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. (15.2 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

1.Cardia2.Fundus3.Body4.Pyloric portion

Parts of the Stomach• Cardia – 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–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–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:

A. Soft, low-residue diet for 2 days(to prevent gas formation)

B. The day before – patient should be NPO or cleansing enemas may be given to assure a properly clean colon.

C. Food and fluids should be withheld for at least 8 to 9 hours prior to examination.

D. Patient is not allowed to smoke cigarettes or chew gum during NPO period.

E. 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– 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

Clinical Indication

• Enteritis or gastroenteritis•Neoplasm•Malabsorption syndromes• Ileus

Cont…

• Enteritis– 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.

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.

Procedures:

• 4 – methods1. UGI – Small bowel combination2. Small bowel series3. Enteroclysis4. 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 DuodenumPA 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