Barium follow through Small bowel series

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Barium follow throughSmall bowel series
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• Gross anatomy
• Small intestine consists of three portions
• Duodenum
• Jejunum
• Ileum
• Ileocecal valve

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Indications

• Pain
• Diarrhoea
• Bleeding
• Partial small bowel obstruction
• Weight loss
• Difficulty swallowing
• Vomiting
• Foreign bodies

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Indications

• Inflammation
• Malabsorption
• Coeliac disease
• Meckels diverticulum
• Food poisoning

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contraindications

• Large bowel obstruction
• Perforation

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Additional drugs

• Buscopan
• Glucagon
• Maxalon
• Sodium bicarbonate
• Laxatives

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Technique

• Usually started out as barium swallow and/or
  barium meal. However if there is to be a follow
  through then usually there is no administration
  of effervescent granules.
• PA or AP
• Patient preparation
• Laxative abdominal preparation 24 hours prior to
  study.
• Metaclopramide 20mg 20 mins prior to exam
• Or Maxalon
• Stops hiccups, and vomiting

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• There is generally no need for a radiographer in
  the room but if you must be in there,
  Radiographer should be in lead gown with thyroid
  protection.
• Patient should be undressed to underpants, with
  any removable artifact taken away, with gown on
  and opening at back.
• Generally no need for preliminary film.
• Patient is given a pre mixed barium mixture, and
  instructed to drink, the time is to be recorded
  (when the first cup was given).

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Anteroposterior

• Patient position
• Patient positioned supine with pillow under head.
• May turn head either side, try not to rotate
  body.
• Extend arms down and away from body
• Place lead shield over gonads.
• Central ray
• Direct central ray perpendicular to plane of film
  to enter midsagittal plane at level of iliac
  crests. (as per abdomen radiograph)
• Centre cassette to central ray (in bucky) and
  place appropriate time markers on film prior to
  exposure.

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• Additional notes
• For barium studies a kVp range from 100-120 is
  generally used or for water-soluble contrast
  80-90kVp is more acceptable.
• (water-soluble) dilution and absorption prevent
  demonstration of the point of obstruction.
• Image criteria
• Area of entire small intestine should be included
  on each and every radiograph.
• Time marker
• Abdomen should be demonstrated without rotation.
• Radiographs are usually obtained at 30 minute
  intervals after ingestion, until the contrast has
  reached the ileocecal valve.
• If the examination takes longer than 2 hours
  radiographs are taken hourly.

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Small intestine pathology

• Cancer (adenocarcinoma, adenoma)
• Atresia
• Crohns
• Leiomyosarcoma
• Myeloma
• Perforation
• Ulcer
• Coeliac