Fluoroscopic Investigations Fluoroscopic Investigations Of The Gastrointestinal Tract Of The Gastrointestinal Tract

Pharynx , Oesophagus and Pharynx , Oesophagus and stomachstomach

References

• Radiographic procedures: By Stephen Chapman• Positioning in Radiography: By k.C.Clarke.• Text book of radiographic positioning and related anatomy;bykenneth L.Bontrager.

Websites

• http://www.e-radiography.net/

Learning Learning ObjectivesObjectives

With the end of these lectures the With the end of these lectures the student will be able to:student will be able to: List common indications for ordering Ba swallow List common indications for ordering Ba swallow

/meal exam /meal exam Explain Ba swallow/meal exam limitationsExplain Ba swallow/meal exam limitations Explain the contraindications for using barium Explain the contraindications for using barium

sulphate in the examination of the oesophagus sulphate in the examination of the oesophagus and stomach.and stomach.

Describe the anatomy of the oesophagus and Describe the anatomy of the oesophagus and stomach and explain their functionstomach and explain their function

Describe room preparation and identify supplies Describe room preparation and identify supplies for Ba swallow and barium meal seriesfor Ba swallow and barium meal series

Describe how to perform barium swallow / mealDescribe how to perform barium swallow / meal Explain patient care, after completing the Explain patient care, after completing the

barium proceduresbarium procedures

Critique Ba swallow /meal radiographs Critique Ba swallow /meal radiographs in term of in term of positioning ,image quality, radiographic positioning ,image quality, radiographic anatomy ,and pathologyanatomy ,and pathology

What is the function of esophagus?

Transport of food by peristalsis.

Barium Swallows –IndicationsBarium Swallows –Indications Pain on swallowing Pain on swallowing Fistulae between trachea & Fistulae between trachea &

oesophagus oesophagus

(non-ionic c/a preferred) (non-ionic c/a preferred) Assessment of action of oesophagus Assessment of action of oesophagus following a stroke following a stroke

Oesophageal varices / DiverticulaOesophageal varices / Diverticula As part of a barium meal As part of a barium meal

investigation investigation Dysphagia Dysphagia Carcinoma / obstruction /Hiatus Carcinoma / obstruction /Hiatus

hernia hernia HemetemesisHemetemesis

Barium Swallow - TechniqueBarium Swallow - Technique

Patient is placed in the erect RAO Patient is placed in the erect RAO positionposition

Ample mouthful of barium is swallowed Ample mouthful of barium is swallowed & spot films are taken (rapid sequence) & spot films are taken (rapid sequence)

Spot films of the upper & lower Spot films of the upper & lower oesphagus are taken oesphagus are taken

May need rapid serial radiography May need rapid serial radiography sequencesequence

a series of plain films or uses fluoroscopy to identify any pathology

Barium Swallow - Typical film Barium Swallow - Typical film seriesseries

PositionPosition

DemonstratesDemonstrates

Erect RAO (35-40 degree)Erect RAO (35-40 degree) Esophagus between vertebral Esophagus between vertebral column & heartcolumn & heart

Erect LAOErect LAO Esophagus between hilar Esophagus between hilar region of lung & Thoracic region of lung & Thoracic

spinespine

Erect AP Erect AP Esophagus through Esophagus through superimposed thoracic superimposed thoracic

vertebraevertebrae

LateralLateral Entire esophagus between Entire esophagus between thoracic spine & Heartthoracic spine & Heart

Following Barium Swallow upper GI series may performed to diagnose pathology in the, stomach, and duodenum

Barium Swallow - TechniqueBarium Swallow - Technique

LimitationsLimitationsNot good for evaluating small ulcersNot specific for diagnosis of esophagitis

Barium Swallow Barium Swallow

(Normal Films)(Normal Films)

Figure1: Shows the lower end of a normal esophagus with a smooth connection

between the lower esophagus and stomach. Figure 2: Shows the lower end of the esophagus with a small

hiatus hernia, which occurs when a small portion of the stomach pushes

up into the chest.

Figure2 Figure1

Barium SwallowBarium Swallow

APAP RAORAO

Aftercare of the patientAftercare of the patient Patient given tissue to wipe & clean Patient given tissue to wipe & clean

mouthmouth

Patient aware of where & when to Patient aware of where & when to

obtain results.obtain results.

Patient given the chance to ask any Patient given the chance to ask any

questions. questions.

The patient should drink plenty of fluids and may need a laxative after the test because the barium can be constipating

Barium Swallow Barium Swallow

(Pathology Films)(Pathology Films)

AchalasiAchalasiaa

Distended esophagus with distil stricturedue to Achalasia - Failure of distil sphincter to relax – causing obstruction.

