Comparison Of The Efficacy Of Bowel Preparation Regimens For Intravenous Urography In Federal Teaching Hospital, Abakaliki And Imo State University Teaching Hospital, Orlu

This work is a comparison of the efficacy of bowel preparation regimen used in two teaching hospitals: Imo State University Teaching Hospital Orlu and Federal Teaching Hospital, Abakaliki. It is geared towards finding out the cause of poor visualisation of the renal tract after bowel preparation, to find a permanent solution to waste of time and resources for both the patient and the hospital. With the results obtained there will be a better visualisation of the renal tract in an IVU investigation thus leading to more accurate diagnosis. Also there will be a reduction in waste of time and resources of the patients as well as the hospital. Sixty-eight (68) preliminary films were studied in this work with forty (40) of the films obtained from FETHA and twenty-eight from IMSUTH. The efficacy of the bowel preparation used by the two hospitals was assessed by awarding scores to each preliminary film. From the results of the two hospitals it was shown that preliminary films of Imo State University Teaching Hospital had 53.6% success rate, while Federal Teaching Hospital Abakaliki had 35% success rate. Since there was a marked reduction in the remnant gas and faecal matter after the bowel preparation in IMSUTH compared to that at FETHA despite the extra day of preparation with the inclusion of ultracarbon to reduce gas, bowel preparation should be continued but with a modification in the diet taken by the patients, proper monitoring of the patients and an improvement in the literacy of the patients about the need to strictly adhere to the bowel preparation instructions given by the radiographer.   

Figure I: Outcome of bowel preparation regimens between IMSUTH and FETHA... ... ..   ... ..   ..   ... ... .. 29 

Figure II: Outcome of bowel preparation regimens between IMSUTH and FETHA in the right upper quadrant   .  30

Figure III: Outcome of bowel preparation regimens between IMSUTH and FETHA in the right lower quadrant   . ... ... .31

Figure IV: Outcome of bowel preparation regimens between IMSUTH and FETHA in the left upper quadrant   .  32

Figure V: Outcome of bowel preparation regimens between IMSUTH and FETHA in the left lower quadrant   .  33

Table 1: Outcome of bowel preparation regimen in Imo State University Teaching Hospital, Orlu (IMSUTH)     ... .... ..24

Table 1a: Outcome of bowel preparation regimen in the right upper quadrant of the abdomen at (IMSUTH)    24

Table 1b: Outcome of bowel preparation regimen in the right lower quadrant of the abdomen at (IMSUTH)   .25

Table 1c: Outcome of bowel preparation regimen in the left upper quadrant of the abdomen at (IMSUTH)    25

Table 1d: Outcome of bowel preparation regimen in the left lower quadrant of the abdomen at (IMSUTH)... .. ..   ... ..26

Table 2: Outcome of bowel preparation regimen at Federal Teaching Hospital Abakaliki (FETHA)        ..26

Table 2a: Outcome of bowel preparation regimen in the right upper quadrant of the abdomen at (FETHA)    ..27

Table 2b: Outcome of bowel preparation regimen in the right lower quadrant of the abdomen at (FETHA)    ..27

Table 2c: Outcome of bowel preparation regimen in the left upper quadrant of the abdomen at (FETHA)    ..28

Table 2d: Outcome of bowel preparation regimen in the left lower quadrant of the abdomen at (FETHA)    ..28

Table 3: Statistical t-test table   34

Title page  - - - - - - - - -    i

Approval page - - - - - - -   ii

Certification  - - - - - - - -  iii

Dedication - - - - - - - - - - iv

Acknowledgement - - - -  v

Abstract   vii

List of figures - - - - - - -  vii

List of tables - - - - - - - -  ix 

Table of contents - - - - - -xi 

CHAPTER ONE: INTRODUCTION

1.1 Background of the study - - - - - - - - - - -1

1.2 Statement of the problem - - - - - - - - - - -3

1.3 Purpose of the study - - 3

1.4 Significance of the study  4

1.5 Scope of the study - - -  4

1.6  Literature review - - - - 4

CHAPTER TWO: THEORITICAL BACKGROUND

2.1 Small intestine - - - - - - - 11

2.2 Large intestine - - - - - - - 12

2.3 Bowel preparation - - - - -13

CHAPTER THREE: RESEARCH METHODOLOGY

3.1 Research design - - - - - - 22

3.2 Sample population and sample size - - - - - 22

3.3 Source of data - - - - - - -  22

3.4 Method of data collection 23

3.5 Data presentation and analysis - - - - - - - - - 23

3.6 Test of hypothesis - - - - - 

CHAPTER FOUR: DISCUSSIONS, SUMMARY OF FINDINGS, CONCLUSION RECOMMENDATIONS, LIMITATIONS AND AREAS OF FURTHER STUDY

4.1 Discussions  - - - - - - - - - 35

4.2 Summary of findings - - - 37

4.3 Conclusions - - - - - - - - - 38

4.4 Recommendations - - - - - 38

4.5 Limitations of the study -  39

4.6 Areas for further studies - 39

The ultimate goal of bowel preparation is to empty and cleanse the bowel for a diagnostic procedure (using x rays to detect a disease process in the intestines) or for surgical intervention (such as removal of polyps, cancer, or narrowing of the intestinal diameter) 1.

A good bowel preparation allows the doctor to clearly see the lining of the bowel and thoroughly examine the colon. The procedure is then more likely to be accurate and complete. If the bowel is not completely clean and empty the procedure may need to be postponed or repeated. Potential complications may also occur or potential cancer lesions could be missed. The ideal colon preparation would rapidly and reliably clean the colon of faecal material while having no effect on the gross or microscopic appearance of the colon 2, 3.

Bowel preparation has long been considered necessary to improve the diagnostic quality of radiological examinations of abdominal region such as Intravenous Urography (IVU) and colonoscopy 4, 5.   A clean colon free from residue and with good coating of barium is a prerequisite for a successful examination and also goes a long way to reduce faecal contamination in cases of colonic surgery 6.

According to Gelfand et al., there is still no substantial consensus on the optimal method of bowel preparation before barium enema examination. Each has its own merits and drawbacks, preference varying between different hospitals. In general, bowel preparation may entail modifying ones diet, taking of oral laxatives (drugs which speed up excretion of lower bowel content) or bowel preparation medication and then taking large volumes of water 6.

However, no work has been done to ascertain the efficacy of the bowel preparation used by different hospitals in this eastern region of Nigeria.