Cleansing enema or bowel preparation for barium studies. This is particularly for patients undergoing barium studies of the lower gastrointestinal (GI) tract. There are many ways of bowel preparation according to the Radiologist such as:
Normal saline is the safest solution because it has same osmolarity as that in the surround the colon. Therefore it will not change the fluid in the body.
It is also well tolerated by infants and children because of the very little change in fluid and electrolyte balance.
DEFINITION OF BARIUM ENEMA
Barium Enema or also known as gastrointestinal examination (inner intestine) . It uses x-ray to produce image of the large intestine . The two kinds of barium enema examination which is separate contrast technique where barium sulphate is injected into the rectum to get more clear image of the large intestine and the second one is the double contrast technique which is also known as air contrast where the air will be injected to the rectum.
The process of barium enema may be performed for various reason. One of the reason is to assist in the diagnosis of large intestine or colorectal cancer, and inflammatory diseases. Detection of polyps which is a benign cancer cells that grow on surface tissue of the large intestine and rectum, diverticular is a sack that being pushed out from the intestine and changes of the large intestine also can be detected by the barium enema examination. Furthermore, the uses of double contrast technique is the best way to detect small tumors for example the polyps early inflammatory disease and bleeding caused by ulcer. Moreover, one of the importance of doing the barium enema examination process is regarding to the patient's history with respect to the changes of the patient's bowel habits including diarrhea, constipation and pain in the lower abdomen that results in the secretion of blood, pus, mucus in the patient feces. This examination is also recommended to be carried out every five to ten years to examine normal patients for the colon cancer which is the second most dangerous disease or tumors in the world that can cause death. However, patients who have close relatives who has the colon cancer or pre-cancer polyps are regarded as those which have a higher risk for the disease and they should be examined to detect any signs of abnormality in their colon.
PRECAUTION
The process of barium enema examination is the most efficient and effective examination to detect early signs that could lead to detection of other types of disease or in other words it helps in the diagnose process of the disease but it is not the only way to detect the early signs. In 1997, some studies show that a colonoscopy procedure which is a way to examine the interior of the colon and rectum using a flexible fibreoptic luminous, inserted through the anus that is carried out by specialist or more specifically known as an experienced gastroenterologists. Other than that, colonoscopy is a more accurate diagnosis technique for making early detection of cancer or polyps in the colon. So, if there is any signs of abnormality has been detected, the biopsy procedure will be carried out which is takes a piece of living tissue of an organ or part of the body for microscopic examination. Some physicians will use sigmodoscopy which is examination of the rectum and sigmoid colon using sigmoidoscope. It is used in the studies of diarrhea or rectal bleeding especially to detect coilitis or cancer at the rectum).
INDICATION
Appendicitis
Crohn disease
Colonic polyps
Diarrhea
Lower gastrointestinal bleeding
Ulcer
DESCRIPTION
To begin the process of barium enema, the patients will have to lay on the table top which is horizontal in position. The purpose of the table top being positioned horizontally is to take an abdomen x-rays. After the table top is being positioned to a different position, the rectal tube was smoothed using a lubricant and is inserted into the abdomen through the rectum at the anus. The rectal tube purpose is to help the medical assistant or any medical officer that was involved to enter the barium liquid slowly into the intestine. At the same time, while filling up the barium liquid into the abdomen, one of the assistant or medical officer have to give full observation because it is important to make sure the patient anal is shrink tight with the tube in the rectum to help maintain the position and prevent the barium from leaking. That step was taken to emphasize patient about how important the accuracy to prevent from leakage of barium. Rectal balloon may also be helpful to patients receiving barium. The table top then will be tilted or the patient will be changed to another position to assist in the filling of barium liquid process. After the barium liquid fills up in the intestine, the abdomen x-ray examination will be conducted to detect any abnormal activities within the intestine. One of the ways is after filling the barium into the intestine, the rectal tube will be removed as soon as possible and the patient has to take out the barium as much as they can. After the process is done, an additional x-ray examination will be conducted and followed by the double contrast enema. If the procedure is done quickly, a thin layer of barium enema may be generated and will be leaved in the intestine and air will be injected slowly to expand the lumen of the intestine. At a certain times, there is no x-ray examination will be conducted until the air is injected in.
PATIENT PREPARATION
To conduct the most accurate barium enema examination, patients must obey with all the diets that have been set and the instruction of bowel preparation with respect to the certain examination. Furthermore, this preparation will usually require some type of regulation, including prohibition of taking the products or anything else from dairy ingredients and liquid diet for a period of twenty four hours. The liquid diet means that the patient should be taking a large amounts of water or fluids that do not contains dairy ingredients as dairy drinking for the twelve to twenty four hours before the examination. So, patient's also been given laxatives and will be asked to carry out cleansing enema for themselves.
