Dr Mohamed El Safwany, MD.

The student should learn at the end of this lecture radiographic imaging aspects of barium meal.

Barium meal is radiological study of esophagus, stomach, duodenum. Done by oral administration of contrast media barium sulphate

Gastric or duodenal obstruction Malignancies of gastro esophageal junction, stomach, duodenum Upper abdominal mass Motility disorders Systemic diseases like TB GIT hemorrhage

Epigastric pain suggestive of peptic ulceration Anorexia Weight loss Vomiting Anemia Heart burn Dyspepsia

CAUSE OF VOMITING: Gastro esophageal reflex Pyloric obstruction Mal rotation

1.Complete large bowel obstruction 2.Suspected perforation (unless water soluble contrast medium used) PATIENT PREPARATION : 1. NPO after midnight(6 hrs) 2.abstain from-smoking, chewing gum or antacids->dec fluid in stomach which impairs barium coating.

1.Hypotonic agent Buscopan(hyoscine butyl bromide,20 mg i.v) or 0.1-0.2 mg i.v glucagon is injected intravenously -relax stomach and suspend peristalsis. A packet of effervescent granules swallowed with small amount of water- releases CO2 and gastric distension.(approx 400ml CO2) High density barium is swallowed(120ml) and double contrast views of oesophagus is obtained standing RAO.

Patient placed on table, lowered to horizontal Then turned onto left side and finally supine. Patient rolled from side to side so as barium coats mucosal surfaces properly-washes over the mucus . Sequences of films of stomach obtained

Typical Film Series

Position Supine RAO Supine Supine LAO Supine Left Lateral Prone Demonstrates Antrum and greater curve Antrum and body Lesser curve Fundus Duodenal loop

Prone,RAO,Supine,LAO Erect RAO, LAO

Duodenal Cap series

Erect

Fundus

When barium enters duodenum, patient is turned RAO fills duodenum with gas, Duodenal Cap films are taken.

ADVANTAGES: Pylorospasm, Fistulae, Enlarged Gastric Rugae, Filling Defect Due To Large Mass

DISADVANTAGES: Lack of sensitivity of small ulceration

ADVANTAGE: highly accurate detecting abnormalities following gastric surgery, bile reflex gastritis, marginal ulceration, recurrent carcinomas DISADVANTAGES: Misses some polyp, ulcers, erosion , sup carcinoma

Barium given with gas forming powder in last few mouthfuls HYPOTONIC DUODENOGRAPHY

SINGLE CONTRAST

DOUBLECONTRAST

FUNDUS BODY PRONE

SUPINE ERECT OR

PRONE RT SIDE DOWN SUPINE WITH 60 HEAD END ELEVATION

ANTRUM, PRONE RT DOWN PYLORUS D1,C LOOP DOWN PRONE RT

SUPINE RT SIDE UP
SUPINE RT SIDE UP PRONE RT SIDE DOWN

D4

SUPINE

COMPLICATION; Peritonitis Aspiration pneumonia Impaction,-convert partial obstruction into complete obstruction Gastric dilatation Barium embolisation if bleeding ulcer is present

X-ray showing Gastric ulcer With symmetrical radiating Mucosal folds. By histology, no evidence of Malignancies was observed.

X-ray showing Extensive carcinoma involving the cardia & Fundus

Pyloric stenosis

David Suttons Radiology Clarks Radiographic positioning and techniques

Two students will be selected for assignments.

Role of Buscopan injection in barium meal?

Thank You