PERFORMING A BARIUM MEAL

Department of Diagnostic Radiology

23 March 2012

M. Pieters

Anatomy of the stomach

J-shaped Varies in size and shape

Stomach in situ

Anatomy of the stomach

Anatomy of the stomach

Layers of the stomach

Three muscle layers, three mucosal layers

Arterial supply

Coeliac artery

Common hepatic artery

Posterior relations

Posterior relations

Anterior relations

Lesser sac

Venous drainage

Lymph drainage of the stomach

Stomach innervation

Barium meal

Indications

Dyspepsia Weight loss GIT haemorrhage Failed upper GIT endoscopy Assessment of perforation site Upper abdominal mass Unexplained iron deficiency anaemia Partial obstruction

Contra-indications

Complete large bowel obstruction

Complications

Aspiration Intra-peritoneal leakage Ba appenticites

Contrast agents

Barium Sulphate eg. E-Z HD 250% Carbex granules

Patient preparation

NPO 6hrs prior History – no pharmacological contra-

indications

Technique (Double contrast)

Position Film Action Reasoning Visualization

Erect/sitting

- Pt drinks fizzing agent

To distend the stomach

-

On left side Screen Pt drinks barium

Delays passage to duodenum

Greater curve

Supine, tilted to the right side

Screen Cough or swallow H2O

Ba flows to GE-junction

Observe for reflux

Unchanged - IV muscle relaxant

- -

Roll to right, complete circle, end supine, left tilt

- Coating of the gastric mucosa

Technique (Stomach Spot Films)Position Film Action Reasoning Visualizatio

n

Supine, tilted to the left

RAO - - Antrum and greater curve

Supine PA - - Antrum and body

Supine, tilted to the right

LAO - - Lesser curve en face

On right side, head up 45o

Left lateral - - Fundus

AP

Position Film Action Reasoning Visualization

Return to supine, on left side, then prone

AP Pt on compression pad

Avoid Ba flooding duodenal loop

AP of the Duodenal loop

Roll to right side, supine, then supine tilted to the left

RAO - Avoid Ba flooding duodenal loop

RAO of the Duodenal cap

Turn supine (shortest route)

PA - - PA of the Duodenal cap

Lie supine and tilted to the right

LAO - - LAO of the Duodenal cap

Technique (Duodenal Spot Films)

Technique (Erect Views)

Fundal lesion suspected

Position Film Visualization

Erect PA Fundus

Erect RAO Duodenal cap and Fundus

Erect LAO Duodenal cap and Fundus

Technique (Oesophageal views) Barium swallow to conclude exam Either spot films or dynamic screening

Position Film Visualization

Erect RAO Oesophagus

Bibliography

A Guide to Radiological Procedures 5th ed - Aitchison Diagnostic and Surgical Imaging Anatomy:

Chest.Abdomen.Pelvis - Federle Anatomy for Diagnostic Imaging 3rd ed – Ryan Atlas of Human Anatomy 5th ed – Netter Atlas of anatomy – Gilroy

Web references: http://www.Instantanatomy.net http://www.Dartmouth.edu http

://www.individual.utoronto.ca/ecolak/gi_techniques/techniques/ugi/frame_set.htm