ARRT Patient Care Practice Exam

For a GI series requested on a patient with a suspected perforated ulcer, what type of contrast medium is appropriate?

1. Thin barium sulfate suspension

2. Thick barium sulfate suspension

3. Water-soluble iodinated media

4. Oil-based iodinated media

The correct answer is: Water-soluble iodinated media

In the case of a suspected perforated ulcer, the use of water-soluble iodinated media is the appropriate choice for the contrast medium during a gastrointestinal (GI) series. The rationale behind this is that if a perforation is present in the gastrointestinal tract, barium sulfate can lead to significant complications. If barium were to leak into the abdominal cavity due to a perforation, it could cause irritation and lead to barium peritonitis, a serious and potentially life-threatening condition. Water-soluble iodinated media, on the other hand, is designed to be less toxic in case of extravasation into the peritoneal cavity. These agents are absorbed and excreted by the kidneys, minimizing harmful effects compared to barium. This makes iodinated contrast a safer option in scenarios where a perforation is suspected. Additionally, these media allow for effective imaging of the gastrointestinal tract while providing the necessary details without the risk associated with barium in compromised anatomy. Other types of contrast, like thin or thick barium sulfate suspensions or oil-based iodinated media, do not provide the same safety profile in the event of a perforation, making them inappropriate for this specific clinical situation.