Procedures

/ Procedures

Procedures we use at Rocky Mountain Pediatric Gastroenterology

Barium Enema (Barium X-Ray; Lower GI Series)

Definition

A barium enema is a rectal infusion of barium given to coat the lining of the colon and rectum. It is done before x-rays are taken in order to create better x-ray images of the lower intestine. Barium is a milky fluid that absorbs x-rays.

Parts of the Body Involved

Colon and rectum.

Reasons for Procedure

A barium enema is done to enhance x-ray images. X-rays are taken of the colon and/or rectum to look for the following:

Abnormal growths, such as polyps or cancers

Ulcers

Diverticula (small pouches protruding through the wall of the colon)

Thickening of the lining of the colon or rectum

For pediatric patients, an unprepped barium enema can be done to screen for Hirschsprung's Disease.

Risk Factors for Complications during the Procedure

Allergy to the latex balloon on the tip of enema tube (rare).

Severe rectal inflammation. Patients with active colitis should not have a barium enema.

Pregnancy. X-rays of the abdomen and pelvis should usually not be done during pregnancy.

What to Expect

Prior to Procedure:
Your intestines must be empty before this test. Therefore, the day before your test, do the following:

Eat a clear liquid diet

Take laxatives

Take warm water enemas

Do not eat or drink anything after midnight

For pediatric patients, your doctor may order an unprepped barium enema. This means your intestines do not need to be empty and laxatives are unnecessary.

During Procedure:

You can expect to put on a hospital gown and lie on an x-ray table.

The room will be darkened during the test.

You will hold your breath when x-ray pictures are taken.

You will change positions.

The x-ray table will be tilted to different positions.

Anesthesia:
Usually none. In some cases, you may be given an injection to relax the rectum.

Description of the Procedure:
A well-lubricated enema tube is gently inserted into the rectum. Barium is injected through this tube into the colon and rectum. A small balloon at the end of the tube is inflated to keep the barium inside. X-rays are taken. After x-rays are taken, the enema tube is removed, and you are shown to the bathroom to expel the barium.

For a double air contrast examination:
After expelling the barium, the enema tube is reinserted. A small amount of air is injected into the colon, and more x-rays are taken. The tube is removed. You are again shown to the bathroom to expel air and any remaining barium.

After Procedure:

You will be shown to the bathroom to pass the barium, and you may be given a laxative to help.

You will likely feel some mild to moderate abdominal cramping, which may require you to wait awhile before driving home.

How Long Will It Take?
1-2 hours

Will It Hurt?
You may feel some discomfort when the enema tube is inserted. During the test, you may feel some discomfort, including bloating and severe cramping. You may also feel as if you need to move your bowels.

Possible Complications:

Inflammation of the lining of the rectum due to an allergic reaction to latex balloon

Perforated rectum or colon (serious, but rare)

Fetal malformation, if done during pregnancy

Average Hospital Stay
None

Postoperative Care:

You can return to your regular diet immediately following the test.

You can return to regular activities immediately following test (or as soon as you feel able).

You should drink lots of fluids because barium can cause dehydration.

You may be given laxatives to help pass barium, which can cause constipation.

Your stool may appear white or gray for 2-3 days after the test, due to the barium.

Outcome

A radiologist will examine the x-rays. (In rare cases, if the x-rays are blurred, the test may have to be repeated.) Usually within a few days, your doctor will tell you the results. If results are abnormal, your doctor will recommend follow-up testing and treatment options.

Call Your Doctor If Any of the Following Occurs

Severe pain

Your doctor does not call with the results within 3-5 days

Capsule Endoscopy

Click Here to learn more about Capsule Endoscopy.

Colonoscopy

Definition

Visual exam of the lining of the large intestine, also called the bowel or colon, with a colonoscope. A colonoscope is a flexible tube with a light and a viewing device. It allows the doctor to view the inside of the colon through a tiny video camera.

