Alimentary Canal› Mouth› Pharynx› Esophagus› Stomach› Small / Large

Intestine

Accessory glands› Liver› Gallbladder› Salivary

glands› Pancreas

Originates around C-6

In thorax, it is anterior to spine, posterior to trachea and heart

Passes through diaphragm through esophageal hiatus

Inferior to diaphragm curves sharply left

Increases in diameter Joins stomach at

esophagogastric junction

At level of xyphoid tip 4 layers of the

esophagus› Outermost - fibrous› Muscular› Submucosal› Innermost - Mucosal

Dilated saclike portion of digestive tract

Composed of same 4 layers as esophagus› Outermost - fibrous› Muscular› Submucosal› Innermost - Mucosal

Divided into 4 parts› Cardia› Fundus› Body› Pyloric portion

Entrance to stomach is cardiac orifice› Controlled by cardiac

sphincter Exit is the pyloric

orifice› Controlled by pyloric

sphincter

Contains same four layers as stomach and esophagus

Mucosa contains projections called villi to facilitate digestion and absorption

Divided into 3 parts:› Duodenum› Jejunum› Ileum

8 - 10 inches in length

Widest portion of small intestine

Follows a C-shaped course

Contains 4 regions› Superior, descending,

horizontal, ascending› 1st region is known

as the duodenal bulb› 4th portion joins

jejunum and is supported by ligament of Trietz

› Head of pancreas is contained in duodenal loop - second portion

Jejunum› Upper remaining 2/5 of

small bowel Ileum

› Terminates at ileocecal valve

Both are gathered into freely movable loops (gyri)

Attached to posterior abdominal wall by mesentary

Generally found in central and lower part of abd. cavity within arch of large intestine

DEFENISI : Pemeriksaan radiologis dengan

menggunakan kontras media untuk memvisualisasikan saluran pencernaan bagian atas secara dinamik dengan fluoroskopi dan radiografi.

Menggunakan kontras media positif ( kontras ) dan negatif (udara) untuk

menilai abnormalitas pergerakan, lumen dan mukosa .

Kontras : Barium Sulfat dan menggunakan evervescent untuk menghasilkan udara.

Penilaian : esofagus –gaster- duodenum.

Kelainan mobilitias Kelainan mukosa (ulkus, divertikel,

inflamasi) Keganasan Degeneratif Kelainan kongenital Kelainana obstruktif

Perforasi Alergi kontras Obstruksi total upper GI

Anamnese pasien adanya obstruksi Puasa selama 6 jam sebelum

pemeriksaan Persiapan kontras barium , esofagus 1:

1 dan saluran cerna yang lain 1: 3 Bila curiga perforasi atau fistel

menggunakan kontras water soluble

Kontras diminumkan mll oral ( 1; 1) , untuk mengisi esofagus sambil dilakukan fluoroskopi

Lalu kontras Barium sulfat (1 : 3 ) diminumkan mll oral , namun untuk mengisi udara di lambung, pasien menggunakan evervescent .

Posisi pasien supine

Pasien diminta untuk berputar, terlentang , miring , telungkup , miring kontralateral dilakukan 2 kali. Lakukan fluoroskopi untukmelihat kelainan.

Setelah full filling , dapat dinilai mulai gaster, duodenum saat bulbus terbuka dan terisi pars descendens dan ascendens duodenum

Varises esofagus Achalasia esofagus Striktur esofagus Atresia esofagus Esofagitis Tumor esofagus Fistula esofagus Divertikulum dan spasme esofagus

Congnital : hernia diafragmatika, sliding hernia, etc

Gastritis Gastric Ulcer plg sering terjadi pada :

minor curvature , anthrum pyloricum, corpus, fundus, cardia

Tumor , mis : adeno ca, leiomiosarkoma

Congenital : atresia duodeni, spasme duodeni

Duodenitis Tumor : polip, divertikulum benign maligna : filling defek irreguler ,

umbrella sign Tumor Caput Pancreas : enlarge C

loop

Cricopharyngeus Muscle

At level of C5-C6,Part of upper esophageal

sphincter (UES)

Esophagus

Barium Swallow, Single ContrastBarium Swallow, Single Contrast

Barium Swallow, Single ContrastBarium Swallow, Single Contrast

Main Indication:

Dyshagia

Identation of A.A

Single Contrast

Indentation of L.main

bronchus

Double Contrast

Barium Swallow, Single ContrastBarium Swallow, Single Contrast

Double Contrast

Heart

L.V.

L.A.

