Hypotonic Duodenography

Definition

Hypotonic duodenography is an x-ray procedure that produces images of the duodenum. The duodenum is the first part of the small intestine.

Purpose

Hypotonic duodenography may be ordered to detect tumors of the head of the pancreas or the area where the pancreatic and bile ducts meet the small intestine. Lesions causing upper abdominal pain may be demonstrated by duodenography, and the procedure can aid in the diagnosis of chronic pancreatitis.

Precautions

Some patients with narrowing of the tubes in the upper gastrointestinal tract should not receive duodenography. Patients with certain heart disorders and glaucoma are cautioned against receiving an agent called anticholinergic, which is administered during the procedure to lessen intestinal muscle spasms. A hormone called glucagon may also be used to relax the intestines, but its use is not recommended in patients with most forms of diabetes.

Description

Hypotonic duodenography is also referred to as x ray of the duodenum or simply as duodenography. The patient is seated while the radiologist places a catheter in the nose and down into the stomach. Then the patient lies down and the tube is continued to the duodenum. The radiologist is guided in this placement by a fluoroscopic image. (Fluoroscopic equipment shows an immediate x ray. In this case, the x ray shows the location of the catheter as it is moved into the stomach and duodenum.) Next, either the glucagon is administered intravenously or anticholinergic is injected into the patient to relax the muscles of the intestine.

After several minutes, the physician will administer barium through the catheter. Barium is a contrast agent that will help highlight the area on the fluoroscopy screen and x rays. After a few films are taken, some of the barium is withdrawn and air is sent in through the catheter. Additional images are acquired and the catheter is then removed. The procedure takes from 30-60 minutes.

Preparation

Patients are required to fast from midnight before the test until after the test, or about 6-12 hours. Just prior to the exam, patients should remove dentures, glasses, and other objects that may interfere with the procedure. The patient may be instructed to empty his or her bladder just prior to duodenography.

Aftercare

The barium should be expelled within two to three days. Extra fluids and/or an agent given by the physician to help encourage bowel movement may aid in barium elimination. Physicians and patients should watch for possible reactions to the anticholinergic or glucagon. If an anticholinergic is used, patients are advised to empty their bladder within a few hours after the exam and to wait two hours for clearing of vision or have someone drive them home. Patients will notice that their stools are chalky white from the barium for one to three days following the procedure.

Risks

Abdominal cramping may occur when the physician instills air into the duodenum, but aside from the discomfort, there are few risks associated with this procedure. Side effects from the contrast, hormones or agents may occur. Those patients with diabetes, heart disease, or glaucoma run the highest risk of reaction and should not receive anticholinergic or glucagon, depending on their specific conditions. Elderly patients or those who are extremely ill, must be closely monitored during the procedure for possible return of fluid, or gastric reflux.

Normal results

The linings of the duodenum and surrounding tissues will look smooth and even. The shape of the head of the pancreas will appear normal and near the duodenal wall.

Abnormal results

Any masses or irregular nodules on the wall of the duodenum may indicate tumors or abnormality of tissue. Tumors of the head of the pancreas or of the opening into the intestine from the pancreatic and bile ducts may be seen. Chronic pancreatitis may be indicated on the x rays. In many instances, follow-up laboratory or imaging studies may be ordered to further study the abnormal findings and confirm a diagnosis.

Resources

ORGANIZATIONS

American College of Radiology. 1891 Preston White Drive, Reston, VA 22091. (800) 227-5463. 〈http://www.acr.org〉.

National Cancer Institute. Building 31, Room 10A31, 31 Center Drive, MSC 2580, Bethesda, MD 20892-2580. (800) 422-6237. 〈http://www.nci.nih.gov〉.

KEY TERMS

Anticholinergic— A drug that lessens muscle spasms in the intestines, lungs, bladder, and eye muscles.

Fluoroscopic (fluoroscopy)— An x-ray procedure that produces immediate images and motion on a screen. The images look like those seen at airport baggage security stations.

Glucagon— A hormone that changes glycogen, a carbohydrate stored in muscles and the liver, into glucose. It can be used to relax muscles for a procedure such as duodenography.

Pancreas— A five-inch-long gland that lies behind the stomach and next to the duodenum. The pancreas releases glucagon, insulin and some of the enzymes which aid digestion. Pancreatitis is the swelling of the pancreas which can nausea, jaundice, and severe pain and may be fatal.