Transcript Upper Gastro-Intestinal Series

Stomach & Barium Meal
RT-205B MIDTERM
What is a stomach?
Stomach
• A dilated, saclike portion of the digestive tract
extending between the esophagus and the
small intestine.
• Serves as the reservoir for swallowed food and
fluid.
• It has an entrance valve and exit valve of food
materials
– Esophageal Sphincter
– Pyloric Sphincter
• The stomach is about 12
inches (30.5 cm) long and is
6 inches. (15.2 cm) wide at
its widest point. The
stomach's capacity is about
1 qt (0.94 liters) in an adult.
4 – layers of stomach
• Covering layer, the serosa
• Muscular layer consisting of
oblique, circular, and longitudinal
fibers
• Sub-mucus layer
• Thick, soft mucosal lining(rugae)
4 – division of stomach
1.Cardia
2.Fundus
3.Body
4.Pyloric portion
Parts of the Stomach
• Cardia
– is the section immediately surrounding the
esophageal opening.
• Fundus
– is the superior portion of the stomach that expands
superiorly and fills the dome of the left diaphragm.
• Body
– descending from the fundus and beginning at the level
of the cardiac notch.
• Pyloric portion
– distal part of the stomach.
– Consist of the – pyloric vestibule and pyloric antrum.
Stomach
Barium Meal/Upper GI series
• Radiographic examination of
the distal esophagus, stomach,
and duodenum with the use of
radiolucent and radiopaque
contrast medium.
Function
• To study radiographically the
form and function of the distal
esophagus, stomach, and
duodenum, as well as to
detect abnormal anatomical
and functional conditions.
Indications
• Peptic ulcer
• Hiatal hernia
• Acute or chronic gastritis
• Tumor, carcinoma and benign
• Diverticulum
• Bezoars
Clinical Indication
• Peptic Ulcer - Erosions of the
stomach or duodenal mucosa due
to various physiological or
environmental conditions, such
as excessive gastric secretions,
stress, diet and smoking.
Clinical Indications
• Hiatal Hernia
– portion of stomach will herniate through
the diaphragmatic opening.
• Gastritis
– Inflammation of the lining or mucosa of the
stomach.
• Tumor
– Small mass growing from the mucosal wall.
Clinical Indications
• Diverticula
–are a weakening and out-pouching
of a portion of the mucosal wall.
• Bezoar
–mass of undigested material that
gets trapped in stomach.
Contraindications:
• Patient has a history of bowel
perforation, laceration, or viscous
rupture, the use of barium sulfate
may be contraindicated.
• Complete large bowel
obstruction
If suspected for perforation
• For the assessment of the site
of perforation it is essential
that a water-soluble contrast
media is used (ex. LOCM or
Non-ionic contrast media)
Patient Preparation
Patient Preparation:
A. Soft, low-residue diet for 2 days(to prevent gas
formation)
B. The day before – patient should be NPO or
cleansing enemas may be given to assure a
properly clean colon.
C. Food and fluids should be withheld for at least
8 to 9 hours prior to examination.
D. Patient is not allowed to smoke cigarettes or
chew gum during NPO period.
E. To x-ray department for examination
2 – General GI – examination
Technique are used
• single contrast
method
• double contrast
method
2 – General GI – examination
Technique are used
• Double contrast – the method of choice
to demonstrate mucosal pattern.
• Single contrast – uses;
– Children – since it usually is not necessary
to demonstrate mucosal pattern
– Very ill adults – to demonstrate gross
pathology only.
Different type of Examination of the GI
tract
• Biphasic examination
– combination of single and double contrast.
• Hypotonic Duodenography
– requiring intubation
– used for evaluation of postbulbar duodenal
lesions and for the detection of pancreatic
disease.
– Described by Liotta.
Position of Patient: Stomach
• RAO – to demonstrate the antrum and greater
curve
• SUPINE – to demonstrate the antrum and
body
• LAO – to demonstrate the lesser curve en face
• Left lateral tilted, head up 450 – to
demonstrate the fundus
Cont…
• From the left lateral position the patient
returns to supine position and rolls into his
left side and over into a prone position.
– This sequence of movement is required to avoid
barium from flooding into the duodenal loop.
• Duodenal loop
– Prone – patient is lies on a compression pad to
prevent barium from flooding into duodenum
– RAO – additional view of anterior wall of the
duodenal loop
Spot films of the duodenal cap
• Prone
• RAO – the patient attains the is
position from the prone position by
rolling first onto the left side, for the
reasons mentioned.
• Supine
• LAO
Additional views
• Erect position – demonstrate the
fundus if there are suspected
lesions.
• Spot film of the esophagus are
taken, while barium is being
swallowed, to complete the
examination.
Different Variations
Position of Patient: Stomach
• Upright PA projection (14x17)
– To demonstrate the type and relative pos. of the
stomach.
