Barium meal and BMIT radiology studentss

Radiology representative

1. BARIUM MEAL AND BMFT

2. Barium meal Barium meal is the radiological study of oesophagus,stomach,duodenum and proximal jejunum by oral administration of contrast media.

3. ANATOMY STOMACH DUODENUM

4. Abdominal mass

5. Gastro-intestinal Hemorrhage

6. G astric and Duodenal obstruction

7. MALIGNANCY

8. D iseases such as tuberculosis of upper GIT tract

9. Motility disease of GI tract Achalasia of Esophagus

10. Gastro- Oesophageal Reflux

11. Pyloric Obstruction

12. Contraindications Suspected cases of gastro-duodenal perforation

13. History of aspiration

14. Large Bowel O bstruction

15. Fistulous communication with any other organ other than G.I.T

16. Recent biopsy from G.I.T

17. Preparation Patient should not eat or drink for 6hrs

18. Restrain from smoking

19. Fasting is harmful for diabetic patients. Hence early morning appointment has to be arranged.

20. In patients with gastric outlet obstruction, prolonged fasting or intravenous Metoclopramide may be necessary.

21. Contrast media Single contrast study Low density barium suspension(80%-100%w/v)is used.30%w/v suspension is used for high kV single contrast study Double Contrast Study High density(250%w/v),low viscosity barium suspension is used to produce best mucosal coating and hence detail

22. Single contrast technique

23. Single contrast study In erect position, fluoroscopy is done to visualize both domes of diaphragm and lung bases.

24. Patient is asked to swallow 10-15ml of 80-100 %w/v barium suspension while esophagus is seen under fluoroscopy.

25. The table is made horizontal and patient is asked to rotate with right side going up

26. Radiography is done to see mucosal relief.

27. Mucosal Relief

28. Patient is kept supine and 100-250ml of barium is given.

29. Spot films of filled fundus is taken

30. Patient is turned prone oblique right side down so that barium enters duodenum.

31. Spot films for duodenal bulb and C loop is taken in both distended and empty states.

32. C loop of duodenum

33. With patient in supine position and table in erect position, spot films are taken in anterior oblique position .

34. Erect oblique position-single contrast Rugal folds 2. Duodenal C loop

35. In erect position, right anterior oblique view of stomach shows incisura angularis. Proximal jejunum is also seen well.

36. More barium is given to distend stomach wall. Graded compression is given to see mucosal folds and spot films are taken.

37. Patie nt is rotated to observe all margins of stomach .

38. To evaluate retro gastric space,200-250ml of barium is given

39. Then in supine position,translateral is taken.

40. Barium in the esophagus (A) Diaphragmatic sphincter is clearly seen (B) Entered the fundus and displaced the Air-bubble (C) Rugal folds of the body of the stomach (D) Supine Oblique view- single contract

41. Single contrast high kVp technique Barium sulphate 30% w/v is used. Radiography is done at 120-130 kV. This permits visualization through the barium column so that lesions will not be drowned by the low density barium.

42. Advantages Optimum for patients who are immobile or unable to swallow gas forming tablets. Pylorospasm,fistulae and rugae are best seen. Pylorospasm Rugae

43. Demonstration of Rugal folds

44. Filling defects due to large masses are more identifiable

45. Procedure of choice to examine patients with suspected gastric or duodenal obstruction.

46. Disadvantages Lack of sensitivity in detecting small erosion or ulceration, superficial, gastric carcinomas and mucosal abnormalities.

47. Double contrast barium study Preparation A dry free fluid free stomach is essential since secretion prevent adequate mucosal coating and mimic tumor.

48. Gas forming Agents Sodium bicarbonate and citric acid are given orally. Eno, fruit salt and gastrovision through Ryle’s tube.

49. Smooth Muscle Relaxants Hyoscine when given intravenously (1ML20MG) produces good distension of stomach and bowel by smooth muscle relaxation and produces effacement of mucosal folds.

50. Technique Injection buscopan IV is given before giving barium to study stomach. To study stomach and duodenum, injection buscopan is given when barium enters duodenum

51. 100-150 ml of high density low viscosity barium is given.

