Fluoroscopic Investigations
Of The Gastrointestinal Tract
Pharynx , Oesophagus and stomach
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 Objectives
With the end of these lectures the student
will be able to:
List common indications for ordering Ba swallow /meal exam
Explain Ba swallow/meal exam limitations
Explain the contraindications for using barium sulphate in the
examination of the oesophagus and stomach.
Describe the anatomy of the oesophagus and stomach and explain
their function
Describe room preparation and identify supplies for Ba swallow
and barium meal series
Describe how to perform barium swallow / meal
Explain patient care, after completing the barium procedures
Critique Ba swallow /meal radiographs in term of positioning
,image quality, radiographic anatomy ,and pathology
What is the function of esophagus?
Transport of food by peristalsis.
Barium Swallows –Indications
Pain on swallowing
Fistulae between trachea & oesophagus
(non-ionic c/a preferred)
Assessment of action of oesophagus following a
stroke
Oesophageal varices / Diverticula
As part of a barium meal investigation
Dysphagia
Carcinoma / obstruction /Hiatus hernia
Hemetemesis
Barium Swallow - Technique
a series of plain films or uses fluoroscopy to identify
any pathology
Patient is placed in the erect RAO position
Ample mouthful of barium is swallowed & spot
films are taken (rapid sequence)
Spot films of the upper & lower oesphagus are
taken
May need rapid serial radiography sequence
Barium Swallow - Typical film series
Position Demonstrates
Erect RAO (35-40 degree) Esophagus between vertebral column
& heart
Erect LAO Esophagus between hilar region of
lung & Thoracic spine
Erect AP Esophagus through superimposed
thoracic vertebrae
Lateral Entire esophagus between thoracic
spine & Heart
Barium Swallow - Technique
Following Barium Swallow upper GI series
may performed to diagnose pathology in
the, stomach, and duodenum
Limitations
Not good for evaluating small ulcers
Not specific for diagnosis of esophagitis
Barium Swallow
(Normal Films)
Figure2 Figure1
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.
Barium Swallow
AP RAO
Aftercare of the patient
Patient given tissue to wipe & clean mouth
Patient aware of where & when to obtain results.
Patient given the chance to ask any questions.
The patient should drink plenty of fluids and
may need a laxative after the test because
the barium can be constipating
Barium Swallow
(Pathology Films)
Achalasia
ACHALASIA
Distended esophagus with distil stricture
due to Achalasia - Failure of distil sphincter
to relax – causing obstruction.
Strictures Esophageal Spasm
Carcinoma
Tracheo - oesophageal fistula
Leaks of contrast
Normal Swallow
into the trachea
Stomach
Barium meal
Stomach Anatomy
J-Shaped
Continuous with
Oesophagus & duodenum
Three sections
Fundus
Body
Pyloric Antrum
Barium Meal
Indications
Dyspepsia / reflux / Upper abdomen pain/ Nausea/ Weight loss
Fullness or distension
Peptic ulceration (defects in mucosa extending through muscularis
mucosae)
Gastritis ( Inflammation of the stomach)
Polyps
Upper abdominal mass
Gastrointestinal haemorrhage
Pyloric / cardiac stenosis
Hiatus hernia ( Slipping of the upper portion of the stomach through the
oesophageal hiatus
Partial bowel obstruction
Assessment of site of perforation (What type of contrast to use?)
Contra-indications:
Complete bowel obstruction
Barium meal
Contrast media & patient preparation
High density, low viscosity barium
Nil orally for 6 hours prior
Explanation of procedure
Physical & psychological preparation
No smoking (>gastric motility)
Check for contra-indications to pharmacological agents
( What are the contra indication for Buscopan?)
Barium Meal Investigation
Can perform double (CO2 & Barium) or single
contrast examinations
Single contrast examinations are used in paediatrics
& grossly ill patients
Double contrast examinations - demonstrate
mucosal pattern
Equipment should contain ability to perform spot
film images.
Barium meal - 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
Barium meal - Typical film series
RAO
Stomach and C-loop of the duodenum with duodenal bulb in profile
Barium meal - Typical film series
PA (Prone)
Duodenal loop + duodenal with body and pylorus filled with barium
Barium meal - Typical film series
Right lateral
Retro gastric space
Barium meal - Typical film series
AP (supine)
Entire stomach and duodenum + Fundus of stomach filled with barium
Barium meal - Typical film series
LPO
Duodenum Bulb without superimposition with the pylorus + Fundus of
stomach filled with barium
LAO
Lesser curve
Prone , RAO, LAO , Supine, Erect Duodenal Cap series
Note : In the erect position the Fundus of the stomach is filled with air
Barium meal ( Normal anatomy)
Barium meal ( Normal anatomy)
(3) greater curvature (4) lesser curvature (5) fundus (6) small bubble
of gas. (7) pyloric region (8) second part of the duodenum
( Pathology)
PYLORIC STENOSIS
( Pathology)
GASTRIC CARCINOMA
( Pathology)
*Note distended
distil esophagus
with herniation of
gastric fundus into
chest through
esophageal hiatus.
Normal Hiatus Hernia
( Pathology)
DUODENAL ULCER
?
Any Questions
Thank you