Parts of the Body Involved

Large intestine (colon), rectum

Reasons for Procedure

Colonoscopy is performed to visualize, diagnose, and sometimes treat problems inside the large intestine. The procedure is most often recommended for the following reasons:

To locate the source of lower intestinal bleeding

To diagnose changes in bowel habits

To determine the cause of lower abdominal pain

To detect early signs of colon cancers or pre-cancers (polyps) in individuals without symptoms but who are at increased risk for these conditions

To obtain tissue samples for testing

To remove a polyp (an abnormal growth on the inside lining of the intestine)

To stop intestinal bleeding

Risk Factors for Complications during the Procedure

Active colitis, diverticulitis, or other acute bowel disease

Previous treatment with radiation therapy

Treatment with certain medications, including aspirin and other drugs with blood-thinning properties

What to Expect Prior to Procedure:
Your doctor will likely do the following:

Physical exam

Health history

Review of medications

Test to check for hidden blood, called "occult blood"

In the days leading up to your procedure:

Your colon must be completely cleaned out before the procedure. Any stool left in the colon will block the doctor's view and limit the procedure's success. A number of cleansing methods may be used, including enemas, laxatives, and a clear-liquid diet. You may be asked to drink a large container of solution that aids in the complete emptying of the colon. This preparation may start several days before the procedure.

Do not take bulk-forming laxatives or iron-containing medications or supplements for one week before the procedure, unless told otherwise by your doctor.

Do not take aspirin or other anti-inflammatory or blood-thinning drugs for one week before the procedure, unless told otherwise by your doctor.

Do not eat or drink anything for 8 to 10 hours before the procedure.

If you have insulin-dependent diabetes, ask your doctor about any adjustments to your insulin dose.

Arrange for a ride to and from the procedure.

Anesthesia:
General anesthesia will be given by a Pediatric Anesthesiologist during the procedure. This ensures no discomfort during the procedure for our pediatric patients.

Description of the Procedure:
Pediatric patients
are generally positioned on their back with the knees brought up in a frog-legged position. Biopsies in pediatric patients can identify inflammation, possible allergies and can diagnose conditions such as bleeding polyps and inflammatory bowel disease.

After Procedure:
Laboratory exam of removed fluid or tissue

How Long Will It Take?
The colonoscopy takes less than one hour. Expect to stay at the hospital or doctor's office for another hour or two or until the sedative wears off. Because of the anesthesia used, it is a good idea to have someone drive you home from the procedure.

Will It Hurt?
There is no discomfort during the procedure since general anesthesia is used for pediatric patients.

Possible Complications:

Bleeding

Perforation or puncture of the bowel

Average Hospital Stay
None

Postoperative Care:

Do not drive for at least eight hours

Rest for the remainder of the day

Feelings of bloating, gas, or cramping may persist for 24 hours

Resume medications as instructed by your doctor

Resume your normal diet, unless told otherwise by your doctor

Outcome
The doctor will usually give you a preliminary report after the medication wears off and you are more alert. The results from a biopsy can take as long as one to two weeks to be completed, so schedule follow-up with GI doctor to review results and develop treatment plan.

Call Your Doctor If Any of the Following Occurs

Signs of infection, including fever and chills

Bleeding; notify the doctor if you pass a teaspoon or more of blood

Black, tarry stools

Severe abdominal pain

Coughing, shortness of breath, chest pain, severe nausea or vomiting

CT Scan of the Abdomen (Abdominal CT)

Definition
An x-ray scan that uses a computer to produce cross-sectional images of the abdomen.

Parts of the Body Involved
Abdomen

Reasons for Procedure
A CT scan is done to study the organs and vascular system within the abdomen for signs of injuries, tumors, or other disease.
Your doctor may recommend an abdominal CT if you have the following symptoms:

Pain

Bowel changes

Blood in the urine or stool

Urinary difficulties

Jaundice

Weight loss

Unexplained fever

Abdominal injury

Fluid accumulation in the abdomen

Many conditions and diseases can be diagnosed with an abdominal CT. These include:

Tumors and cysts

Spread of cancer form another location (metastases)

Aortic aneurysm

Gall bladder disease, including gallstones

Pancreatitis

Abscess

Kidney stones

Kidney disease

Bleeding in the abdomen

Liver disease

Risk Factors for Complications During the Procedure
None

What to Expect

Prior to Procedure:
Depending on which tissues your doctor wants to examine, you may be given a contrast dye. If this is the case, do not eat or drink anything for 4 hours before your exam.

