Stomach & Barium Meal

1. Stomach & Barium Meal RT-205B MIDTERM

2. What is a stomach?

3.  Stomach • Adilated,  saclike portion of the digestive tract extending between the esophagus and the small intestine. • Serves as the reservoir for swallowed food and fluid. • It has an entrance valve and exit valve of food materials • Esophageal Sphincter • Pyloric Sphincter

4.  The stomach is about 12 inches (30.5 cm) long and is 6 inches. (15.2 cm) wide at its widest point. The stomach's capacity is about 1 qt (0.94 liters) in an adult.

5. 4 – layers of stomach • Covering layer, the serosa • Muscular layer consisting of oblique, circular, and longitudinal fibers • Sub-mucus layer • Thick, soft mucosal lining(rugae)

6. 4 – division of stomach • Cardia • Fundus • Body • Pyloric portion

7. Parts of the Stomach • Cardia • is the section immediately surrounding the esophageal opening. • Fundus • is the superior portion of the stomach that expands superiorly and fills the dome of the left diaphragm. • Body • descending from the fundus and beginning at the level of the cardiac notch. • Pyloric portion • distal part of the stomach. • Consist of the – pyloric vestibule and pyloric antrum.

8. Stomach

10. Barium Meal/Upper GI series • Radiographic examination of the distal esophagus, stomach, and duodenum with the use of radiolucent and radiopaque contrast medium.

11. Function • To study radiographically the form and function of the distal esophagus, stomach, and duodenum, as well as to detect abnormal anatomical and functional conditions.

12. Indications • Peptic ulcer • Hiatal hernia • Acute or chronic gastritis • Tumor, carcinoma and benign • Diverticulum • Bezoars

13. Clinical Indication • Peptic Ulcer - Erosions of the stomach or duodenal mucosa due to various physiological or environmental conditions, such as excessive gastric secretions, stress, diet and smoking.

14. Clinical Indications • Hiatal Hernia • portion of stomach will herniate through the diaphragmatic opening. • Gastritis • Inflammation of the lining or mucosa of the stomach. • Tumor • Small mass growing from the mucosal wall.

15. Clinical Indications • Diverticula • are a weakening and out-pouching of a portion of the mucosal wall. • Bezoar • mass of undigested material that gets trapped in stomach.

16. Contraindications: • Patient has a history of bowel perforation, laceration, or viscous rupture, the use of barium sulfate may be contraindicated. • Complete large bowel obstruction

17. If suspected for perforation • For the assessment of the site of perforation it is essential that a water-soluble contrast media is used (ex. LOCM or Non-ionic contrast media)

18. Patient Preparation

19. Patient Preparation: • Soft, low-residue diet for 2 days(to prevent gas formation) • The day before – patient should be NPO or cleansing enemas may be given to assure a properly clean colon. • Food and fluids should be withheld for at least 8 to 9 hours prior to examination. • Patient is not allowed to smoke cigarettes or chew gum during NPO period. • To x-ray department for examination

20. 2 – General GI – examination Technique are used • single contrast method • double contrast method

21. 2 – General GI – examination Technique are used • Double contrast – the method of choice to demonstrate mucosal pattern. • Single contrast – uses; • Children – since it usually is not necessary to demonstrate mucosal pattern • Very ill adults – to demonstrate gross pathology only.

22. Different type of Examination of the GI tract • Biphasic examination • combination of single and double contrast. •  Hypotonic Duodenography • requiring intubation • used for evaluation of postbulbar duodenal lesions and for the detection of pancreatic disease. • Described by Liotta.

23. Position of Patient: Stomach • RAO – to demonstrate the antrumand greater curve • SUPINE – to demonstrate the antrum and body • LAO – to demonstrate the lesser curve en face • Left lateral tilted, head up 450 – to demonstrate the fundus

24. Cont… • From the left lateral position the patient returns to supine position and rolls into his left side and over into a prone position. • This sequence of movement is required to avoid barium from flooding into the duodenal loop. • Duodenal loop • Prone – patient is lies on a compression pad to prevent barium from flooding into duodenum • RAO – additional view of anterior wall of the duodenal loop

25. Spot films of the duodenal cap • Prone • RAO – the patient attains the is position from the prone position by rolling first onto the left side, for the reasons mentioned. • Supine • LAO

26. Additional views • Erect position – demonstrate the fundus if there are suspected lesions. • Spot film of the esophagus are taken, while barium is being swallowed, to complete the examination.

