1. Stomach & Barium Meal
RT-205B MIDTERM

2. What is a stomach?

3.  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

4. 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.

5. 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)

6. 4 – division of stomach
Cardia
Fundus
Body
Pyloric portion

7. 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.

8. Stomach

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

11. 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.

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

13. 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.

14. 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.

15. 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.

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

17. 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)

18. Patient Preparation

19. 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

20. 2 – General GI – examination Technique are used
single contrast method
double contrast method

21. 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.

22. 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.

23. 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

24. 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

25. 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

26. 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.

27. Different Variations

28. 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

29. 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.

30. 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 caudal.

31. 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

32. 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

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

34. Radiographic Contrast of the stomach:

35. Bezoar of the stomach:

37. Small Intestine

38. 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.

39. 3 Divisions of a small intestine

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

41. 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.

42. 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)

43. 2 – strict contraindications
Pre-surgical patients & suspected a perforated hollow viscous.
Possible large bowel obstruction.

44. 4 – methods Procedures: UGI – Small bowel combination
Small bowel series
Enteroclysis
Intubation method

45. 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                           

46. 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.

47. 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.

48. 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.

49. Barium filled small intestine

51. Enteroclysis

52. Positioning

53. 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)

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

55. 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