Practical Pointers for the General Practitioner in Diagnosing Tuberculosis

Abstract

When the study is made by retrograde filling, the picture is identical except that the barium passes the involved segment and into the unaffected ileum, while the reverse is true when the barium is administered orally. We cannot allow this opportunity to pass without doing a little missionary work in behalf of more thorough preparation of patients prior to study of both the small and large bowel. Careful attention to the instructions will pay dividends in more reliable information; information which will show much detail concerning the condition of the mucous membrane and muscular activity that can never be gained when the bowel is filled with normal content. In preparing a patient we ask that he be given a cleansing enema two hours before examination. Food is withheld for twelve hours. The intestine is then clean at the time of examination. The patient is given eight ounces of barium and water to which tragacanth and malted milk have been added. These two ingredients slightly delay the passage of barium from the stomach. This delay permits us to visualize larger areas at each observation. The patient is seen at 15 to 20 minute intervals until the meal has passed into the colon. This usually consumes from 5 to 7 hours and during this period we visualize every loop. The motility of the bowel as well as the appearance of the lumen and mucosa are described for it is impossible to put all of the detail on films. To study the ileocecal region by means of the enema, the patient is instructed to take a cleansing enema two hours before he presents himself for study. If it is possible and the appointment is early he is requested to fast the morning of the examination and his evening meal preceding study is restricted. We find this method of preparation is satisfactory and does not leave the bowel irritable, while the use of castor oil, as recommended by Weber for colon studies, leaves the colon very irritable. In closing, we would like to emphasize that it is our rule to demonstrate actual tissue change before suggesting tuberculous enteritis to referring clinicians. Hypermotility and bowel spasm may be suggestive of intestinal tuberculosis, but these manifestations accompany many pathological processes which do not have the tubercle bacillus as the causative agent. Again we would like to emphasize that the proper preparation of the patient for study is most important. None of you would consent to examine a stomach Roentgenoscopically unless the stomach was empty. The importance of the clean colon is just as great. 1130 S. W. Morrison Street. References 1 Brown and Samson: Intestinal Tuberculosis, Lea & Febiger. 2 Bockos, Tumen and Kornblum: Annals of Int. Med., Vol. 13, Feb. 1940.