1
Q
what anatomy does barium/ contrast swallow see
A
esophagus
2
Q
indication for barium swallow
A
- dysphagia
- anemia
- pain (during swallow)
3
Q
contraindication for barium swallow
A
- GIT perforation
- intravasation
- constipation
4
Q
2 types of contraindications
A
absolute contraindication
relative contraindication
5
Q
when is contrast swallow used instead of barium swallow
A
when barium swallow is contraindicated
6
Q
most common iodinated contrast for contrast swallow
A
gastrografin
7
Q
characteristics of barium swallow contrast
A
- barium sulfate
- most common oral contrast agent for GIT studies
- resembles a milk shake appearance
- available in various flavours, prepared by mixing with water
8
Q
characteristics of contrast swallow contrast
A
- HOCM (gastrografin: yellowish, water-based solution mixed with iodine; bitter)
- any non-ionic iodinated contrast LOCM (eg Iopamiro)
9
Q
rank of choices for esophageal contrast
A
- barium
- HOCM
- LOCM
10
Q
indication for contrast swallow
A
- suspected lower GIT perforations
- short period after operation
- acute hemorrhage
- gastro-colic fistula
- localisation of FB or tumour before endoscopy
- acute condition which may require immediate surgery
11
Q
contraindications for gastrografin swallow
A
- any GI studies of infant: risk of dehydration (HOCM)
- tracheoesophageal fistula: pulmonary edema
12
Q
advantages of barium sulphate
A
- inert
- better coating properties
- low cost
13
Q
single or double contrast for swallow study
A
single contrast
14
Q
what are the possible single contrast media used for swallow study
A
- barium (E-Z-HD)
- gastrografin/ ioparimo/ omnipaque
15
Q
how much water to add to barium sulfate to make a thicker suspesion
A
50ml
16
Q
how much water to add to barium sulfate to make a thinner suspesion
A
65ml
17
Q
advantages of thick barium
A
- better coating power
- assist passage as a bolus to distend the tract better
18
Q
disadvantages of thick barium
A
- may mask fine lesions
- may have some residue barium stick onto the wall of the tract
19
Q
how is swallow study procedure done
A
- patient in upright position
- feed CM to patient
- hold a mouthful of barium until immediately before exposure for the demonstration of deglutition
4.
a) swallow the contrast in bolus during normal breathing
b) swallow several mouthfuls of barium in rapid successions
20
Q
what is the after care of barium swallow
A
- white fecal matter for a few days
- advised to drink adequate volumes of water
21
Q
what is VFSS
A
- stimulate habitual swallowing behaviours in patients with signs and symptoms of dysphagia
22
Q
limitation of VFSS
A
- time constraints due to radiation dose
- procedure only samples swallow function, it does not fully represent mealtime function
- barium increases viscosity and alter liquid and solid food composition and are not natural food - resulting in disordance between the result of VFSS and real meal
- limited ability to evaluate fatigue effect on swallowing
- barium is an unnatural food bolus with potential refusal by patient
23
Q
indication of VFSS
A
- assess integrity of airway protection
- assess effectiveness of different postures, manoeuvres, bolus modifications, different viscosity of food to improve swallow
24
Q
contraindication of VFSS
A
- medically unstable or uncooperative patients
- when the information obtained from the study is unlikely to change the patient’s management
- patient is unable to be adequately positioned
25
VFSS patient positioning
- imaging chair is primarily used, patient to be in true lateral position
- side-lying only for patients with medical conditions and cannot sit upright
26
order of contrast mixed with substrate given to patient for VFSS
thick fluid > solid food > thin fluid
27
after care for VFSS procedure
generally none except:
- CXR if aspiration suspected
- physio to do percussion
28
what is the function of barium meal
- peristalsis
- ? pyloric stenosis
29
what is the pre procedure preparation for barium meal study
- NPO for 8 hours before exam
- no smoking and chewing gums
30
what are the contrast used for barium meal
EZHD and baros
31
when is single contrast used in barium meal study
- infants/ children
- very ill adults
32
what is the radiographer's main responsibility in barium meal study
- assist patient in achieving different postures
33
what are the projections taken for a barium meal study
supine: PA, RAO, LAO
34
when patient is in RAO undercouch position for a barium meal study, where would the residue barium collection be
fundus
35
when patient is in LAO undercouch position for a barium meal study, where would the residue barium collection be
split into 2 - fundus and pylorus
36
what is the after care for a barium meal study
- encourage fluid intake
- stool may become white in colour
- patient must not leave dpt until any blurring of vision caused by Buscopan has resolved
36
what is the after care for a barium meal study
- encourage fluid intake
- stool may become white in colour
- patient must not leave dpt until any blurring of vision caused by Buscopan has resolved
37
pre preparation for FT
- low residue diet for 2 days before exam
- NPO for 8 hours before exam
38
FT after care
- patient should be warned of white fecal matter
- patient should be advised to drink adequate volumes of water
- laxatives may be provided
39
patient preparation for SBE
- low residue diet for 2 days before exam
- NPO 8 hours
- pharynx anesthesized with Xylocaine spray
40
instrument used in SBE
bilbao-dotter tube with guidewire or silk tube
41
what preliminary film is needed for SBE
supine abdomen
42
after care of SBE
- NIL orally for 5hrs post procedure
- pt warned that diarrhea may occur
43
preparation of patient for barium enema
- low residue diet 3 days prior
- fluid intake and laxative on the day prior to exam
44
contraindication for buscopan
- glaucoma
- gravis
- pyloric stenosis
- benign prostate hypertrophy
45
contraindication of glucagon
- pheochromocytoma
- insulinoma
46
after care of barium enema
- stool might be white for a few days
- drink more water
- cannot leave dpt until blurring of vision resolves
47
complication for barium enema
- perforations
- obstruction
- intramural barium
- cardiac arrhythmia
- transient bacteraemia
- side effects of pharmacological agents used
48
what are the things to look out for in a barium/contrast swallow study
- size and location of esophagus
- shape and patency
- function
49
how is barium contrast prepared for barium meal and FT
EZ HD + 65ml warm water
50
how is barium contrast prepared for barium swallow
EZ HD + 50ml
51
Contrast used for VFSS
EZ-paque:
- EZ-HD thick (+52ml warm water)
- EZ-HD thin (+100ml warm water)
EZ paste
thicken up powder
52
what medical conditions will allow patients to do VFSS in a side lying position
- low BP
- acute stroke
- spinal cord injury bracing
- other skeletal limitations
53
Advantages of SBE over FT
- can avoid the obscuring of small bowel by the Barium filled upper GI tract
- can avoid pyloric control over rate of barium transit
54
why is low residue diet necessary
to prevent gas formation from excessive fermentation of intestinal contents
55
advantages of buscopan
- immediate action
- short duration (~15 mins)
- cheap
56
side effect of buscopan
- vision blur
- dry mouth
- tachycardia
- urinary retention
- acute gastric dilatation
57
advantages of glucagon
- more potent
- short duration
- not interefere with bowel transit time
58
side effect of glucagon
- longer waiting time (~1min)
- cost
Fluoro and angio
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