You'll remove your clothes and put on a hospital gown. You'll also need to remove all metal-containing items, including jewelry and watches.

During Procedure:
If a contrast dye is needed, it is either injected into a vein, or you will drink it in the form of a barium solution. You'll be positioned on a special movable table, called a gantry, part-way inside the CT scanner, which is usually donut-shaped.

Anesthesia:
None

Description of the Procedure:
The gantry advances you very slowly through the CT scanner. You'll need to be very still during the entire test. As the scanner takes pictures, you'll hear some humming and clicking. The technician will ask you to hold your breath at certain points, so that the picture is not blurred by movement. You are able to talk to the technician and/or doctor during the exam, so if you are in pain, frightened, or concerned in any way, you can communicate this immediately.

After Procedure:
If you've received contrast dye, drink extra fluids to more quickly flush it out of your body.

How Long Will It Take?
10-60 minutes, depending on how much area must be scanned and how much detail is required.

Will It Hurt?
The scan itself will not hurt, although you may feel restless. When you receive an injection of contrast dye, you may feel flushed, and you may notice a salty or metallic taste in your mouth. Some people experience brief nausea as the dye circulates.

Possible Complications:
Allergic or anaphylactic response to contrast dye

Average Hospital Stay
None

Postoperative Care:
None

Outcome
A radiologist analyzes and interprets the images created by the CT Scan and sends a report to your doctor. Be sure to make a follow-up appointment with you GI doctor to review the results and determine your child's treatment plan.

Call Your Doctor If Any of the Following Occurs

You have had contrast dye and notice:

Hives

Itching

Nausea

Swollen, itchy eyes

Tightness of throat

Difficulty breathing

Diagnostic Ultrasound of the Abdomen (Sonogram)

Definition

Examination of the internal organs in the abdomen using high-frequency sound waves. If a Doppler ultrasound is done, the doctor is able to see blood flow in major blood vessels.

Parts of the Body Involved

An abdominal ultrasound can examine the following:

Abdomen

Liver

Spleen

Pancreas

Gallbladder

Kidneys

Ovaries and uterus (including pregnant uterus and fetus within)

Aorta and other abdominal arteries (via Doppler ultrasound)

Reasons for Procedure

Ultrasound produces real-time images of soft tissue and can capture movement of internal organs. Therefore, it is used to visualize and diagnose problems inside the abdominal cavity. A diagnostic ultrasound is most often performed for the following reasons:

To diagnose an injury or disease of the liver, gallbladder, spleen, pancreas, kidneys, or other organs inside the abdomen

To help determine the cause of abdominal pain

To identify gallbladder or kidney stones

To assess for tumors, cysts, abscesses, or other masses in the abdomen

To help determine why an internal organ is enlarged

To examine a pregnant uterus and the fetus within

To evaluate the aorta for the presence of an aneurysm

To evaluate narrowing of the arteries in the abdomen

To assess a spleen injury

To evaluate liver disease or pancreatitis

To locate a foreign object in the abdomen, such as a bullet

Risk Factors for Complications during the Procedure

Both obesity and dehydration can make it more difficult to identify organs during the test

Air in the intestines may block views of the internal organs

The presence of barium or other contrast materials in the intestine can block views of the internal organs (therefore, abdominal ultrasound should be done before other diagnostic imaging tests that require contrast material)

What to Expect

Prior to Procedure:
Your doctor will likely do the following:

Physical exam

Sometimes, blood tests and other tests

When making the appointment, ask about dietary instructions. You may be asked to fast for 8-12 hours before the test to decrease the amount of gas in the intestines. For some types of ultrasound, a full bladder helps visualization. In these cases, you will be asked to drink six or more glasses of water, and not to urinate before the scan.

Wear comfortable, loose-fitting clothing

During Procedure:
Lie still on a flat table in a darkened room. The darkness helps the technician see images on the screen.