ACHALASIA

Esophageal SpasmEsophageal SpasmStricturesStrictures

CarcinomaCarcinoma

Tracheo - oesophageal fistula

Leaks of Leaks of contrastcontrast into the into the tracheatrachea

Normal Normal SwallowSwallow

StomachStomachBarium mealBarium meal

Stomach AnatomyStomach Anatomy

J-Shaped J-Shaped Continuous with Continuous with

Oesophagus & Oesophagus & duodenum duodenum

Three sectionsThree sections Fundus Fundus Body Body Pyloric Antrum Pyloric Antrum

Barium MealBarium Meal

Dyspepsia / reflux / Upper abdomen pain/ Nausea/ Weight loss Dyspepsia / reflux / Upper abdomen pain/ Nausea/ Weight loss Fullness or distension Fullness or distension Peptic ulceration (Peptic ulceration (defects in mucosa extending through muscularis

mucosae) Gastritis ( Inflammation of the stomach)Gastritis ( Inflammation of the stomach) Polyps Polyps Upper abdominal mass Upper abdominal mass Gastrointestinal haemorrhage Gastrointestinal haemorrhage Pyloric / cardiac stenosis Pyloric / cardiac stenosis Hiatus hernia ( Slipping of the upper portion of the stomach through the Hiatus hernia ( Slipping of the upper portion of the stomach through the

oesophageal hiatusoesophageal hiatus Partial bowel obstructionPartial bowel obstruction Assessment of site of perforation (Assessment of site of perforation (What type of contrast to use?) What type of contrast to use?)

Contra-indications: Contra-indications: Complete bowel obstructionComplete bowel obstruction

IndicationsIndications

Barium meal Barium meal Contrast media & patient Contrast media & patient

preparationpreparation High density, low viscosity barium High density, low viscosity barium

Nil orally for 6 hours prior Nil orally for 6 hours prior

Explanation of procedure Explanation of procedure

Physical & psychological preparation Physical & psychological preparation

No smoking (>gastric motility) No smoking (>gastric motility)

Check for contra-indications to pharmacological Check for contra-indications to pharmacological

agentsagents

( What are the contra indication for ( What are the contra indication for Buscopan?)Buscopan?)

Barium Meal InvestigationBarium Meal Investigation Can perform double (COCan perform double (CO22 & Barium) or & Barium) or

single contrast examinationssingle contrast examinations Single contrast examinations are used Single contrast examinations are used

in paediatrics & grossly ill patientsin paediatrics & grossly ill patients Double contrast examinations - Double contrast examinations -

demonstrate mucosal pattern demonstrate mucosal pattern Equipment should contain ability to Equipment should contain ability to

perform spot film images.perform spot film images.

Barium meal - TechniqueBarium meal - Technique Gas producing agent swallowed (eg. Carbex)Gas producing agent swallowed (eg. Carbex) Patient drinks barium whilst lying on left side Patient drinks barium whilst lying on left side Patient lies supine & slightly on their right Patient lies supine & slightly on their right

side side Check for reflux Check for reflux Smooth muscle relaxant given to the patient Smooth muscle relaxant given to the patient

Buscopan (20mg iv) or Glucagon (0.3mg iv)Buscopan (20mg iv) or Glucagon (0.3mg iv) Patient rolls onto their right side & quickly Patient rolls onto their right side & quickly

over in a complete circle - finish in a RAO over in a complete circle - finish in a RAO position position

This has the effect of coating the gastric This has the effect of coating the gastric mucosa with barium mucosa with barium

Barium meal - Typical film Barium meal - Typical film seriesseries

RARAOOStomach and C-loop of the duodenum with duodenal bulb Stomach and C-loop of the duodenum with duodenal bulb in profilein profile

Barium meal - Typical film Barium meal - Typical film seriesseries

PA (Prone)PA (Prone)

Duodenal loop + duodenal with body and pylorus Duodenal loop + duodenal with body and pylorus filled with barium filled with barium

Barium meal - Typical film Barium meal - Typical film seriesseries

Right Right laterallateralRetro gastric Retro gastric space space

Barium meal - Typical film Barium meal - Typical film seriesseries

AP (supine)AP (supine)

Entire stomach and duodenum + Fundus of stomach filled Entire stomach and duodenum + Fundus of stomach filled with barium with barium

Barium meal - Typical film Barium meal - Typical film seriesseriesLPLP

OODuodenum Bulb without superimposition with the Duodenum Bulb without superimposition with the pylorus + Fundus of stomach filled with barium pylorus + Fundus of stomach filled with barium

LALAOOLesser curveLesser curve

Prone , RAO, LAO , Supine, ErectProne , RAO, LAO , Supine, ErectDuodenal Cap series Duodenal Cap series

Note : In the erect position the Fundus of the stomach is filled with airNote : In the erect position the Fundus of the stomach is filled with air

Barium meal ( Normal Barium meal ( Normal

anatomy)anatomy)

Barium meal ( Normal Barium meal ( Normal

anatomy)anatomy)

(3) greater curvature (4) lesser curvature (5) fundus (6) small bubble of gas. (7) pyloric region (8) second part of the duodenum

PYLORIC STENOSISPYLORIC STENOSIS

( Patholo( Patholo

gy)gy)

GASTRIC CARCINOMAGASTRIC CARCINOMA

( Patholo( Patholo

gy)gy)

Hiatus Hiatus HerniaHernia

*Note distended distil esophagus with herniation of gastric fundus into chest through esophageal hiatus.

NormalNormal

DIAPHRAGM

( Patholo( Patholo

gy)gy)

DUODENAL ULCER

( Patholo( Patholo

gy)gy)

Thank you

Any Questions?