Barium Enema

Barium Enema is a topic covered in the Davis's Lab & Diagnostic Tests.

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Synonym/Acronym:
Air-contrast barium enema, double-contrast barium enema, lower GI series, BE.

Rationale
To assist in diagnosing bowel disease in the colon such as tumors and polyps.

Patient Preparation
Instruct the patient to eat a low-residue diet for several days before the procedure and consume only clear liquids during the 24 hr before the procedure, including the evening before the test. There are no activity restrictions unless by medical direction. Instruct the patient to fast and restrict fluids for 8 hr, or as ordered, prior to the procedure. Fasting may be ordered as a precaution against aspiration related to possible nausea and vomiting. The American Society of Anesthesiologists has fasting guidelines for risk levels according to patient status. More information can be located at www.asahq.org.

Note: If iodinated contrast medium is scheduled to be used in patients receiving metformin or drugs containing metformin for type 2 diabetes, the drug may be discontinued on the day of the test and continue to be withheld for 48 hr after the test.

Regarding the patient's risk for bleeding, the patient should be instructed to avoid taking natural products and medications with known anticoagulant, antiplatelet, or thrombolytic properties or to reduce dosage, as ordered, prior to the procedure. Number of days to withhold medication is dependent on the type of anticoagulant. Note the last time and dose of medication taken. Protocols may vary among facilities.

Inform the patient that a laxative and cleansing enema may be needed the day before the procedure, with cleansing enemas on the morning of the procedure, depending on the institution's policy. Patients with a colostomy will be ordered special preparations and colostomy irrigation.

If studies involving the entire digestive tract are required (e.g., upper GI or barium swallow), verify that the barium enema is performed first to avoid retention in the abdomen of residual barium from the swallow study, which may obscure details of interest.


Pediatric Preps
2 years or youngerClear liquid diet 24 hr prior to the procedure; a pediatric Fleet enema (a half or whole suppository [glycerin or bisacodyl (Dulcolax)] may be ordered instead of the enema) on the evening before and morning of the procedure up to 3 hr prior to the procedure; NPO for 4 hr before procedure
3–16 years
  • Low-residue diet for 48 hr prior to procedure
  • Clear liquid diet for 24 hr prior to procedure; castor oil or Neoloid, a flavored castor oil, may be ordered the night before the procedure; dose is based on either weight or age—for castor oil, 26–80 lb, give 1 oz, 81 lb or greater, give 2 oz; for Neoloid, 2–5 yr give 2 teaspoons (9.9 mL), 6–8 yr give 1 tablespoon (14.8 mL), 8–18 yr give 2 tablespoons (29.6 mL)—or bisacodyl oral tablet may be substituted based on age (3–8 yr give 1 tablet, 9 yr and older give 2 tablets)
  • Fleet enemas, until fecal return is clear, up to 3 hr prior to procedure
  • NPO for 4 hr prior to procedure

Normal Findings

  • Normal size, filling, shape, position, and motility of the colon
  • Normal filling of the appendix and terminal ileum.

Critical Findings and Potential Interventions
N/A

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Synonym/Acronym:
Air-contrast barium enema, double-contrast barium enema, lower GI series, BE.

Rationale
To assist in diagnosing bowel disease in the colon such as tumors and polyps.

Patient Preparation
Instruct the patient to eat a low-residue diet for several days before the procedure and consume only clear liquids during the 24 hr before the procedure, including the evening before the test. There are no activity restrictions unless by medical direction. Instruct the patient to fast and restrict fluids for 8 hr, or as ordered, prior to the procedure. Fasting may be ordered as a precaution against aspiration related to possible nausea and vomiting. The American Society of Anesthesiologists has fasting guidelines for risk levels according to patient status. More information can be located at www.asahq.org.

Note: If iodinated contrast medium is scheduled to be used in patients receiving metformin or drugs containing metformin for type 2 diabetes, the drug may be discontinued on the day of the test and continue to be withheld for 48 hr after the test.

Regarding the patient's risk for bleeding, the patient should be instructed to avoid taking natural products and medications with known anticoagulant, antiplatelet, or thrombolytic properties or to reduce dosage, as ordered, prior to the procedure. Number of days to withhold medication is dependent on the type of anticoagulant. Note the last time and dose of medication taken. Protocols may vary among facilities.

Inform the patient that a laxative and cleansing enema may be needed the day before the procedure, with cleansing enemas on the morning of the procedure, depending on the institution's policy. Patients with a colostomy will be ordered special preparations and colostomy irrigation.

If studies involving the entire digestive tract are required (e.g., upper GI or barium swallow), verify that the barium enema is performed first to avoid retention in the abdomen of residual barium from the swallow study, which may obscure details of interest.


Pediatric Preps
2 years or youngerClear liquid diet 24 hr prior to the procedure; a pediatric Fleet enema (a half or whole suppository [glycerin or bisacodyl (Dulcolax)] may be ordered instead of the enema) on the evening before and morning of the procedure up to 3 hr prior to the procedure; NPO for 4 hr before procedure
3–16 years
  • Low-residue diet for 48 hr prior to procedure
  • Clear liquid diet for 24 hr prior to procedure; castor oil or Neoloid, a flavored castor oil, may be ordered the night before the procedure; dose is based on either weight or age—for castor oil, 26–80 lb, give 1 oz, 81 lb or greater, give 2 oz; for Neoloid, 2–5 yr give 2 teaspoons (9.9 mL), 6–8 yr give 1 tablespoon (14.8 mL), 8–18 yr give 2 tablespoons (29.6 mL)—or bisacodyl oral tablet may be substituted based on age (3–8 yr give 1 tablet, 9 yr and older give 2 tablets)
  • Fleet enemas, until fecal return is clear, up to 3 hr prior to procedure
  • NPO for 4 hr prior to procedure

Normal Findings

  • Normal size, filling, shape, position, and motility of the colon
  • Normal filling of the appendix and terminal ileum.

Critical Findings and Potential Interventions
N/A

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