52. Gas forming agents are given.

53. Patient is asked to rotate and filming is taken in standard views.

54. Supine position-double contrast

55. Advantages Highly accurate method of detecting abnormalities following Gastric surgery

56. Bile reflux gastritis

57. Marginal ulceration

58. Recurrent carcinomas

59. Disadvantages Misses some polps, ulcers, erosions, superficial carcinoma.

60. After care

61. The patient should be warned that his bowel motion will be white for few days Patient must not leave the department until blurring of vision is resolved.

62. BARIUM MEAL FOLLOW THROUGH

63. SMALL INTESTINE Extends- pylorus of stomach to caecum. 6.5m in length 3 parts:- Duodenum Jejunum Ileum

64. DUODENUM Proximal fixed part 10 inches(25 cm) 4 parts Retroperitoneal structure Level- L1,L2,L3

65. ILEUM JEJUNUM 3.5m long 2.5m long location:- Left n upper part of abdomen location:- lower Rt. portion of abdomen Wall- thicker, more vascular Wall- thinner, less vascular Mucosal folds- more (4-7/cm) Mucosal folds- less (3-5/cm) Villi- long n leaf like Villi- shorter

66. BMFT Radiographic examination of the GIT- esophagus, stomach, small intestine upto ileo-caecal junction. Performed after a barium meal examination .

67. INDICATIONS Crohn’s disease Suspected small bowel obstruction-foreign body, tumors, volvulus. Suspicion of small bowel disease-Abdominal pain and diarrhea. Failed nasogastric intubation. Elderly patients with suspected jejunal diverticulosis.

68. Contrast media Medium density barium suspension (50-60% w/v) High density not used as it may produce appearance of fold thickening, clumping in small bowel. Gastrograffin- used in case of small bowel obstruction.

69. preparation Colon should be cleaned with purgative like Dulcolax 2tabs HS Low roughage diet, high intake of fluids- 48hrs prior to investigation. No food, fluids taken- 12hrs prior to investigation. Tranquilizers, antispasmodics stopped 48hrs prior to investigation. Empty bladder prior to procedure.

70. Technique 10-15 ml of 80-100 % barium suspension is given Patient is made to rotate in a continuous clockwise manner – mucosal relief film 600-900 ml of 50-60 % of barium administered. Positioning Purpose Right side down dependent(RPO) Duodenal bulb and C loop Prone Separate bowel loops Supine right side up(LPO) For ileo-caecal junction

71. D cap n C-loop Separate bowel loops ileo-caecal junction

72. Double contrast technique Same as single contrast study Gas producing agent should be given when Ba reaches the caecum Patient is slightly left side head down position Gas to leave the stomach and enter the small bowel

73. Peroral pneumocolon It is done at the end of BMFT when terminal ileum is suspicious and needs clarification . It is mainly to evaluate distal ileum Preparation colonic preparation is similar to Ba enema .

74. Technique Ba is administrated orally. When Ba has reached the Rt. and proximal traverse colon, air is insufflated into the rectum and refluxed into distal ileum. Glucagon can be used to relax the ileocaecal valve .

75. Retrograde small bowel examination Ba and air refluxed through the ileoceacal valve during a Ba enema examination may be used to examine the small bowel.

76. Advantages A routine overhead radiograph following use of the pneumocolon technique for SBM examination can yield unsuspected & clinically significant colonic findings.

77. Overlap of contrast filled bowel loops in pelvis can be overcome by -table head down -30 degree caudal view of pelvis -emptying the UB Gastric and bowel peristalsis may be increased by - metoclopramide, glucagon - 20-40 ml of sodium/meglumine diatrozate to barium reduces transit time - use of cold water to dilute barium

78. ADVANTAGES Easily performed No discomfort to patient Physiological process DISADVANTAGES Overlap of contrast filled bowel loops in pelvis Poor distension of loops Operator dependence Time consuming

79. complications Leakage of barium from an unsuspected perforation Aspiration Conversion of partial large bowel obstruction into complete obstruction by barium impaction. Barium appendicitis. Side effects of pharmacological agents used .

80. References Textbook of Radiological procedures by Dr.bhushan N lakhkar Chapman Nakienly’s Guide to Radiological Procedures