Thursday, May 07, 2015

What is the Barium Enema | Diseases and conditions: Medical tests.

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Barium enema

The enema is a diagnostic test that studies a possible pathology of the colon (large intestine) through X ray. To do so, is introduced by the rectum a barium compound called contrast that fills all the light of the colon. This contrast is opaque to x-rays, hence the name of barium enema, and allows to draw the entire surface of the colon and diagnose various diseases. Sometimes this test is also called barium enema.
There are two kinds of enema:

Simple enema

Also called "simple contrast", in which the colon is filled with contrast and draws possible pathologies that are in the light of the intestine.

Of double-contrast barium enema

The barium enema of "double-contrast", in which the colon is filled with contrast, but then allowed to leave, staying only a thin layer over the intestinal mucosa. Subsequently, the colon is filled with air, which provides images of the mucosa of the colon of better quality than that obtained with the simple enema. The enema double contrast is tolerated worse than the simple enema and takes more time, for this reason, sometimes the realization of the simple enema is preferred.

When doing a barium enema

The most common reasons that the realization of a barium enema may be requested are as follows:
Identify and monitor the evolution of diseases that involve intestinal inflammation such as Crohn's disease or ulcerative colitis.
Detect intestinal diverticula or narrowing lesions. Diverticula are small sacs that can be found in the intestinal wall, and occasionally become inflamed resulting in a diverticulitis.
Also used as a colon cancer screening test, although currently the realization of a colonoscopy for these purposes is often preferred.
In Chagas disease, a parasitic disease common in America, which can be attended with pathology of the esophagus or colon.
To study the cause of intestinal symptoms such as changes in the bowel, weight loss, or anemia that may be caused by chronic bleeding by the intestinal mucosa.
On rare occasions you can use as a treatment of a bowel disease that usually occurs in children called intussusception. Occurs when a part of the intestine is folded over itself, which can cause intestinal obstruction. The force exercised by the contrast on this crease can make it disappear curing disease.

Preparation for the enema

These are the issues that you must consider when you undergo a barium enema:
Duration: a simple enema is performed in about 30-45 minutes although barium is maintained within the intestine only about 10 - 15 minutes. The realization of an enema double contrast can take more than one hour.
Entry: the test can be done on an outpatient basis.
Is necessary to be accompanied?: do not need to be accompanied. However, sometimes it can be finished tired after the race, so it is recommended that someone take him home.
Drugs: for testing will need to clean the colon for 1-3 days before the procedure. They will give you instructions to do so by means of laxatives, which are administered orally or enemas. Diet to be followed during this period depends on the type of laxative that would provide. Generally we recommend a low residue diet, therefore, you should not eat foods such as potatoes, vegetables, fruits, or unfiltered juices during the three days prior to the test. These instructions may change according to the laxative to prepare the test. If after taking laxatives, stool are not liquid and clear can recommend you put a warm water enema, and repeat the enema every 30 to 60 minutes until clean water ejects. This enema is sometimes replaced with a suppository. In any case, you will be given a sheet of instructions that must be followed strictly.
Food: in general will alert you to see in fasting, but you must follow the instructions of your doctor in this sense.
Clothing: you can wear any clothes you want to but it should be easy to remove.
Documents: should be informed consent, which is a role where they explain you what is the test and its potential risks. You should read it carefully and take it signed. You must take the wheel of the test request.
Contraindications: It should not do an enema in the following cases:
  • In cases of diseases of the colon that can worsen if you perform an enema opaque, as for example a bowel obstruction, acute gastrointestinal bleeding, perforation of the colon, or a pathological dilation of the colon called toxic megacolon.
  • In pregnancy, because technique is done with x-rays, which may harm the fetus.
  • Allergy or intolerance to contrast or to the solutions that are given as a laxative.
  • Very debilitated people or that they can move properly during the scan.
  • Pathology of the year that would prevent the introduction of contrast.
  • People with a colostomy, i.e. when any pathology of the colon has been necessary to join the end of the colon to the abdominal wall.
Pregnancy and lactation: should be avoided in pregnancy, especially during the first quarter, because of the risk of radiation to the fetus. Breastfeeding in general is not a contraindication the test. The amount of contrast that can be excreted by the milk is very small, and the amount that the baby is absorbed by the intestine is less than 1% of what they eat. Therefore, the amount that can reach the baby is so small that he is not recommended in general stop breastfeeding. Solutions percutaneous to prepare the bowel is usually compatible with breastfeeding, although diarrhea may cause the infant. Always you should inform the physician of the possibility of pregnancy or if you are breast feeding, if you can postpone the test or replaced by another more secure. Those mothers who are concerned about the minimal risk that you may have about your child the test can avoid breastfeeding during the 24 hours following the completion of the procedure. During these 24 hours the mother can remove the milk through a pump and discard. Another option that you can choose, in anticipation of this period that won't be breastfeeding, is mother to remove the milk before the test and store enough to meet the needs of the child for 24 hours.

