FLUORO

• Single-contrast barium: 

  • Depicts function and morphology

  • Less sensitive for inflammation (mucosa)

  • Preferred for patients w limited mobility and those w prior GI tract surgery

• Double-contrast barium: mucosa, structure and function

  • Indications:

    • Inflammatory conditions: esophagitis, gastritis, duodenitis

    • Structure issues: Strictures, hiatal hernia, neoplasms

    • Motility problems: Achalasia, delayed gastric emptying

  • Contraindications: concern for bowel perforation or SBO

  • Relative contraindications: aspiration risk, immobility, inability to safely perform necessary positioning/maneuvers

Preparations

• Barium sulfate:

  • Thin density 60% w/v

  • Thick density barium sulfate: 237% w/v (for dc studies)

  • Pros: low cost

  • Cons: can degrade subsequent CT

• Water-soluble iodinated contrast agent: perforation or leak

  • High-osmolarity contrast material

    • Pros: aspiration pneumonitis and fluid shift

  • Low osmolarity contrast agent

  • Cons: caution in those w hx of contrast agent sensitivity

• Effervescent gas crystals

  • Produces 400 mL CO2 to distend lumen for double contrast views

  • Cons: rarely causes patient discomfort

• 13 mm barium tablet or marshmellow

  • Used to delineate degree of esophageal narrowing, frozen or stale marshmallows are preferred bc they maintain their shape

  • Pros: low cost, dissolve easily (marshmallow > tablet)

  • Risk of aspiration

Patient hx from medical record:

• Medical record: exam indication, greatest clinical concern

• PMHx, PSHx, recent endoscopy and findings, review pertinent prior imaging

Patient hx from patient

• CC, duration, prior chest/abd surgery, prior imaging studies or endoscopy for sx? Difficulty swallowing liquids/solids/pills? Need help standing/moving on table?

• Patient fasting for 4 hours or overnight. 

General DONTS of GI:

• Don't use a rectal balloon in the following. Instead DRE and tape tube in place:

  • Known or suspected proctitis

  • UC

  • Rectal carcinoma

  • Low-rectal anastomoses or J pouches. 

• DONT perform barium enema when

  • Fulminant colitis or toxic megacolon is suspected

  • Free colonic perforation is suspected

• Dont give barium via mouth if colonic obstruction is suspected.

• Dont give gastrografin to patient with known or suspected aspiration or TE fistula. ALWAYS use omnipaque. 

• DONT give more than 1 bottle of gastrograffin orally

• Dont vigorously inflate the compression paddle on elderly patients 

• Dont begin a GI or GU procedure in a woman of childbearing age w/o inquiring about the possibility of pregnancy

• Dont do a fistula, sinus tract or extravasation study w/o a preliminary film. ALWAYS use hypaque, gastrograffin, or omnipaque. 

• Dont perform barium swallows on a patient w a gastric pull through in the supine position.