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Introduction ⬇

A small bowel follow-through is usually scheduled in conjunction with UGI series and is performed to diagnose small bowel diseases (e.g., ulcerative colitis, tumors, active bleeding, obstruction). With fluoroscopy imaging, the x-rays are transmitted to a computer monitor allowing visualization of movement of contrast medium through the small bowel. The contrast material, such as barium sulfate or diatrizoate meglumine and diatrizoate sodium solution, highlights Meckel diverticulum, congenital atresia, bowel obstruction, filling defects, regional enteritis, lymphoid hyperplasia, tuberculosis of the small intestine (malabsorption syndrome), sprue, Whipple disease (infectious disease caused by Tropheryma whipplei leading to malabsorption), intussusception, and edema.

The mesenteric small intestine begins at the duodenojejunal valve and ends at the ileocecal valve. The mesenteric small intestine is not routinely included as part of a UGI study.

Procedure ⬆ ⬇

  1. Have the patient change into a hospital gown after removing street clothes and accessories. Perform a preliminary abdominal x-ray with the patient on the examining table.

  2. Have the patient swallow the prescribed amount of contrast medium while the patient is standing in front of the fluoroscopy machine.

  3. Take timed images after contrast material is swallowed, usually every 30 minutes.

  4. Remember that the examination is not complete until the ileocecal valve has filled with contrast material. This may take several minutes (for those patients with a gastric bypass) to several hours.

  5. Follow guidelines in Chapter 1 for safe, effective, informed intratest care.

Procedural Alert

  1. If the patient has diabetes, alert the radiology department and schedule examination for early morning. If the patient is taking metformin, special considerations may be necessary. Consult with the radiology department to determine whether this medication regimen must be suspended during and for several days after study.

  2. Determine whether the patient is hypersensitive to barium. Although rare, presence of this allergy must be communicated to the radiology department so alternate contrast can be used.

  3. All female patients of reproductive age must be screened for pregnancy before performing this study.

Clinical Implications ⬆ ⬇

Abnormal small bowel follow-through results may indicate the following conditions:

  1. Anomalies of small intestine

  2. Errors of rotation

  3. Meckel diverticulum

  4. Atresia

  5. Neoplasms

  6. Regional enteritis

  7. Tuberculosis

  8. Malabsorption syndrome

  9. Intussusception

  10. Roundworms (ascariasis)

  11. Intra-abdominal hernias

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the purpose and procedure of the test. Refer to barium contrast test (consult barium contrast precautions). Written reminders for pretest instructions are helpful, especially for diet limitations. Screen female patients for pregnancy status. If positive, advise the radiology department.

  2. Maintain total fast for at least 8 hours prior to the examination.

  3. Do not administer laxatives or enemas to a patient with an ileostomy.

  4. Instruct the patient regarding the need to hold still and to follow breathing instructions during the procedure.

  5. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed.

  2. Tell the patient that normal diet and activity may be resumed. Assist the patient if necessary.

  3. Monitor stools for color and consistency.

  4. Counsel the patient about motility disorders and other small intestine abnormalities. Follow-up procedures may be necessary.

  5. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Interfering Factors ⬆ ⬇

  1. Delays in small intestine motility can be due to the following circumstances:

    1. Morphine use

    2. Severe or poorly controlled diabetes

  2. Increases in motility in the small intestine can be due to the following circumstances:

    1. Fear or anxiety

    2. Excitement

    3. Nausea

    4. Pathogens

    5. Viruses

    6. Diet (e.g., very high fiber)

Reference Values ⬆

Normal

Normal small intestine contour, position, and motility