Stomach & duodenum
Barium meal Fluoroscopy + spot films Preparation
The Normal Anatomy of Stomach 1- Shape. 2-Size. 3-Site The Normal Anatomy of Stomach 1- Shape. 2-Size. 3-Site. 4-Anatomical parts. 5-Mucosal pattern.
Normal Anatomy of Duodenum Duodenal cap. Duodenal loop
Hypertrophic pyloric stenosis Cause: A. Congenital type B. Adult type
Epidemiology Pyloric stenosis is relatively common and has a male predilection (M:F ~ 4:1), and is more commonly seen in Caucasians 4. It typically occurs between the 4-8 weeks of life. There may be a positive family history. Incidence of hypertrophic pyloric stenosis is approximately 2-5 per 1,000 births per year in most white populations, Hypertrophic pyloric stenosis refers to idiopathic thickening of gastric pyloric musculature which then results in progressive gastric outlet obstruction
In a normal situation, the pyloric muscle thickness (diameter of a single muscular wall on a transverse image) should normally be less than 3 mm (most accurate 3) and the length (longitudinal measurement) should not exceed 15 mm.
Gastric outlet obstruction (often abbreviated as GOO) is a medical condition where there is an obstruction at the level of the pylorus, which is the outlet of the stomach. Individuals with gastric outlet obstruction will often have recurrent vomiting of food that has accumulated in the stomach, but which cannot pass into the small intestine due to the obstruction. The stomach often dilates to accommodate food intake and secretions. Causes of gastric outlet obstruction include both benign causes (such as peptic ulcer disease affecting the area around the pylorus), as well as malignant causes, such as gastric cancer
Radiographic Ba meal examination of the Pyloric stenosis 1. Marked dilatation of the stomach attends the pelvic cavity 2.Failure of passage of contrast into the duodenum. 3.Multiple filing defects are seen within the stomach due to retained food material .
Barium meal image of a case of corrosive-induced gastric outlet obstruction benign narrowing GASTRIC CA
PEPTIC ULCER GU, DU and IU. The Ba PEPTIC ULCER GU, DU and IU. The Ba. meal findings are : 1-Direct signs : * Ulcer crater ( nitch): Either in enface or in profile * Associated signs: I. Spasm II. Radiated mucosal folds. III. Edema (Hampton's line). 2- Indirect signs : I. Hyper peristaltic waves. II. Companion B sign. III. Thick mucosal folds & hyper peristaltic stomach (angry mucosa)
Radiographic Signs of a benign gastric ulcer Ulcer crater-collection of barium on dependent surface which usually projects beyond anticipated wall of stomach in profile (penetration) Hampton’s line-1 mm thin straight line at neck of ulcer in profile view which represents the thin rim of undermined gastric mucosa
lesser curvature gastric ulcer lesser curvature gastric ulcer. Red arrows point to Hampton's Line, a thin, straight line at neck of ulcer in profile view which represents the thin rim of undermined gastric mucosa. The blue arrows point to the ulcer mound, a smooth, sharply delineated soft-tissue mass surrounding a benign ulcer. Note how the ulcer projects beyond the confines of the expected wall of the stomach.
Gastric carcinoma refers to a primary malignancy arising from the gastric epithelium. 3 presentation Polypoidal Infiltrative * localized * generalized Ulcertaive type barium meal presentation of the CA stomach 1.Carcinoma produce single or multiple irregular filling defect with alteration of near by mucosal Pattern . 2.Localized or generalized narrowing of the stomach rigid in appearance with shoulding sign on either sided aspect of the narrowing .
3- Ulcerative Ca Either : I. Polypoidal tumour with ulceration or II 3- Ulcerative Ca Either : I.Polypoidal tumour with ulceration or II. Complicated benign gastric ulcer on Ba. Meal : * Filling defect with central ulcer crater * No mucosal radiation , due to destruction . * The ulcer crater is not projected out side the lumen ( meniscus sign ) * Hour glass deformity ( X ) of stomach
Duodenal ulcers (DUs) affect nearly 10% of the adult population at some time,[1]and these lesions account for two thirds of all peptic ulcers, which are defined as mucosal breaks of 3 mm or greater; gastric ulcer accounts for the rest Most duodenal ulcers are depicted as round or ovoid pools of barium; about 5% may be linear, and most are smaller than 1 cm in diameter. Giant duodenal ulcers, defined as those >2 cm in diameter, have an increased risk of perforation, obstruction, and bleeding. Multiple ulcers occur in about 15% of patients[1] ;Zollinger-Ellison syndrome should be considered in these patients. About 95% of duodenal ulcers occur in the duodenal bulb,[1] and the rest occur in the post bulbar duodenum, bulber U which consists of the proximal 2 cm of the descending duodenum above the ampulla of Vater. As many as half of all duodenal ulcers occur in the anterior wall of the bulb.
Complicated Chronic DU 1-Tri foil deformity ( tri foil tree ) 2-Pseudo diverticulum (Akerland diverticulum) 3-Gastric outlet obstruction.( pyloric obstruction ).
During Ba examination � Bird's Beak deformity of lower oesophagus - Achalsia cardia (Barium Swallow) � Cork screw oesophagus-- Diffuse oesophageal spasm (Barium Swallow) � Commonest radiological appearance of gastric � Trifoliate duodenum - Chronic duodenal ulcer with scarring (Barium Meal) � Hour Glass stomach - Peptic ulcer � Single-bubble appearance - pyloric stenosis � Double-bubble sign--Duodenal atresia, duodenal stenosis, � Triple-bubble sign - Jejunal atresia � Coiled spring appearance -Intussusception
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