Anesthesia:
None

Description of the Procedure:
The technician applies a conductive gel to the abdomen, and presses a transducer against the skin. This is a small, hand-held device that converts energy from one form to another. The gel helps transmit sound waves between the skin and the transducer, because these waves cannot travel through air.
The transducer sends high-frequency sound waves toward the internal organs, which reflect the sound waves back to the skin. The transducer receives these sound waves and converts them into electrical impulses that become a visible image on the echocardiography machine.
The technician watches the images as they appear on the machine's screen. The technician can capture a still image or videotape moving images for review at a later time. To obtain clearer and more complete images, the technician may move the transducer to different places on the abdomen. You may be asked to change positions or hold your breath during the exam.

After Procedure:
Clean gel off the abdomen.

How Long Will It Take?
About 30 minutes.

Will It Hurt?
No. An ultrasound is not invasive and not painful. The gel may feel cold when it is first applied, and holding the transducer tightly against the skin produces a sensation of pressure and in some cases discomfort. For instance, pressure on a full bladder feels uncomfortable.

Possible Complications:
None

Average Hospital Stay
None

Postoperative Care:

Clean the gel off your skin

Resume normal activities unless directed otherwise by the doctor

Outcome
A radiologist analyzes and interprets the images created by the ultrasound and gives a report to your doctor. Your doctor will make recommendations for treatment based on this report.

Call Your Doctor If Any of the Following Occurs

Your symptoms become worse

Endoscopy
ERCP (Endoscopic Retrograde Cholangiopancreatography)

Click Here to learn more about ERCP.

Flexible Sigmoidoscopy

Definition

A visual exam of the rectum and the lower portion of the colon, called the sigmoid colon, with an instrument called a flexible sigmoidoscope. This instrument shines light and allows the doctor to view the inside of the intestine (bowel) through a tiny video camera. Sigmoidoscopy can also be used to obtain tissue samples for testing.

Parts of the Body Involved

Sigmoid colon, rectum

Reasons for Procedure

Flexible sigmoidoscopy is used to examine and diagnose problems inside the rectum and the sigmoid colon. The procedure is most often performed for the following reasons:

Screen for colorectal cancer. This is recommended every 3-5 years for all people over 50, and earlier and more frequently for people with a family history of colon cancer or certain bowel diseases (such as intestinal polyps, Crohn's disease, or ulcerative colitis)

Obtain a tissue sample for biopsy

Identify the source of rectal bleeding, diarrhea, constipation, pain, or inflammation

Detect the presence of polyps (small growths than can turn cancerous)

Monitor response to treatment in patients with inflammatory bowel disease

Pediatric patients - identify causes of rectal bleeding such as internal fissures, polyps, and allergic colitis

Risk Factors for Complications during the Procedure

Pre-existing severe heart or kidney condition

Treatment with certain medications, including aspirin and other drugs with anti-coagulant or "blood-thinning" properties

Patient is unable to cooperate

Acute, severe abdominal pain due to a bowel perforation or another serious, acute intestinal condition

Prior abdominal surgery or radiation treatments

What to Expect

Prior to Procedure:
Your doctor will likely do the following:

Physical and rectal exam

Health history

Evaluation of all medications taken

Test to check for hidden blood in your stool called "occult blood"

In the days leading up to your procedure:

Your lower intestine must be completely cleaned out before the procedure. Any stool left in the intestine will block the doctor's view. This preparation may start several days before the procedure. Follow your doctor's instructions, which may include any of the following cleansing methods:

Enemas - fluid introduced into the rectum to stimulate a bowel movement

Laxatives

A clear-liquid diet

Oral cathartic medications - a large container of fluid to drink, which stimulates a bowel movement

Ask when making the appointment about any medication restrictions; you may need to stop taking anti-inflammatory and blood thinning medications, including aspirin and ibuprofen, 7-10 days before the procedure

You may also need to stop taking iron supplements or vitamins containing iron

The night before, eat a light meal and do not eat or drink anything after midnight

Wear comfortable clothing

During Procedure:
You'll be positioned either on your left side with knees bent and drawn up toward your chest, on your back with your feet in stirrups (as for a pelvic examination), or on a special table. Try to relax and breathe slowly and deeply.

Anesthesia:
For pediatric patients, the decision to use anesthesia is made on an individual case basis. Discuss this with your doctor.

