radiography whenever appropriate
Use pulsed systems with image storage devices in fluoroscopy.

Aftercare
Record volumes and descriptions of contrast media and drugs administered.
General patient psychological aftercare
Ensure the patient understands the procedure for collecting the results.
Warn the patient of the possibilities of constipation and appropriate counter measures

Complications
Aspiration of barium mixture
Leakage of barium into the peritoneum with and unsuspected perforation

Other Imaging Techniques
Barium small bowel enema
Radionuclide Imaging for GI Bleed
CT.