Performing a Barium meal Department of Diagnostic Radiology 23 March 2012 M. Pieters

Anatomy of the stomach J-shaped Varies in size and shape

Stomach in situ

Anatomy of the stomach

Anatomy of the stomach

Layers of the stomach Three muscle layers, three mucosal layers

Arterial supply Coeliac artery Common hepatic artery

Posterior relations

Posterior relations

Anterior relations

Lesser sac

Venous drainage

Lymph drainage of the stomach

Stomach innervation

Barium meal

Indications Dyspepsia Weight loss GIT haemorrhage Failed upper GIT endoscopy Assessment of perforation site Upper abdominal mass Unexplained iron deficiency anaemia Partial obstruction

Contra-indications Complete large bowel obstruction

Complications Aspiration Intra-peritoneal leakage Ba appenticites

Contrast agents Barium Sulphate eg. E-Z HD 250% Carbex granules

Patient preparation NPO 6hrs prior History – no pharmacological contra-indications

Technique (Double contrast) Position Film Action Reasoning Visualization Erect/sitting - Pt drinks fizzing agent To distend the stomach On left side Screen Pt drinks barium Delays passage to duodenum Greater curve Supine, tilted to the right side Cough or swallow H2O Ba flows to GE-junction Observe for reflux Unchanged IV muscle relaxant Roll to right, complete circle, end supine, left tilt Coating of the gastric mucosa *RAO = Pt supine and slightly tilted to the left. ** When arae gastrica in the antrum are visible, good coating has been achieved.

Technique (Stomach Spot Films) AP Position Film Action Reasoning Visualization Supine, tilted to the left RAO - Antrum and greater curve Supine PA Antrum and body Supine, tilted to the right LAO Lesser curve en face On right side, head up 45o Left lateral Fundus ** When arae gastrica in the antrum are visible, good coating has been achieved. !!!! ALSO ADD PICS of MODEL and EXAMPLES of IMAGES @ Would happen if pt turned on right side then prone

Technique (Duodenal Spot Films) Position Film Action Reasoning Visualization Return to supine, on left side, then prone AP Pt on compression pad Avoid Ba flooding duodenal loop AP of the Duodenal loop Roll to right side, supine, then supine tilted to the left RAO - RAO of the Duodenal cap Turn supine (shortest route) PA PA of the Duodenal cap Lie supine and tilted to the right LAO LAO of the Duodenal cap ** When arae gastrica in the antrum are visible, good coating has been achieved. !!!! ALSO ADD PICS of MODEL and EXAMPLES of IMAGES @ Would happen if pt turned on right side then prone

Technique (Erect Views) Fundal lesion suspected Position Film Visualization Erect PA Fundus RAO Duodenal cap and Fundus LAO ** When arae gastrica in the antrum are visible, good coating has been achieved. !!!! ALSO ADD PICS of MODEL and EXAMPLES of IMAGES @ Would happen if pt turned on right side then prone

Technique (Oesophageal views) Barium swallow to conclude exam Either spot films or dynamic screening Position Film Visualization Erect RAO Oesophagus ** When arae gastrica in the antrum are visible, good coating has been achieved. !!!! ALSO ADD PICS of MODEL and EXAMPLES of IMAGES @ Would happen if pt turned on right side then prone

Bibliography A Guide to Radiological Procedures 5th ed - Aitchison Diagnostic and Surgical Imaging Anatomy: Chest.Abdomen.Pelvis - Federle Anatomy for Diagnostic Imaging 3rd ed – Ryan Atlas of Human Anatomy 5th ed – Netter Atlas of anatomy – Gilroy Web references: http://www.Instantanatomy.net http://www.Dartmouth.edu http://www.individual.utoronto.ca/ecolak/gi_techniques/techniques /ugi/frame_set.htm