• Upright left lateral position
– Demonstrate the left retrogastric space
• Recumbent PA projection
– demonstrate gastroduodenal surfaces
– CR angled 20 – 25degs cephalic – infants
– 35 – 45degs cephalic - adults
Cont…
• One or more Recumbent RAO positions
– gastric peristalsis is usually more active in this
position.
• A right lateral position is used to demonstrate
the duodenal loop in profile, duodenojejunal
junction, & right retrogastric space.
• Recumbent AP projections,
– 11x14 films demonstrate the retrogastric portion
of the duodenum and jejunum.
Modification of technique for young
children
• The examination is modified to identify the
three major causes of vomiting – gastroesophageal reflux, and pyloric obstruction.
– Single contrast technique is used with 100%
barium and no paralytic agent.
– Small volume of barium – enough to just fill the
fundus in a supine position
– Child is in semi prone into a LPO or RAO. A better
advantage if 20-400 caudal.
Cont…
• Once barium enters the duodenum, the infant is
returned to supine position and a radiograph is
taken with child supine perfectly still as barium
passes around the duodeojejunal flexure.
• Once malrotation is diagnosed or excluded, a
further volume of barium is administered until
the stomach is reasonably full.
– The child is rotated 180 to elicit gastro-esophageal
reflux
After Care
• Patient is advised to drink lots of
water and expect to have a white
fecal.
• Laxative should be taken to
totally remove the barium to
avoid barium impactions, which is
painful
Complications
• Leakage of barium from an
unsuspected perforation
• Aspiration
• Conversion of partial large bowel
obstruction to a complete
obstruction by impaction of
barium
Radiographic Contrast of the stomach:
Bezoar of the stomach:
Small Intestine
Small Intestine
• Small Bowel Series
– Radiographic study specifically of the small
intestine.
• Purpose:
– to study the form and function of the 3 –
components of the small bowel, as well as to
detect any abnormal conditions.
3 Divisions of a small intestine
Clinical Indication
• Enteritis or gastroenteritis
• Neoplasm
• Malabsorption syndromes
• Ileus
Cont…
• Enteritis
– term describing the inflammation or infection of the small
bowel.
• Neoplasm
– describing “new growth”.
– This new growth may be benign or malignant.
• Malabsorption Syndromes
– GI tract is unable to process and absorb certain nutrients.
– Sbs – mucosa may appear to be swollen or thickened due
to the content irritation.
• Ileus
– obstruction of the small intestine.
2 – types of Ileus
• Adynamic or Paralytic
–due to the cessation of peristalsis
• Mechanical obstruction
–physical blockage of the bowel.
–(ex. tumor, adhesions, or hernias)
2 – strict contraindications
• Pre-surgical patients &
suspected a perforated hollow
viscous.
• Possible large bowel
obstruction.
Procedures:
• 4 – methods
1. UGI – Small bowel combination
2. Small bowel series
3. Enteroclysis
4. Intubation method
UGI – Small bowel combination
• Basic Routine:
– routine UGI – Series
– note time patient ingested 1st cup(8 oz) of barium.
– Ingested 2nd cup of barium
– 30 min. PA – radiograph
– ½ hour interval radiographs( iliac crest – center)
– until barium reaches large bowel (usually 2 hrs.)
• 1 hr. interval radiographs, if more time is
needed after 2 hours
Small Bowel Series
• Basic Routine:
– plain abdomen radiograph (scout)
– 2 cups (16 oz) of barium ingested ( note time)
– 15 – 30 min. radiograph
– ½ hour interval radiographs until barium reaches
large bowel (2hrs)
– 1 hour interval radiographs, if more time is
needed.
Enteroclysis – SBS
• Basic Routine:
– Thru the nose, an intubation into the duodenum
– barium sulfate suspension is instilled
– air or methylcellulose is instilled
– fluoroscopic spot films & conventional
radiographs are taken.
– Upon successful completion of exam, intubation
tube is removed.
Intubation method – SBS
• Basic Routine:
– A tube inserted in the mouth until to the
duodenum
– contrast media instilled
– note time that contrast media is instilled
– 15 – 30 min. radiographs
– radiologist will specify filming sequence after 2
hrs.
Barium filled small intestine
Enteroclysis
Positioning
Stomach and Duodenum
PA projection
• Film: 10x12 in lengthwise for recumbent
projections
• 11x14 in or 14x17 lengthwise for upright
study.
• PT is in recumbent position or upright position
• Center the film longitudinally at the level of L2
(midway between the xiphoid process and
umbilicus)
Cont…
•Central ray
–Direct it perpendicularly
to the midpoint of the
cassette at the level of L2
Stomach: RAO
• Film: 10x12 lengthwise
• Pt position is in a recumbent position
• Position approximately 40 to 700 required to give
the best image of the pyloric canal and
duodenum depends on the size and shape of the
stomach.
• Central ray:
– Perpendicularly midway between the vertebral
column and the lateral border of the abdomen at
approximate level of L2