Barium meal is radiological study of esophagus, stomach, duodenum.

Done by oral administration of contrast media barium sulphate

Gastric or duodenal obstruction Malignancies of gastro esophageal

junction, stomach, duodenum Upper abdominal mass Motility disorders Systemic diseases like Tb Git hemorrhage

Epigastric pain suggestive of peptic ulceration

Anorexia Weight loss Vomiting Anemia Heart burn Dyspepsia

CAUSE OF VOMITING:

Gastro esophageal reflex Pyloric obstruction Mal rotation

1.Complete large bowel obstruction 2.Suspected perforation (unless water

soluble contrast medium used)PATIENT PREPARATION : 1. NPO after midnight(6 hrs) 2.abstain from-smoking, chewing gum or

antacids- ->dec fluid in stomach which impairs

barium coating.

1.Hypotonic agent Buscopan(hyoscine butyl bromide,20 mg i.v) or 0.1-0.2 mg i.v glucagon is injected intravenously -relax stomach and suspend peristalsis.

A packet of effervescent granules swallowed with small amount of water- releases CO2 and gastric distension.(approx 400ml CO2)

High density barium is swallowed(120 ml- 250% w/v) and double contrast views of oesophagus is obtained standing RAO.

Patient faces Xray table,lowered to horizontal

Then turned onto left side and finally supine.

Patient rolled from side to side so as

barium coats mucosal surfaces properly-washes over the mucus .

Sequences of films of stomach obtained—

Typical Film Series  Position Demonstrates

Supine RAOAntrum and greater curve

Supine Antrum and bodySupine LAO Lesser curveSupine Left Lateral

Fundus

Prone Duodenal loop

Prone,RAO,Supine,LAOErect RAO, LAO

Duodenal Cap series

Erect Fundus

When barium enters duodenum, patient is turned RAO – fills duodenum with gas, DC films are taken.

Under fluoroscopic guidance, on the compression views-filling defects or abnormal collections are detected.

Note: young children- main indication identify cause of vomiting eg:-pyloric obstruction, malrotation,and GOR.single contrast technique preferred(30% w/v Barium sulfate with no paralytic agent).

Flow technique identifies-subtle mucosal abnormalities.

Note : kV range double contrast- 70-120 kV.

single contrast-120-150kV . Note: If partial gastrectomy or drainage

procedures (eg; pyloroplasty or gastrenterostomy), begin with prone swallow using high density barium. Reaching duodenum or Genterostomy-turned supine for DC films.DC of stomach and esophagus follows.

ADVANTAGES: Pylorospasm, Fistulae, Enlarged

Gastric Rugae Are Best Seen Filling Defect Due To Large Mass

Easily IdentifiableDISADVANTAGES: Lack of sensitivity of small erosion

linear ulceration sup gastric ca subtle mucosal abnormalities

ADVANTAGE: highly accurate detecting abnormalities

following gastric surgery, bile reflex gastritis, marginal ulceration, recurrent carcinomas

Abnormalities of efferent loopDISADVANTAGES: Misses some polyp, ulcers, erosion , sup

carcinoma

Barium given with gas forming powder in last few mouthfuls

HYPOTONIC DUODENOGRAPHY

SINGLE CONTRAST

FUNDUS SUPINE

BODY ERECT OR PRONE

ANTRUM, PRONE RT DOWN PYLORUS

D1,C LOOP PRONE RT DOWN

D4 SUPINE

DOUBLECONTRAST

PRONE RT SIDE DOWN

SUPINE WITH 60

HEAD END ELEVATION

SUPINE RT SIDE UP

SUPINE RT SIDE UP

PRONE RT SIDE DOWN

Surface: reticular pattern – multiple interconnecting grooves.

Divides- polygonal islands(2-4 mm)areae gastricae.distal 2/3rds.

Presence- excludes diffuse atrophic gastritis

>4mm sign of gastritis Fundus and body.- longitudinal folds or

rugae.

Duodenum- Extends from pylorus to duodenojejunal

flexure-cap,second part(descending horizontal,third part(ascending) and fourth part.

Barium meal-cap-fine velvety reticular surface pattern by villi.

Barium caught under mucosal pattern – incomplete erosive duodenitis

Barium caught underfold between 1st and 2 nd part of duodenum-ulcer pic

Beyond cap-mucosal folds-narrow bands across whole width.

Major papilla of Vater(2ND PART) Central fold and 2 oblique folds Minor papilla(Santorini- 2 CM PROXIMAL)

Frail and immobile, modification. Single contrast examination: 100%w/v barium – oesophagus, stomach

and duodenum Compression applied-lower stomach and

duodenum. Approximates front and back walls with thin layer in between.

Protruding lesion-radiolucent filling defect Depressed-eg:ulcer --focal extra density.

warning about bowel motion white for sometimes

COMPLICATION; Peritonitis Aspiration pneumonia Impaction,-convert partial obstruction

into complete obstruction Gastric dilatation Barium embolisation if bleeding ulcer is

present

BENIGN MALIGNANTRound to oval punched out lesion with straight walls &

flat smooth base

Irregular outline with necrotic or hemorrhagic

base

Smooth margins with normal surrounding

mucosa

Irregular & raised margins

Mostly on lesser curvature Anywhere

Majority<2cm Any size

Normal adjoining rugal folds that extend to the

margins of the base

Prominent & edematous rugal folds that usually do not extend to the margins

X-ray showing Gastric ulcer With symmetrical radiating

Mucosal folds.By histology, no evidence of Malignancies was observed.

X-ray showing Extensive carcinoma involving the cardia & Fundus

Pyloric stenosis