Description of the Procedure:
The doctor first performs a digital rectal exam. Then the doctor slowly inserts the lubricated sigmoidoscope, which is about the thickness of a human finger, through the rectum and into the colon. The scope injects air into the colon to widen the passage. The doctor guides the instrument through the lower colon and examines the lining, looking for any abnormalities. A small video camera in the sigmoidoscope lets the doctor view an image of the colon's lining and rectum. A tissue sample and/or intestinal polyps may be removed and analyzed.

After Procedure:
Laboratory exam of removed tissue.

How Long Will It Take?
20 - 30 minutes

Will It Hurt?
Most patients report some discomfort when the instrument is inserted, as well as cramping, muscle spasms, or lower abdominal pain during the procedure. You may also feel the urge to move your bowels. Tell the doctor if you experience severe pain.

After the procedure, gas pains and cramping are common, but should subside with the passing of gas.

Possible Complications:

Bleeding

Perforation or puncture of the bowel

Patients with pre-existing heart murmurs or known heart valve disease may be susceptible to infection after this examination, and may be given antibiotics to prevent this

Average Hospital Stay
None

Postoperative Care:

If tissue was removed, a small amount of bleeding may occur during the first few days after the procedure

Resume medications as instructed by your doctor

Resume normal diet, unless directed otherwise by your doctor

If you're given antibiotics, finish the entire prescription

Outcome
After removing the sigmoidoscope, the doctor will usually give a preliminary report. Depending on what your doctor finds, a complete colonoscopy may be recommended. A colonoscopy is a similar procedure using a flexible instrument that goes further into your colon than the sigmoidoscope. With this procedure your entire colon can be examined, and polyps or other small growths can be removed for a biopsy. It may take 1-2 weeks for results of a biopsy.

Call Your Doctor If Any of the Following Occurs

Bleeding from your rectum; notify your doctor if you pass a teaspoon or more of blood

Black stools

Severe abdominal pain

Hard, swollen abdomen

Signs of infection, including fever or chills

Nausea

Inability to pass gas or stool

Gastrostomy, Permanent and Temporary

Definition
Surgical procedure to place a tube through the abdomen and into the stomach.

Parts of the Body Involved
Stomach, abdomen

Reasons for Procedure
A gastrostomy can provide a route for feedings or allow the stomach to be drained and kept empty. The procedure is most often performed for the following reasons:

To feed a person who is unable to suck or swallow due to stroke, cancer, traumatic facial injury, birth defect, or other medical condition

To feed a person who is unable to eat enough food by mouth to provide proper nutrition To provide a route for tube feeding, when it is needed for four weeks or longer

To act as a drainage tube to bypass obstruction from tumor, scarring, or ulcer

Risk Factors for Complications during the Procedure

Advanced age

Pre-existing medical conditions

Blood clotting (coagulation) deficits

Debilitation

Confusion (patient may pull tube out)

What to Expect

Prior to Procedure:
Your doctor will likely do the following:

Physical exam

Assessment of swallowing ability

The day before and the day of your procedure:

Arrange to have someone drive you to and from the procedure

The night before, eat a light meal and do not eat or drink anything after midnight unless told otherwise by your doctor

Wear comfortable clothing

During Procedure:
IV fluids, anesthesia, possibly a sedative.

Anesthesia:
General or local with a sedative, depending on the type of procedure. An open procedure requires general anesthesia. The more common endoscopic placement is performed with a local anesthetic and a sedative.

Description of the Procedure:
There are two methods used to perform a gastrostomy, an open surgical procedure and the more common percutaneous (through the skin) endoscopic gastrostomy (PEG).

Percutaneous endoscopic gastrostomy tube placement (PEG):The doctor threads a gastroscope (a type of endoscope, which is a long, thin tube with a light and camera at the end), through the mouth, down the throat, and into the stomach. Air is injected to stretch and enlarge the stomach. The doctor looks through the scope into the stomach and uses the endoscope to assist with tube placement.

Local anesthesia is injected at the site where the tube will be. A percutaneous needle is inserted through the skin and abdominal wall and into the stomach. A guide wire is passed through this needle and into the stomach, where it is clamped, and the needle is removed. The endoscope is removed, and the gastrostomy tube is gently guided through the mouth, down the throat, and into the stomach. The tube is then pulled partly out of the body through the incision in the abdominal wall. The endoscope is reinserted through the mouth and into the stomach, in order to help secure the inside portion of the tube. The outside portion of the tube is secured as well, then cut to the correct size, and fitted with a connector. Once the tube is in place, the stomach is deflated.