27. Different Variations

28. Position of Patient: Stomach • Upright PA projection (14x17) • To demonstrate the type and relative pos. of the stomach. • Upright left lateral position • Demonstrate the left retrogastric space • Recumbent PA projection • demonstrate gastroduodenal surfaces • CR angled 20 – 25degs cephalic – infants • 35 – 45degs cephalic - adults

29. Cont… • One or more Recumbent RAO positions • gastric peristalsis is usually more active in this position. • A right lateral position is used to demonstrate the duodenal loop in profile, duodenojejunal junction, & right retrogastricspace. • Recumbent AP projections, • 11x14 films demonstrate the retrogastric portion of the duodenum and jejunum.

30. Modification of technique for young children • The examination is modified to identify the three major causes of vomiting – gastro-esophageal reflux, and pyloric obstruction. • Single contrast technique is used with 100% barium and no paralytic agent. • Small volume of barium – enough to just fill the fundus in a supine position • Child is in semi prone into a LPO or RAO. A better advantage if 20-400caudal.

31. Cont… • Once barium enters the duodenum, the infant is returned to supine position and a radiograph is taken with child supine perfectly still as barium passes around the duodeojejunal flexure. • Once malrotation is diagnosed or excluded, a further volume of barium is administered until the stomach is reasonably full. • The child is rotated 180 to elicit gastro-esophageal reflux

32. After Care • Patient is advised to drink lots of water and expect to have a white fecal. • Laxative should be taken to totally remove the barium to avoid barium impactions, which is painful

33. Complications • Leakage of barium from an unsuspected perforation • Aspiration • Conversion of partial large bowel obstruction to a complete obstruction by impaction of barium

34. Radiographic Contrast of the stomach:

35. Bezoar of the stomach:

37. Small Intestine

38. Small Intestine • Small Bowel Series • Radiographic study specifically of the small intestine. • Purpose: • to study the form and function of the 3 – components of the small bowel, as well as to detect any abnormal conditions.

39. 3 Divisions of a small intestine

40. Clinical Indication • Enteritis or gastroenteritis • Neoplasm • Malabsorption syndromes • Ileus

41. Cont… • Enteritis • term describing the inflammation or infection of the small bowel. • Neoplasm • describing “new growth”. • This new growth may be benign or malignant. • Malabsorption Syndromes • GI tract is unable to process and absorb certain nutrients. • Sbs – mucosa may appear to be swollen or thickened due to the content irritation. • Ileus • obstruction of the small intestine.

42. 2 – types of Ileus • Adynamic or Paralytic • due to the cessation of peristalsis • Mechanical obstruction • physical blockage of the bowel. • (ex. tumor, adhesions, or hernias)

43. 2 – strict contraindications • Pre-surgical patients & suspected a perforated hollow viscous. • Possible large bowel obstruction.

44. Procedures: • 4 – methods • UGI – Small bowel combination • Small bowel series • Enteroclysis • Intubation method

45. UGI – Small bowel combination • Basic Routine: • routine UGI – Series • note time patient ingested 1st cup(8 oz) of barium. • Ingested 2nd cup of barium • 30 min. PA – radiograph • ½ hour interval radiographs( iliac crest – center) • until barium reaches large bowel (usually 2 hrs.) • 1 hr. interval radiographs, if more time is needed after 2 hours                           

46. Small Bowel Series • Basic Routine: • plain abdomen radiograph (scout) • 2 cups (16 oz) of barium ingested ( note time) • 15 – 30 min. radiograph • ½ hour interval radiographs until barium reaches large bowel (2hrs) • 1 hour interval radiographs, if more time is needed.

47. Enteroclysis – SBS • Basic Routine: • Thru the nose, an intubation into the duodenum • barium sulfate suspension is instilled • air or methylcellulose is instilled • fluoroscopic spot films & conventional radiographs are taken. • Upon successful completion of exam, intubation tube is removed.

48. Intubation method – SBS • Basic Routine: • A tube inserted in the mouth until to the duodenum • contrast media instilled • note time that contrast media is instilled • 15 – 30 min. radiographs • radiologist will specify filming sequence after 2 hrs.

49. Barium filled small intestine