performing a barium meal department of diagnostic radiology 23 march 2012 m. pieters
TRANSCRIPT
PERFORMING A BARIUM MEAL
Department of Diagnostic Radiology
23 March 2012
M. Pieters
Anatomy of the stomach
J-shaped Varies in size and shape
Stomach in situ
Anatomy of the stomach
Anatomy of the stomach
Layers of the stomach
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
Dyspepsia Weight loss GIT haemorrhage Failed upper GIT endoscopy Assessment of perforation site Upper abdominal mass Unexplained iron deficiency anaemia Partial obstruction
Contra-indications
Complete large bowel obstruction
Complications
Aspiration Intra-peritoneal leakage Ba appenticites
Contrast agents
Barium Sulphate eg. E-Z HD 250% Carbex granules
Patient preparation
NPO 6hrs prior History – no pharmacological contra-
indications
Technique (Double contrast)
Position Film Action Reasoning Visualization
Erect/sitting
- Pt drinks fizzing agent
To distend the stomach
-
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 - IV muscle relaxant
- -
Roll to right, complete circle, end supine, left tilt
- Coating of the gastric mucosa
Technique (Stomach Spot Films)Position Film Action Reasoning Visualizatio
n
Supine, tilted to the left
RAO - - Antrum and greater curve
Supine PA - - Antrum and body
Supine, tilted to the right
LAO - - Lesser curve en face
On right side, head up 45o
Left lateral - - Fundus
AP
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, supine, then supine tilted to the left
RAO - Avoid Ba flooding duodenal loop
RAO of the Duodenal cap
Turn supine (shortest route)
PA - - PA of the Duodenal cap
Lie supine and tilted to the right
LAO - - LAO of the Duodenal cap
Technique (Duodenal Spot Films)
Technique (Erect Views)
Fundal lesion suspected
Position Film Visualization
Erect PA Fundus
Erect RAO Duodenal cap and Fundus
Erect LAO Duodenal cap and Fundus
Technique (Oesophageal views) Barium swallow to conclude exam Either spot films or dynamic screening
Position Film Visualization
Erect RAO Oesophagus
Bibliography
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