Stomach & Barium Meal RT-205B MIDTERM

What is a stomach?

 Stomach A dilated,  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

The stomach is about 12 inches (30. 5 cm) long and is 6 inches. (15  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.

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)

4 – division of stomach Cardia Fundus Body Pyloric portion

Parts of the Stomach Cardia Fundus Body Pyloric portion 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.

Stomach

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

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.

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

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.

Clinical Indications Hiatal Hernia Gastritis Tumor 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.

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

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

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)

Patient Preparation

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

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

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.

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.

Position of Patient: Stomach RAO – to demonstrate the antrum and 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

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

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

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.

Different Variations

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

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 retrogastric space. Recumbent AP projections, 11x14 films demonstrate the retrogastric portion of the duodenum and jejunum.

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 20-400 caudal.

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

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

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

Radiographic Contrast of the stomach:

Bezoar of the stomach:

Small Intestine

Small Intestine Small Bowel Series Purpose: 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.

3 Divisions of a small intestine

Enteritis or gastroenteritis Neoplasm Malabsorption syndromes Ileus Clinical Indication Enteritis or gastroenteritis Neoplasm Malabsorption syndromes Ileus

Cont… Enteritis Neoplasm Malabsorption Syndromes Ileus 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.

Mechanical obstruction 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)

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

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

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                           

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.

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.

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.

Barium filled small intestine

Enteroclysis

Positioning

Stomach and Duodenum PA projection Film: 10x12 in lengthwise for recumbent projections 11x14 in or 14x17 lengthwise for upright study. PT is in recumbent position or upright position Center the film longitudinally at the level of L2 (midway between the xiphoid process and umbilicus)

Cont… Central ray Direct it perpendicularly to the midpoint of the cassette at the level of L2

Stomach: RAO Film: 10x12 lengthwise Pt position is in a recumbent position Position approximately 40 to 700 required to give the best image of the pyloric canal and duodenum depends on the size and shape of the stomach. Central ray: Perpendicularly midway between the vertebral column and the lateral border of the abdomen at approximate level of L2