Patients will be covered thoroughly with robe, where the robe is covered with the table top that is horizontally positioned.
After the barium or air is injected into the intestine, the patient will experience pain through cramps or desire and urge to defecate.
Patient will be instructed to take and breath slowly and deeply by the patients mouth to reduce the pain.
CARE AFTER BARIUM ENEMA EXAMINATION
The patient is suggested to follow some steps as soon as possible after the barium enema examination, including:
Drink up as much water as possible in helping to counter the effects of dehydration from bowel preparation and the examination conducted.
Take time for resting. Barium enema and bowel preparation will usually be performed and it can cause the fatigue.
A cleansing enema procedure will be given to remove excess barium that is being left. Feces which is light in colour will be produced for a period of twenty-four hours to seventy-two hours depending on the examination.
DANGER THAT MAY OCCUR (RISK)
Although barium enema is considered as safe and harmless examination to the basic routine of human life, it can cause complications to some patient. These indications are suggested to be remembered before the barium enema examination performed:
Patients with high heart rate / speed, ulcerative colitis (intestine inflammation, symptoms usually is diarrhea), megacolon or a surgical hole in the bowel are prohibited to undergo barium enema examination.
Examination should be conducted with caution if the patient has a blocked intestine, ulcerative colitis, diverticulitis (diverticulum inflammation, often occur in one or more diverticula colon), or common bloody diarrhea .
Complications that may be caused by the examination including a hole in large intestine, water intoxication in the body, barium granulomas (inflamed a group of cells), and allergic. All of these reaction are rarely occur.
NORMALRESULT OF EXAMINATION
When patients undergo separate contrast enema which is single-contrast enema, their intestine filled up with barium to differentiate the normal colon. Result of normal examination shows that the arrangement of barium is arranged properly. After the barium fluid is taken out, the intestinal wall will collapse. Result of the normal x-ray will show lines of the normal intestine and can see the hairy surfaced of the colon. Result of normal double contrast enema examination develop intestine which was available with the thin surface of barium, but with the help of air that produces images of the mucosa more clearly. Different positions taken from the patient allows the barium fluid to collect images with the help of gravity of the intestinal wall.
ABNORMAL RESULT OF EXAMINATION
Barium enema allows abnormalities to show on the image of x-ray which can help in the diagnose of various types of different conditions. Although most colorectal cancer occurs in the rectosigmoid (the area around large intestine intersection between sigmoid colon and rectum) or upper rectum that merge with the sigmoid colon and it is better if it was detected by using a different method of examination which is called proctosigmoidoscopic, enema can detect the other early cancer signs. Identification of polyps , diverticulosis and immflamatory disease, for example, diverticulus and ulcerative colitis can be obtained by x-ray barium. Structural changes in the intestine, gastroenteritis (inflammation of gastric and intestine) and several cases of appendix can also be detected with the x-ray examination .
QUECTION AND ANSWER
Questions:
What is the complication that may happen?
Answers:
Barium enema is a safe examination. For some people that feels uneasy and have a bowel problems every day, barium that is left to dry and may cause constipations. If the patient drink / eat lots of fluids, vegetables and fruits, these problems are usually rare. A further complication is penetration of the large intestine and barium will enter the abdomen. Because the examination is performed under direct view (fluoroscopy) of Radiologist, problems like this are very rare and will be treated immediately. The intestine is provided with both recommend a minimum of gut contents would come out if there are 'leaks'. There is little radiation in this examination. Potential showed a positive reaction in this screening examination shows this is far from any risk.
Questions:
What is the precautions that should do after the barium enema examination?
Answers:
Patients may have diarrhea and are advised not to begin normal life activities or return to work the next day. If circumstances allow it, patients are encouraged to take plenty of fluids, eat lots of vegetables and fruits in order to defecate easily. If you see a bit of white / pink mixed in your stool, this is normal because the barium out through feces.
Questions:
Is knowledge of patients about barium enema is important?
Answers:
Given a good inventory is an important step in the process of barium enema, all patients should know some information about the reasons why, the need for tools and other knowledge about the cleansing treatment. X-ray specialist should explain more clearly about the procedures before starting the examination. Patients should be told that the barium enema can sometimes cause cramping and a barium enema recipients have a high desire for defecation is a normal. Some leakage of barium will occur and patients should not feel embarrassed if a situation like that is because it is a common thing, especially for older patients. Intensive care should be taken when inserting the enema tip surface of the rectum was available for irritated, due to the double movement of stools (bowel) during the preparation of the patient. Specialist x-rays or other medical specialists involved should be recorded on the history of the patients with glaucoma cases (the loss of vision caused by too much pressure in the eye) if the patient should receive glucagon injection. Patients should be fully protected at all times and patient care is taken when the patient is in a standing position because too many people who feel weak after undergoing bowel preparation.
