Page 31 - Radiology Book

rny gastric byPass ugi
1. Obtain digital scout lm of left upper quadrant.
2. In a standing lateral position, have the patient swallow one swallow
of water-soluble contrast and uoro the lateral pharynx. If there is no aspiration, place patient erect AP and have them drink a few swallows of contrast, centering over left upper quadrant. Watch for emptying and extravasation. Table spot image over pouch.
3. If possible, place patient supine. Obtain 3 to 4 digital spot images of the gastric pouch and Roux-limb in several obliquities. Do not magnify these images as most patients are so large that exposure time would be long and result in motion artifact.
4. Have technologist obtain a 10-minute lm of the upper abdomen to con rm contrast emptying into the distal jejunum, beyond where the Roux-limb courses through the transverse mesocolon.
These are not aesthetically pleasing studies because of body habitus, but they can usually answer the two clinical questions:
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1. Is there a leak? This usually occurs at the gastrojejunostomy anastomosis or the blind jejunal stump.
2. Is there obstruction? Usually at gastrojejunostomy, as the Roux-limb traverses the mesocolon, or at the jejunojejunostomy.
air contrast barium enema (acbe)
1. Patient should have received an overnight prep.
2. Start patient prone T-Berg (to facilitate ow).
3. Administer barium with gravity ow into the mid transverse colon.
4. Turn off the barium and insuf ate with air to advance the barium
across the transverse colon to the hepatic exure.
5. Turn the patient to the right decubitus position and then supine.
6. Con rm barium has reached the ascending colon and place patient
erect to allow barium to reach base of cecum.
7. Drain the barium.
8. Return the table to horizontal position. Clamp drainage tube and
insuf ate air.
9. Spot rectosigmoid supine, LPO, and left lateral as above in SCBE.
10. Maneuver the patient to assure good barium coating of the right
colon and adequate distention.
11. Place the patient erect and spot lm the rst splenic exure (RPO)
then the hepatic exure (LPO).
12. Lower table down and spot the cecum supine LPO.
13. If cecum is full of barium, place patient right side down and lower
table head down to drain cecum. Then with head still down return
to LPO and spot cecum as above.
14. Before leaving the room, check to make sure that the colon is well
distended with air.
GI Protocol