barium meal .pptx

barium meal

1. BARIUM MEAL DR. PRADIP PATIL Prof. department of Radio-diagnosis, DY Patil medical college, hospital & research institute Kolhapur

2. Anatomy of the stomach

3. Layers of the stomach

4. Barium meal It is the radiological study of oesophagus, stomach, duodenum and proximal jejunum. It is done by oral adminstration of contrast media(barium sulphate).

5. Indications

6. SYMPTOMS WHICH PROMPTS BARIUM MEAL STUDY Epigastric pain suggestive of peptic ulceration Anorexia Weight loss Vomiting Anemia Heart burn Dyspepsia

7. Contraindications Complete large bowel obstruction Suspected gastro-duodenal perforation (unless water soluble contrast medium used) Aspiration Fistulous communication with organ other than parts of GIT Recent biopsy from GIT, as barium granuloma may form at biopsy site.

8. Patient preparation Fasting for 6 hours / overnight fasting Avoid cigarette smoking as it may interfere with optimum coating of the mucosa. In patients with Gastric outlet obstruction- prolonged fasting , or I.V metoclopramide , NG intubation, aspiration of the contents may be necessary.

9. Barium meal investigations C an perform double ( co2 and barium ) or single contrast examinations . S ingle contrast- using high density and big amount of barium suspension alone to fill the stomach and duodenum. D ouble contrast- using low density and small amount of barium suspension with air to coat the wall of stomach and duodenum. B i-phasic contrast- it combines both types in one procedure.

10. Technique Barium suspension is given and patient is made to swallow while esophagus is seen under fluoroscopy. The table is made horizontal, and the patient lying supine is rotated with the right side going up A good coating of the entire stomach is thus obtained and radiography is done to show the mucosal relief . The patient is kept supine and about 100-250 ml of barium is given. Spot films of filled fundus in varying obliquity may be taken if any abnormality is detected. Patient is turned prone oblique right side dependent, in this position barium enters the duodenum through the pylorus . Spot films for duodenal bulb and C loop can be taken after adjusting the obliquity to avoid overlap. Patient is then turned supine and table is made erect , spot films for duodenal bulb and C loop are taken in right anterior oblique position . More barium is given, the gastric peristalsis and rate emptying through the pylorus is observed. The patient is rotated under fluoroscopy to observe all margins of the stomach . To evaluate the retrogastric space , about 200-250 ml of barium is given, in supine position, translateral film is taken to demonstrate the retrograde space.

11. CONVENTIONAL SINGLE CONTRAST STUDY ADVANTAGES : Pylorospasm , Fistulae, enlarged Gastric rugae are best seen filling defects due to large mass are easily Identifiable suspected gastric or duodenal obstruction are well seen DISADVANTAGES: Lack of sensitivity in detecting small erosion/ linear ulceration, superficial gastric carcinomas, subtle mucosal abnormalities

12. Technique 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

13. Technique ( D ouble contrast )

14. Anteroposterior

15. Right anterior oblique ( rao )

16. Left posterior oblique(LPO)

17. lateral

18. Left anterior oblique ( lao )

19. Pa axial

20. SINGLE CONTRAST HIGH kV 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 drowned by the low density barium. Adequate mucosal relief is not possible with such low density barium.

21. DOUBLE CONTRAST BARIUM STUDY 100- 150 ml of high density low viscosity barium is given. Injection buscopan is given just before giving barium to study stomach. To study the stomach &duodenum, Buscopan is given when barium enters the duodenum . Gas forming agents (sodium bicarbonate, citric acid) Patient is rotated slowly for mucosal coating, beginning from supine to right lateral to prone to left lateral and back to supine Filming of various parts of stomach and duodenum is done with standard views The table may have to be tilted 30* headup /head low to attain maximum distension of the part to be filmed.

22. SINGLE CONTRAST(SC) DOUBLE CONRAST(DC) FUNDUS supine erect with two views 90degree to each other or prone right side down BODY erect or prone supine with 60degree head end ANTRUM AND PYLORUS Prone right side down Supine right side up D1 AND C LOOP OF DUODENUM Prone right side down Supine right side up D4 OF DUODENUM supine Prone right side down

23. ADVANTAGES Single contrast Optimal for patients who are immobile or unable to swallow gas forming tablets. Pylorospasm , fistulae and enlarges gastric rugae are best seen. Filling defects due to large masses in pyloric and duodenal region are more easily identifiable by single contrast study. Procedure of choice to examine patients with suspected gastric or duodenal perforation. Double contrast highly accurate method of detecting abnormalities following gastric surgery, bile reflux gastritis, marginal ulceration, recurrent carcinomas, abnormalities of the efferent loop.

24. DISADVANTAGES SINGLE CONTRAST Lack of sensitivity in detecting small erosion/linear ulceration, superficial gastric carcinomas and subtle mucosal abnormalities . DOUBLE CONTRAST probably misses polyps, ulcers, erosions, superficial carcinomas.

25. BIPHASIC STUDY Best and most accurate method of evaluation of upper GIT. Has good anatomic and physiologic information Good accuracy compared to endoscopy. GOAL is to have mucosal delineation in double contrast phase and full column distension in single contrast phase. 200-250 ml of 60-100% low viscosity barium is given orally with gas forming powder in the last few mouthfuls.

26. Normal barium meal – single contrast

27. Normal barium meal-double contrast

28. Barium meal, double contrast showing- contrast filled outpouching at greater curvature – malignant gastric ulcer

29. Technique ( S tomach spot Films)

30. RAO Antrum and greater curvature

31. Technique ( Duodenal Spot films)

32. LAO of the D uodenal cap

33. Technique ( Erect views)

34. Technique (Oesophageal views)

35. AFTERCARE The patient should be warned that his bowel motion will be white for few days after the examination and to keep his bowel laxative to avoid barium impaction which can be painful. The patient must not leave the department until any blurring of vision produced by buscopan has resolved.

36. COMPLICATIONS: Peritonitis. Aspiration pneumonia. Barium impaction-converts a partial large obstruction into a complete obstruction. Gastric dilatation. Barium embolisation if a bleeding ulcer is present.

37. Double-contrast : Thickened, lobulated folds are present in the body and antrum of the stomach Double-contrast : Nodular fold thickening is present in the gastric antrum.

38. Double-contrast : Multiple small, round filling defects (mounds of edema) containing a small central collection of barium (erosion or tiny ulceration) are present in the gastric antrum and body.

39. Findings Single-contrast : An ulcer crater is located along the lesser curvature of the gastric antrum. Symmetric and smoothly contoured folds radiate to the crater. The mound of edema is smooth in contour, and the crater is located centrally within the mound. 

40. Findings Double-contrast: An ulcer crater is present on the greater curvature of the stomach. A smooth mound of edema surrounds the centrally located ulcer. The crater does not extend beyond the normal gastric lumen contour. 

41. Carman meniscus sign in malignant gastric ulcer

42. Findings Single-contrast : An ulcer crater is seen on this tangential view of the gastric antrum. A Hampton line (arrow) is seen at the base of the crater.

43. Findings Double-contrast: A polypoid irregular surface filling defect (arrowhead) is present in the gastric fundus and cardia. 

44. Single-contrast : The gastric antrum is markedly narrowed by a large constricting mass. Enhanced abdominal CT. A large polypoid mass is seen arising from the anterior wall of the gastric antrum. 

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