Transcript Performing a Barium meal - University of the Free State

PERFORMING A BARIUM
MEAL
Department of Diagnostic Radiology
23 March 2012
M. Pieters
Anatomy of the stomach
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J-shaped
Varies in size and shape
Stomach in situ
Anatomy of the stomach
Anatomy of the stomach
Layers of the stomach
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Three muscle layers, three mucosal layers
Arterial supply
Coeliac
artery
Common hepatic
artery
Posterior relations
Posterior relations
Anterior relations
Lesser sac
Venous drainage
Lymph drainage of the stomach
Stomach innervation
Barium meal
Indications
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Dyspepsia
Weight loss
GIT haemorrhage
Failed upper GIT endoscopy
Assessment of perforation site
Upper abdominal mass
Unexplained iron deficiency anaemia
Partial obstruction
Contra-indications
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Complete large bowel obstruction
Complications
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Aspiration
Intra-peritoneal leakage
Ba appenticites
Contrast agents
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Barium Sulphate eg. E-Z HD 250%
Carbex granules
Patient preparation
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NPO 6hrs prior
History – no pharmacological contra-indications
Technique (Double contrast)
Position
Film
Action
Reasoning
Visualization
Erect/sitting
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Pt drinks
fizzing agent
To distend the
stomach
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On left side
Screen
Pt drinks
barium
Delays
passage to
duodenum
Greater curve
Supine, tilted
to the right
side
Screen
Cough or
swallow H2O
Ba flows to
GE-junction
Observe for
reflux
Unchanged
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IV muscle
relaxant
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Roll to right,
complete
circle, end
supine, left tilt
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Coating of the
gastric mucosa
Technique (Stomach Spot Films)
AP
Position
Film
Action
Reasoning
Visualization
Supine, tilted
to the left
RAO
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Antrum and
greater curve
Supine
PA
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Antrum and body
Supine, tilted
to the right
LAO
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Lesser curve en
face
On right side,
head up 45o
Left lateral
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Fundus
Technique (Duodenal Spot Films)
Position
Film
Action
Reasoning
Visualization
Return to supine,
on left side, then
prone
AP
Pt on
compression
pad
Avoid Ba
flooding
duodenal loop
AP of the Duodenal
loop
Roll to right side, RAO
supine, then
supine tilted to
the left
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Avoid Ba
flooding
duodenal loop
RAO of the
Duodenal cap
Turn supine
(shortest route)
PA
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PA of the Duodenal
cap
Lie supine and
tilted to the
right
LAO
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LAO of the
Duodenal cap
Technique (Erect Views)
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Fundal lesion suspected
Position
Film
Visualization
Erect
PA
Fundus
Erect
RAO
Duodenal cap and
Fundus
Erect
LAO
Duodenal cap and
Fundus
Technique (Oesophageal views)
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Barium swallow to conclude exam
Either spot films or dynamic screening
Position
Film
Visualization
Erect
RAO
Oesophagus
Bibliography
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A Guide to Radiological Procedures 5th ed - Aitchison
Diagnostic and Surgical Imaging Anatomy: Chest.Abdomen.Pelvis - Federle
Anatomy for Diagnostic Imaging 3rd ed – Ryan
Atlas of Human Anatomy 5th ed – Netter
Atlas of anatomy – Gilroy
Web references:
http://www.Instantanatomy.net
http://www.Dartmouth.edu
http://www.individual.utoronto.ca/ecolak/gi_techniques/techniques
/ugi/frame_set.htm