Open placement: This method is no longer routinely performed due to the risks associated with an open surgical procedure. It may be done at the same time as other stomach surgery or if you cannot tolerate an endoscopy. The surgeon makes an incision through the skin, abdominal wall and, once in the body, another one into the stomach. A tube is placed through the skin and into the stomach, and is stitched into place. The surgeon closes the incision.

After Procedure:
The doctor will verify correct placement of the tube.

How Long Will It Take?
Most PEG procedures take less than 30 minutes.

Will It Hurt?
Anesthesia prevents pain during the procedure.

Possible Complications:

Infection

Bleeding

Anesthesia-related problems

Skin irritation around the tube

Dislodging of the tube

Diarrhea

Average Hospital Stay
None. Patients receiving a PEG tube usually return home the same day, unless they are in the hospital for treatment of another condition.

Postoperative Care:
Depending on your medical condition, you may need to be fed with intravenous fluids for the first day or two after gastrostomy tube placement, or until your intestine is working normally. You'll then be started on clear liquids, and gradually advanced to thicker liquid and solid foods, as you are able to tolerate them.

Other important considerations:

Keep the tube insertion site clean and dry

Wash your hands before touching the area

If antibiotics are ordered, take all of the pills; do not stop even if you feel healthy

Learn how to administer tube feedings and how to flush out your tube to decrease the risk of blockages

Learn how to handle possible serious complications, such as a dislodged tube or aspiration

Outcome
You will receive feedings through the tube, so you, and if necessary, your caregiver, will learn how to care for the tube, administer feedings, and check for problems. Dislodging is most common during the first two weeks that the tube is in place.

Call Your Doctor If Any of the Following Occurs

Signs of infection, including fever and chills

Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site around the tube

The tube clogs or falls out

Cough, shortness of breath, chest pain, or severe nausea or vomiting

Inability to pass gas or defecate

Severe abdominal pain

New abdominal bloating

Kidneys, Ureter, Bladder (KUB) (Abdominal X-Ray, Flat Plate of the Abdomen)

Definition
An x-ray of the abdomen. An x-ray is a test that uses radiation to take a picture of structures inside the body.

Parts of the Body Involved
Abdomen

Reasons for Procedure

To help diagnose the source of nausea, vomiting, pain or other symptoms related to the abdomen

To identify suspected urinary system problems, such as a kidney stone

To identify a tumor or blockage in the intestine or kidneys

To locate a foreign object that has been swallowed

To assess whether there is air or fluid in the peritoneal space (the space surrounding the abdominal organs)

To assess amount of fecal material in colon and evaluate the presence of fecal impactions

Risk Factors for Complications during the Procedure

The following factors can interfere with the clarity of the x-rays:

Large amounts of gas or stool in the intestines

Excessive peritoneal fluid (fluid from the sac that lines the abdomen)

Obesity

Large calcified uterine fibroids

Dye or barium left from previous tests

What to Expect Prior to Procedure:

You will probably be asked not to eat or drink anything for 4 hours before your exam.

You'll remove your clothes and put on a hospital gown. You'll also need to remove all metal-containing items, including jewelry and watches.

Tell your doctor if you:

Have taken any bismuth medications (such as Pepto-Bismol) within the last four days

Had a barium contrast media x-ray within the last four days

Have an IUD currently inserted

Are pregnant or could possibly be pregnant

During Procedure:
No special interventions

Anesthesia:
None

Description of the Procedure:
You will lie flat on your back underneath the x-ray machine, and remain still while the x-ray is taken. You may be asked to shift to other positions for more x-rays (e.g., on your abdomen or even standing).

After Procedure:
You can resume normal activity.