Barium Swallow, Double ContrastBarium Swallow, Double Contrast

Indentation of L.main

bronchus

Single Contrast

Double Contrast

Barium Swallow, Single ContrastBarium Swallow, Single Contrast

Ampulla Normal Varient

Fundus

Body

Barium Swallow, Single ContrastBarium Swallow, Single Contrast

Aortic Arch

Barium Swallow, Double ContrastBarium Swallow, Double Contrast

Narrowing:Could be peristalsis

So other shot is advised

Angular NotchIncisura

Angularis

Barium Meal, Double ContrastBarium Meal, Double Contrast(Supine Position)(Supine Position)

Body

Antrum

Supine Position:Note Barium

Distribution in the Fundus due to gravity

Barium Meal + Follow-ThroughBarium Meal + Follow-Through(Erect Position)(Erect Position)

Barium Meal

Barium Follow-Through

Duodenal Cap

Pyloric Canal

2nd Part of Duodenum

3rd Part of Duodenum

Body

Antrum

DJJ:Normal Position= Left

sideAngular Notch

Incisura Angularis

Jejunum:Plica Circularis on the

outer border

Ileum

Barium Follow-Through to CecumBarium Follow-Through to Cecum(Erect Position)(Erect Position)

2nd Part of Duodenum

3rd Part of Duodenum

DJJ:Normal Position= Left

side

Small Bowel EnemaSmall Bowel Enema

A Modified Follow-Through which is called Small Bowel Enema note that the bowel is more distended here

This procedure involves inserting a thin tube through the mouth, esophagus and past the stomach to inject barium, methylcellulose and water into the small bowel. This allows for better visualization of the small bowel

than can be seen during a small bowel follow-through

Esophagus

Barium Swallow, Single ContrastBarium Swallow, Single Contrast

ProximalDilatations

Narrowing (Stricture)

Bird Peak SignDDx:

Achalasia

Barium Swallow, Single ContrastBarium Swallow, Single Contrast

ProximalDilatations

Distal Narrowing

Benign Stricture:

The transitional Zone looks smooth and free

of filling defects

Barium Swallow, Single ContrastBarium Swallow, Single Contrast

Malignant Stricture:-The transitional Zone looks

Irregular & ill defined - Presence of many filling

defects

DDx:Adeno CASq. Cell

CA

Filling Defect

It shows an irregularity that almost looks like an apple core lesion in the esophagus. This is typical in carcinoma of the esophagus

It shows an irregularity that almost looks like an apple core lesion in the esophagus. This is typical in carcinoma of the esophagus

Filling Defect

Malignant Stricture

Long Irregular Narrowing

Barium Swallow, Single ContrastBarium Swallow, Single Contrast(Oblique)(Oblique)

Barium Swallow, Single ContrastBarium Swallow, Single Contrast(Oblique)(Oblique)

Barium swallow in this patient with achalasia reveals a smooth distal tapering caused by the hypertensive lower esophageal sphincter that straddles the diaphragm, and multiple non-Peristaltic contractions throughout the body of the esophagus. This radiographic appearance sometimes has been called "vigorous achalasia". This term has little value, however, because recent studies suggest that patients with so-called vigorous achalasia cannot be distinguished clinically from non-vigorous achalasia.

Irregular Wall & Dilatation:Tertiary Contraction (Pathological non-propulsive

Contraction)

Funnel Shape

(Achalasia)

Barium Swallow, Single ContrastBarium Swallow, Single Contrast(Oblique)(Oblique)Well Defined

Contrast Filled left cervical level

sac

Pharyngeal Pouch(Zenker's

Diverticulum):occurs in an area of anatomic weakness known as Killian's

dehiscence

Varices Barium swallow examination: AP view: Numerous rounded and elongated smooth-contoured filling defects are present in the inferior two thirds of the esophagus. The contour of the esophagus is irregular and spiculated.

Barium Swallow, Single ContrastBarium Swallow, Single Contrast

Irregular Multiple Filling

Defects

Differential Diagnosis Multiple Esophageal Filling Defects:1.Fungal Infx2.Polyps3.Esophageal Varices (irregular)4.Food Particles

Barium Swallow, Single ContrastBarium Swallow, Single Contrast

Irregular Multiple Filling

Defects(Esophageal

Varices)

Barium Meal, Double ContrastBarium Meal, Double Contrast

Contrast Filled Speculated

Lesion(Gastric Ulcer)

Barium Meal, Double ContrastBarium Meal, Double Contrast

Rugae

Contrast Filled Outpouching at

the Greater Curviture

(Malignant Gastric Ulcer)

Barium Meal + Follow-ThroughBarium Meal + Follow-Through

Contrast Filled Speculated

Lesion(Duodenal Ulcer)

4th Part of duodenu

m

1st Part of duodenum

2nd Part of duodenum

3rd Part of duodenum

Stomach

Barium Meal, Double ContrastBarium Meal, Double Contrast

Ulcer

Speculated Mass

Pylorus

Barium Meal, Double ContrastBarium Meal, Double Contrast(Erect Position)(Erect Position)

Shoulder’s Sign

Mushroom’s Sign(or apple core

Sign)String’s

Sign

DDx:Pyloric Stenosis

For further information refer to “Pediatric Abdomen Radiology” Slides (37-46)