Barium follow through

BARIUM FOLLOW THROUGH

Definition

• Indication
• Contraindications
• Describe technique of barium meal follow through
• Adverse effects
• After care of the patient
• Normal radiological anatomy

Side check up

Definition

Barium follow through is a special contrast radiological procedure of lower portion of the stomach, the duodenum, small intestine and a portion of the caecum following ingestion of sulfate contrast (barium sulphate) done under fluoroscopy.

Its for evaluation of anatomy and physiology and of the lower portion of the stomach, the duodenum, small intestine and a portion of the caecum Series of film are taken at intervals as the column of barium travels through the intestine until it reaches the caecum.

Study of small intestines only is small bowel series. If combined with upper GI series, it`s small bowel follow through.

Applied anatomy

Has 3 parts; duodenum, jejunum and ileum Duodenum is 1st part, shortest, widest and most fixed portion. Primarily in RUQ, also extends into LUQ where it joins the jejunum at duodenojejunal flexure. C-shaped. Internal lining of descending and horizontal portions have tight circular folds with numerous villi resulting in a `feathery` appearance when filled with barium.

Jejunum 2nd part, primarily located to the left of midline in LUQ and LLQ. Makes 2/5 of small intestines. Has circular folds as well.

Ileum, primarily in RUQ, RLQ and LLQ, is the longest portion (3/5 of small intestines). Terminal ileum joins large intestine at ileocecal valve in RLQ. Has no circular folds. Appear as smooth with fewer indentations hence less feathery.

Indications

• Abdominal pain(persistent)
• Diarrhea
• Anemia (?intestinal bleeding)
• Abdominal mass
• Mal-absorption syndrome
• Suspected diverticular(Mekels diverticulum )
• Inflammatory bowel disease..
• Investigations of transit time
• Suspected Partial obstruction

Suspected Strictures

Contraindications

• Complete bowel obstruction
• Perforation
• Obstruction(partial complete)
• Post operative
• Pregnancy
• Suspected perforation
• Suspected of tracheoesophageal fistula

Hypersensitive to barium

Equipment used

• 1.conventonal fluoroscopy
• Image intensifier
• Spot film device
• Television fluoroscopy

Fluoroscopic couch

Other accessories

• cassettes,
• Anatomical markers rt or lt.
• Foot rest
• Hand grips shoulder support

Lead aprons, gloves thyroid shield

Patient Preparation

• As per barium meal…
• Plain abdominal film look for
• Obstruction
• Megacolon
• Calcification

Bowel preparation

Contrast medium used

Dosage:E-z paque 100% W/V 300ml of low density usually in 10-15 min increments or 300ml at once.

Or 150 ml if performed immediately after barium meal.

Cold water is used in preparation of the suspension to stimulate gastric emptying and reduce transit time.

In children 3-4mil/kg is suitable volume Where barium is contraindicated non ionic water soluble contrast media have bee shown to be satisfactory alternative

Trolley set up

As for barium swallow…please make follow up at the department

Procedure/technique

• Barium follow through is a single contrast study

The aim is to deliver a single column of barium into small bowel This is archived by lying the patient on the rt side after barium has been ingested(metoclopramide is used to enhance gastric emptying) Time of ingestion of CM is noted

Position

Prone PA films of the abdomen are taken every 20 min during first hour, Until the barium reached to the terminal ileum, Prone position is used because the presure on the abdomen helps to separate loops of the small bowell Sport films of terminal ileum are taken supine a compression pad is used to displace any overlying loops of small bowel that are obscured by terminal ileum.

1st radiograph taken either 15min or 20min after ingestion of CM. It requires high centering to include diaphragm (stomach).

summary

• PA 30min, most Ba in stomach, duodenum and jejunum.
• PA 1hr, most Ba in jejunum.
• PA 2hrs, most barium in ileum and proximal colon.

Oblique, erect and trendelenburg positions may also be used

Other techniques

• Pneumocolon technique

Enteroclysis..read pliiz

Radiation Protection

As per previous study

Radiographic anatomy

NORMAL SMALL-BOWEL BARIUM STUDIES

Side check up

what comes to your mind when doing bmft

Transit time

Continuous column

Contour changes

After care

As per previous study

Questions

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