Barium Meal

RAdiological study of Upper GI tract, with the use of contrast Agent .

1. Radiographic Round on Barium Meal Presented by: Anjan Dangal B.Sc.Medical Imaging Technology 3rd Year Student National Academy of Medical Sciences(NAMS) Kathmandu, Nepal

2. Radiological study of stomach, duodenum, and proximal Jejunum Route: Oral CM: Barium Sulphate

3. Duodenum: 8 to 10 inches long

4. Indications 1. Failed upper gastrointestinal endosocpy 2. Dyspepsia, Peptic ulceration, Gastritis ( Inflamation of stomach ) 3. Weight loss 4. Upper abdominal mass, Polyps 5. Gastrointestinal haemorrhage 6. Partial obstruction 7.Pyloric or cardiac stenosis Hiatus hernia ( Slipping of upper portion of stomach into esophageal hiatus )

5. • Gas producing agent swallowed (eg. Carbex) • Patient drinks barium whilst lying on left side • Patient lies supine & slightly on their right side • Check for reflux • Smooth muscle relaxant given to the patient • Buscopan (20mg iv) or Glucagon (0.3mg iv) • Patient rolls onto their right side & quickly over in a complete circle - finish in a RAO position • This has the effect of coating the gastric mucosa with barium Technique

6. Double-contrast techniques provide excellent detail of the mucosal surface of the stomach and duodenum

7. Patient Preperation

8. Adequate mucosal coating is achieved by the use of a high-density barium suspension. The type of barium used significantly affects the quality of the examination, as mucosal coating depends on the physical and chemical properties of the barium sulphate suspension. The best results are achieved using either high-density barium (200% wt/vol – i.e. E-Z-HD) or intermediate density (100% wt/vol) barium such as Baritop. Gaseous distension is required in order to distend normal folds and properly visualise the mucosa.

9. Spasmolytic drugs used during the double-contrast barium meal include glucagon and Buscopan (hyoscine N-butyl bromide). Glucagon produces gastric hypotonia within 45 s of the injection. It also tends to delay gastric emptying, allowing better views of the antrum and the body of the stomach. Buscopan produces transient hypotonia of stomach and duodenum. In addition, it causes pyloric relaxation, allowing excellent double-contrast views of the duodenum.

10. Control film

11. Duodenal cap