ABDOMINAL TRIPLE CONTRAST –CT-
INDICATIONS:
1. Mass/lesions
2. Intestinal fistula
3. Obstructions
CONTRAINDICATIONS:
1. Intake of metformin 24-72 hours ago
2. Allergies
3. Below/above normal lvl of creatinine
4. HX of colostomy (depends)
Before the procedure:
- Know the medical history of the pt (allergies and creatinine level result) (LMP for female pts)
- Sign consent form
Psychologic preparations:
- orient patient regarding the procedure
- elaborate about the barium
- Possible downsides(?)
Physiologic preparations:
- light non-fatty evening meal the night before the ct scan procedure
- Intake 2 dulcolax tablets 1 hour after evening meal
- No food intake 12 midnight onwards
- Insert 1 dulcolax suppository (60 cc for adult, 30 cc child *Barium enema RCE notes) at 5:00 in
the morning
- No breakfast allowed of any kind
- No smoking
***The patient should fast for 6-8 hours before the study.
- This ensures normal gallbladder and biliary tract dilatation and reduces the amount of bowel gas.
- A nonvisualized gallbladder is indicative of either gallbladder disease or the patient recently
eating. Therefore, it is essential to determine when a patient last ate.
- This reduces the amount of stomach and bowel gas anterior to the pancreas and ensures normal
gallbladder and biliary tract dilatation, which is significant because the pancreas and biliary tract
are interdependent systems.
- to distend the S.I. and stomach.
Materials for Barium enema:
a. Enema set
b. Forceps- for clumping
c. IV stand
d. Surgical/masking tape
e. KY jelly
METHODS:
1. ORAL: ingestion of 750 ml of water that is mixed with xenetics (contrast material) 30 minutes-1
hour before the procedure. The remaining 250 ml is again given during the actual exam.
*RCE notes (UGIS): POST DISTENTION PHASE.- Barium is allowed to go down-small/large
intestines to demo. normal propulsion of barium from small to large intestine. To demo. Entire
digestive system particularly the haustra of small intestine.
2. RECTAL
- Pt in sims position
- tip of catheter is lubricated and inserted to the rectum and anchored with surgical/masking
tape
- Patient is turned as required to even the coating of entire colon
*after 2 hours(?) (preference of radiologist and also depends on the peristalsis of the patient)
(peristalsis can cause the fluid to pass very quickly through the stomach and duodenum not
allowing enough time to fully evaluate the area of interest.)
*COLONIC NEWGROWTH (most common)
3. INTRAVENOUSLY: cm is introduced via venous system
BREATHING TECHNIQUE: Deep, held inspiration
PT POSITION: Supine
S: with burning epigastric pain, no N/V (nausea and vomiting), no chest pain, denies dyspnea, no febrile
episode
O: awake, alert, conversant, oriented, weak looking, not in respiratory distress
(+) pallor, no jaundice
AS (?), pale palpebral conjunctiva no NVE
SCWE, no retraction, no rales, no wheeze
AP, NRRR, no murmur
Abdomen is soft, nondistended, epigastric tenderness
No edema, weak pulses
(-) DM, CHF, CVD, CKD, IHD
(+) ALLERGIC TO PENICILLIN
PMH(?): anemia, arthritis, sciatica
WAB CT initial: multiple aneurysm from hepatic artery, splenic artery, celiac trunk, inferior
mesenteric artery; hepatic artery aneurysm compressing duodenum approximately 3.2 x 3 cm;
suspicious dissection at the right common iliac artery; aneurysm in the right internal iliac, left
internal iliac, left common iliac a ( a na may underline sa taas)(before) left external iliac, the
large aneurysm is the left internal iliac measuring 5.7 x 5.7 cm; mural thrombus formation on
the aneurysms; normal aorta