Other considerations

It should be noted the technician the possibility of having allergy to latex, because materials containing this substance during the procedure may be used.
It should be noted if you has made in recent days some other proof with contrast by mouth. In such a case, it would have to wait several days to completely remove this contrast to the test.

How the enema

Initially, it will instruct you to undress and put on a hospital gown. Be caught an IV if it is necessary to administer any medication. Lying on a stretcher back will take an x-ray of the abdomen. Then you will be asked you tipping aside and be introduced by year a well lubricated cannula where is will introduce him slowly contrast. The cannula can dispose of a small balloon at its end that swells to avoid that out the contrast. If you have discomfort you will be given painkillers intravenously. During the introduction of the contrast is recommended to breathe slowly and deeply to be relaxed. It is also recommended to do force with the year on the cannula. Above the table will have an x-ray tube called fluoroscope which take x-ray images of the procedure. These images will be visible by a similar to a television monitor.
During the test, you will be asked to change position several times so that the contrast is distributed throughout the entire colon. The stretcher can also be tilted slightly and a technician can be slightly tightened you abdomen to facilitate the movement of the contrast.
Imaging with contrast in the colon normally lasts about 10-15 minutes. Subsequently, you be removed cannula and let out the contrast, which will provide you a wedge or allow you to go to the bathroom. Another x-ray is usually taken after the evacuation. If performed you the double-contrast technique, they can introduce air later and taken new images.
Unless indicate you otherwise, after the test you can return to eat and drink normally. It is recommended to drink plenty of fluids to recover losses by laxatives taken to prepare for the test. You can see that depositions are white or pink for 1 or 2 days after the race.

Complications of the barium enema

The enema is a very safe test. Many patients referred to the most annoying thing is taking laxatives to clean the bowel. Sometimes you can see some intestinal discomfort as "cramping" due to the contrast, but they tend to be mild. Anal discomforts with the cannula may also have. These discomforts may be relieved by taking bath seat, or with the administration of an anesthetic solution after the procedure. During the test you can feel embarrassed by the procedure. There is no reason to do so. They are used to perform this test, doctors and technicians will try to be as comfortable as possible.
It is extremely rare that the procedure may cause serious complications. Sometimes, the contrast medium hardens in the colon and causes constipation or even, on rare occasions, an intestinal obstruction. So you should drink plenty of fluids and, if necessary, is you can put an enema or take some light laxative after the test. Sometimes, the contrast can irritate and inflame the lining of the colon on a temporary basis. The more serious and more uncommon complication is the perforation of the intestine by the pressure exerted by the contrast. This complication requires immediate surgery.
You should contact your doctor if after the test Note bleeding by the year, important constipation, abdominal pain, fever or any other symptoms that worry you.

Results of the barium enema

The images obtained during the test can be seen immediately. However, their interpretation requires much expertise and is carried out by medical radiologists. This specialist will make a written report that will give you a few days of the test along with the radiographic images obtained.
In the report, the radiologist will inform found finds. Maybe it relates that the intestine is not well prepared, or that there are parts of the colon that has not been filled with contrast. In this case it indicates that the results may have limitations. The findings that are most frequently are narrowness of the intestine, polyps or masses in the mucosa of the colon, sacs in your wall (diverticula), signs suggestive of intestinal inflammation, or suggestive signs of pathology of the motility of the colon (e.g. typical of Chagas disease). In the event that the barium enema is used to treat an intussusception in children indicate the success of the procedure.
The doctor has asked the test will give you the results and will instruct you if it is necessary to other complementary examinations or to follow any treatment. It is especially important to take account of the discovery of masses or narrowness in the colon that may suggest the presence of a cancer. In this case, is usually to indicate the completion of a colonoscopy to take samples and confirm or rule out this diagnosis.
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