How Long Will It Take?
About 10 minutes

Will It Hurt?
No

Possible Complications:
None

Average Hospital Stay
None

Postoperative Care:
You may resume all normal activity after the procedure

Outcome
The KUB may help your doctor identify the source of your pain. If these x-rays show a mass, blockage, or other abnormality, you may undergo further testing, which can include:

Ultrasound - a test that uses sound waves to visualize the inside of the body

Abdominal and pelvic CT scan - a type of x-ray that uses a computer to make pictures of the inside of the body

Intravenous pyelography (IVP) - a series of x-rays of the urinary system taken after injection of a dye

Call Your Doctor If Any of the Following Occurs
There are usually no reported complications after this procedure

Liver Biopsy

Magnetic Resonance Imaging (MRI Scan)

Definition
The use of magnetic waves to make pictures of the inside of the body. Using a large magnet, radio waves, and a computer, an MRI produces two-dimensional and three-dimensional pictures.

Parts of the Body Involved
An MRI can be used to evaluate any part of the body.

Reasons for Procedure

To diagnose internal injuries or conditions

To monitor effects of medications and treatments inside the body

Risk Factors for Complications during the Procedure

You may not be able to have an MRI exam if you have any of the following in your body:

Pacemaker

Neurostimulator

Ear implant

Metal clips in your eyes

Implanted port device

Intrauterine device (IUD)

Metal plate, pins, screws, or surgical staples

Metal clips from aneurysm repair

Retained bullets

Any other large metal objects implanted in your body (tooth fillings and braces are usually not a problem)
You should tell the doctor/technician if your occupation involves work with metal filings or particles.

What to Expect

Prior to Procedure:
In the days leading up to your MRI exam:

You may be asked to avoid using hair gel, spray, lotions, powders, and cosmetics before your MRI

If your doctor prescribes a sedative:

Arrange for a ride to and from the exam

Do not eat or drink at least 4 hours before the exam

Take it 1-2 hours before the exam, or as directed

If you have not been prescribed a sedative, eat or drink normally, unless your doctor or the technician tells you otherwise

Once at the MRI center:

You will be asked about the following:

Medical history

Pregnancy, if female

Allergies

Prior head surgery

You'll remove any metal containing objects, such as jewelry, hairpins, hearing aids, glasses, wigs (with metal clips), and/or nonpermanent dentures

An x-ray may be taken beforehand if there is doubt as to whether there are metal objects in your body

You'll also remove all objects from your pockets including your wallet and watch or time piece

During Procedure:

You may be given ear plugs or stereo headphones to wear, due to the loud banging noise the MRI machine makes during the exam

You may receive an injection of contrast imaging dye

Often, a family member or friend will be allowed to remain in the MRI examining room with you

Anesthesia:
None, unless you are claustrophobic, in which case your doctor can prescribe a sedative (such as Valium) to take before the exam.

Description of the Procedure:
You lie very still on a sliding table. Depending on your medical condition, you may have monitors placed to keep track of pulse, heart rate, breathing, etc. The table is slid into the MRI's narrow, enclosed cylinder (unless it is an "Open" MRI). The MRI technician leaves the room, and each of the MRI sequences is performed. The technician gives you any necessary directions, such as to hold your breath momentarily, via the intercom. You are able to talk to the technician through this intercom as well.

If a contrasting dye (usually Gadolinium) is needed, a small IV needle is inserted into your hand or arm before you are slid into the MRI machine. First, a saline solution is dripped into your vein to prevent clotting. Then, usually two-thirds of the way through the exam, the contrasting agent is injected.

When the MRI exam is completed, you are slid out of the machine, the IV needle is removed, and you are asked to dress and wait in the waiting room until MRI images can be checked to be sure no additional images are necessary.

After Procedure:
You will be asked to wait until MRI images are examined to determine if more images are needed. If so, more images will be taken at that time.

How Long Will It Take?
40-90 minutes

Will It Hurt?
The MRI exam is painless. If you have a contrast dye injected, there may be a momentary stinging when the IV needle is inserted, and you may also feel a slight cooling sensation as the dye is injected.

If you are claustrophobic, you may find this exam very difficult. A conventional MRI machine is a very small, enclosed cylindrical tube, and you need to lie very still in it for an extended period of time. However, you can ask your doctor to prescribe a sedative for the exam. Also, ask your doctor about having the exam done in an "Open" MRI machine, which is much larger then a conventional MRI and is usually open on the sides and in the front and back.

