Fluoroscopic Investigations Of The Gastrointestinal Tract Pharynx , Oesophagus and stomach

References Websites Radiographic procedures: By Stephen Chapman Positioning in Radiography: By k.C.Clarke. Text book of radiographic positioning and related anatomy;bykenneth L.Bontrager. Websites http://www.e-radiography.net/

With the end of these lectures the student will be able to: Learning Objectives With the end of these lectures the student will be able to: List common indications for ordering Ba swallow /meal exam Explain Ba swallow/meal exam limitations Explain the contraindications for using barium sulphate in the examination of the oesophagus and stomach. Describe the anatomy of the oesophagus and stomach and explain their function Describe room preparation and identify supplies for Ba swallow and barium meal series Describe how to perform barium swallow / meal Explain patient care, after completing the barium procedures Critique Ba swallow /meal radiographs in term of positioning ,image quality, radiographic anatomy ,and pathology

Transport of food by peristalsis. What is the function of esophagus? Transport of food by peristalsis.

Barium Swallows –Indications Pain on swallowing Fistulae between trachea & oesophagus (non-ionic c/a preferred) Assessment of action of oesophagus following a stroke Oesophageal varices / Diverticula As part of a barium meal investigation Dysphagia Carcinoma / obstruction /Hiatus hernia Hemetemesis

Barium Swallow - Technique a series of plain films or uses fluoroscopy to identify any pathology Patient is placed in the erect RAO position Ample mouthful of barium is swallowed & spot films are taken (rapid sequence) Spot films of the upper & lower oesphagus are taken May need rapid serial radiography sequence

Barium Swallow - Typical film series Demonstrates Position Esophagus between vertebral column & heart Erect RAO (35-40 degree) Esophagus between hilar region of lung & Thoracic spine Erect LAO Esophagus through superimposed thoracic vertebrae Erect AP Entire esophagus between thoracic spine & Heart Lateral

Barium Swallow - Technique Following Barium Swallow upper GI series may performed to diagnose pathology in the, stomach, and duodenum Limitations Not good for evaluating small ulcers Not specific for diagnosis of esophagitis

Barium Swallow (Normal Films)

between the lower esophagus and stomach. Figure2 Figure1 Figure1: Shows the lower end of a normal esophagus with a smooth connection between the lower esophagus and stomach. Figure 2: Shows the lower end of the esophagus with a small hiatus hernia, which occurs when a small portion of the stomach pushes up into the chest.

Barium Swallow AP RAO

Aftercare of the patient Patient given tissue to wipe & clean mouth Patient aware of where & when to obtain results. Patient given the chance to ask any questions. The patient should drink plenty of fluids and may need a laxative after the test because the barium can be constipating

Barium Swallow (Pathology Films)

Achalasia

ACHALASIA Distended esophagus with distil stricture due to Achalasia - Failure of distil sphincter to relax – causing obstruction.

Esophageal Spasm Strictures

Carcinoma

Tracheo - oesophageal fistula Normal Swallow Leaks of contrast into the trachea

Stomach Barium meal

Stomach Anatomy J-Shaped Continuous with Oesophagus & duodenum Three sections Fundus Body Pyloric Antrum

Barium Meal Indications Dyspepsia / reflux / Upper abdomen pain/ Nausea/ Weight loss Fullness or distension Peptic ulceration (defects in mucosa extending through muscularis mucosae) Gastritis ( Inflammation of the stomach) Polyps Upper abdominal mass Gastrointestinal haemorrhage Pyloric / cardiac stenosis Hiatus hernia ( Slipping of the upper portion of the stomach through the oesophageal hiatus Partial bowel obstruction Assessment of site of perforation (What type of contrast to use?) Contra-indications: Complete bowel obstruction

Contrast media & patient preparation Barium meal Contrast media & patient preparation High density, low viscosity barium Nil orally for 6 hours prior Explanation of procedure Physical & psychological preparation No smoking (>gastric motility) Check for contra-indications to pharmacological agents ( What are the contra indication for Buscopan?)

Barium Meal Investigation Can perform double (CO2 & Barium) or single contrast examinations Single contrast examinations are used in paediatrics & grossly ill patients Double contrast examinations - demonstrate mucosal pattern Equipment should contain ability to perform spot film images.

Barium meal - Technique Gas producing agent swallowed (eg. Carbex) Patient drinks barium whilst lying on left side Patient lies supine & slightly on their right side Check for reflux Smooth muscle relaxant given to the patient Buscopan (20mg iv) or Glucagon (0.3mg iv) Patient rolls onto their right side & quickly over in a complete circle - finish in a RAO position This has the effect of coating the gastric mucosa with barium

Barium meal - Typical film series RAO Stomach and C-loop of the duodenum with duodenal bulb in profile

Barium meal - Typical film series PA (Prone) Duodenal loop + duodenal with body and pylorus filled with barium

Barium meal - Typical film series Right lateral Retro gastric space

Barium meal - Typical film series AP (supine) Entire stomach and duodenum + Fundus of stomach filled with barium

Barium meal - Typical film series LPO Duodenum Bulb without superimposition with the pylorus + Fundus of stomach filled with barium LAO Lesser curve Prone , RAO, LAO , Supine, Erect Duodenal Cap series Note : In the erect position the Fundus of the stomach is filled with air

Barium meal ( Normal anatomy)

Barium meal ( Normal anatomy) (3) greater curvature (4) lesser curvature (5) fundus (6) small bubble of gas. (7) pyloric region (8) second part of the duodenum

( Pathology) PYLORIC STENOSIS

( Pathology) GASTRIC CARCINOMA

( Pathology) Normal Hiatus Hernia *Note distended distil esophagus with herniation of gastric fundus into chest through esophageal hiatus. DIAPHRAGM Normal Hiatus Hernia

( Pathology) DUODENAL ULCER

Any Questions? Thank you