Possible Complications:
Allergic reaction to contrast dye, if used (rare)

Average Hospital Stay
None

Postoperative Care:

If you took a sedative, do not drive, operate machinery, or make important decisions until the sedative wears off completely

If you are breastfeeding and receive a contrast dye injection during the MRI exam, wait at least 24 hours after the exam before breastfeeding again, unless told otherwise by your doctor

Outcome
After the exam, an MRI radiologist will analyze the images and send a report to your doctor. Your doctor will discuss the results and any further action, tests, or treatment that may be necessary with you.

Call Your Doctor If Any of the Following Occurs

Any allergic or abnormal symptoms after an exam in which you were injected with contrast dye

Worsening of any of the symptoms that prompted the MRI exam

Upper Endoscopy

Upper Gastrointestinal (GI) Series (Barium Swallow, Barium Meal)

Definition
A series of x-rays of the esophagus, stomach, and duodenum during and after drinking a barium solution. The duodenum is the first part of the small intestine; and the esophagus, stomach, and duodenum are collectively called the upper gastrointestinal (GI) tract or upper digestive system.

Parts of the Body Involved
Esophagus, stomach, duodenum

Reasons for Procedure

An upper GI series may be ordered if you have:

Diarrhea

Weight loss

Abdominal pain

Difficulty swallowing

Regurgitation

Rectal bleeding

Bloody stools or black, tarry stools

Bloody vomit or "coffee-ground" vomit

An upper GI series can help detect:

An ulcer

A blockage

An abnormal growth or tumor

Diverticula - an abnormal pouch or sac opening from a hollow organ, such as the intestine

Gastroesophageal reflux disease (GERD)

A hiatal hernia

Crohn's disease

Pulmonary aspiration - inhalation of fluid, food, or other foreign matter into the lungs

Inflammation of the stomach or small intestine

Risk Factors for Complications during the Procedure

Presence of food in the stomach

Presence of barium in the colon

Perforated or obstructed bowel

Due to the risks of radiation exposure, you should not have an upper GI series if you are pregnant.

What to Expect

Prior to Procedure:

Review your medications with your doctor, there are some that you may need to stop taking before this procedure

Do not eat, drink, or smoke for at least eight hours before

You may be given a medication called glucagon to slow down the activity of the stomach and small intestine

You may be asked to swallow baking soda crystals, which will bubble and produce gas in your stomach, allowing for more detailed x-rays

If you are going to have a small bowel follow-through, you may be asked to take a laxative medication the day before your exam, in order to clean out the small intestine

During Procedure:
Barium sulfate solution

Anesthesia:
None.

Description of the Procedure:
Remove all jewelry and wear a hospital gown. You drink barium, which is a thick, white, chalky milkshake-like liquid that coats the inside lining of the esophagus, stomach, and duodenum. As you drink the barium, the radiologist takes x-rays of the upper GI area, using a machine called a fluoroscope. If your doctor wants to examine the esophagus, you may have pictures taken as you actually swallow the liquid or small bits of food that are covered with barium. You will be asked to change positions frequently in order to coat the entire surface of the GI tract with barium.

If the radiologist wants to examine more of the small intestine, a small bowel follow-through may be done. For this exam, x-ray pictures are taken every 15-30 minutes while the barium travels through the intestine.

After Procedure:
You may eat and drink as usual.

How Long Will It Take?
An upper GI series can take between 30 minutes and two hours. A small bowel follow-through can take 1-4 hours.

Will It Hurt?
No. There is usually no pain associated with the procedure.

Possible Complications:

Constipation for a few days after the procedure

White stool

Bowel obstruction, rare

Aspiration of the barium into your lungs, which can lead to pneumonia

Average Hospital Stay
None

Postoperative Care:

lots of fluids to eliminate the barium from your system

Outcome
A normal upper GI series will show an unobstructed, functioning, healthy digestive tract. Examples of abnormalities that may show up on an upper GI series include obstructions, ulcers of the esophagus, stomach, or small intestine, or irregularities in the swallowing mechanism. Your doctor will make treatment recommendations based on the findings.

Call Your Doctor If Any of the Following Occurs

Abdominal pain or bloating

Constipation doesn't resolve within a few days

Signs of infection, including fever and chills

procedures