BARIUM MEAL
• BY MR. GODFEAR JOHN
1. Definition
2. Indication
3. Contraindications
4. Describe technique of barium meal
5. Adverse effects
6. After care of the patient
7. Normal radiological anatomy (area of
concentration)
Definition
Barium meal is a special contrast radiological
procedure of the lower 1/3 of esophagus, stomach,
duodenum following ingestion of sulfate contrast
(barium sulphate) done under fluoroscopy.
Its for evaluation of anatomy and physiology and of
the lower 1/3 esophagus, stomach, duodenum.
smoking should be avoided since it increase gastric
motility.
Indications
1. Dyspepsia
2. Un explained Weight loss
3. Upper abdominal mass
4. Gastro intestinal hemorrhage
5. Assessment of site of perforation
6. Gastric volvulus
7. Bezoar
8. Gastric diverticulum
9. Suspected gastric ulcer/duodenal
10. Hiatus hernia
11. Reflux esophagitis
12. Pain full swallowing
13. Heart burn
14. Dysphagia
15. odynophagia
16. retrostenal pain
Contraindications
Complete bowel obstruction
Perforation
Obstruction(partial complete)
Post operative
Pregnancy
Suspected perforation
Suspected of tracheoesophageal fistula
Hypersensitive to barium
Equipment used
1.conventonal fluoroscopy
Image intensifier
Spot film device
Television fluoroscopy
Fluoroscopic couch
Other accessories
cassettes,
Anatomical markers rt or lt.
Foot rest
Hand grips shoulder support
Lead aprons, gloves thyroid shield
Preparation of the patient 1
Patient identification 4 cheek pregnancy test
Consent form should be signed.
Patient is nil by mouth 6-8hrs before examination .
3p
Smooth Muscle relaxant
(antispasmodic),buscopan(Hyoscine) should be
given.
Preliminary film
A control film is advised.
Explain the whole procedure to the patient
Preparation of the patient 2
Before a barium meal examination is performed, the
duodenum needs to be empty to allow clear visualization
of structures.
A patient may be given a laxative for bowel preparation
before the procedure to ensure the small bowel is empty
at the time of the examination, which is usually performed
on an empty stomach.
The patient is first asked to change into a hospital gown
and remove all jewellery, dentures, glasses, metal objects
and clothing as these items can interfere with imaging.
the barium contrast liquid is given to the patient to drink.
Contrast medium used
135ml Barium sulphate suspension 250% w/v
of more high density barium suspension
Effervescent agent(carbex granules), Eno®
For double contrast
Trolley set up
• As for barium swallow…please make follow up
at the department..
Procedure/technique
Can be either single contrast or double contrast
Method of choice characterization
for double contrast to demonstrate the mucosa pattern.
(mostly advised)
Single contrast exceptional
i. Children since it usually not necessary to demonstrate the
mucosa pattern
ii. Very ill patient to demonstrate gross pathology only
iii. To precede small bowel series
iv. Assessment of gastric peristalsis
v. Post-pyloroplasty
double contrast
A gas producing agent is swallowed
The patient is then drinks the barium while lying on left side,
supported elbow(this position prevents the barium from reaching
the duodenum too quickly and so obscuring the greater curve of
the stomach.
The patient is then lies supine and slightly on the rt side to bring
the barium up against gastro esophageal junction(this maneuver
is scanned t check for the reflux, which may be reveled by asking
the patient to cough.)
An iv injection of smooth muscle relaxant buscopan 20mg is given
The patient is asked to roll onto rt side and quickly over in a
complete circle to end in RAO (LPO) position.(this roll is
performed to coat the gastric mucosa with barium, good coating
has been achieved if areae gastriae in the antrum are visible.
Spot films taken
FILMS DEMOSTRATES
SUPINE RAO.........ANTRUM&GREATER CURVE
SUPINE..............ANTRUM &BODY
SUPINE LAO......LESSER CURVE
SUPINE LEFT LATERAL.........FUNDUS
PRONE..................DUODENAL LOOP
PRONE,RAO,SUPINE,LAO..DUODENAL CAP SERIES
ERECT RAO,LAO.........FUNDUS
Radiographic anatomy
RAO
Anatomy Demonstrated: • Entire stomach and C-loop of
duodenum are visible.
prone
lateral
supine
Alternative AP Trendelenburg, A partial . A full Trendelenburg angulation
Trendelenburg (head
facilitates the demonstration
down) position may be necessary to fill the
fundus on a thin of hiatal hernia. (Install shoulder brace
asthenic patient for patient safety.)
Mucosal pattern
area of concentration
abnormal anatomy
gastric ulcer on the lesser curve showing as an out pouching of
barium. Radiating folds can also be seen converging towards the
ulcer crater.
ulcers ulcers
areae gastrica.
Gastritis
Enlarged Area gastricea in a
patient with H.pylori Gastritis.
Perforated peptic ulcer
Pyloric stenosis.
Other imaging modalities
• Read…….
Radiation protection
Minimize the fluoroscopic time and current
Collimate the x ray beam
Shield should be used to sensitive organs
Complications
Aspiration of barium
Barium impaction &large bowel obstruction
Barium induced appendicitis
Leakage of barium from unsuspected
perforation
Constipation
After care
Patient is informed about possibility of
constipation there fore is advised plenty of
water/fluids and take mild laxatives
Aspiration of barium is gradually clearly by the
body but if there is immediate reaction the
patient is treated accordingly
Ensure patient understand the procedure for
receiving better results
Adverse effects
Side effect of drug used.
Mild-moderate-severe
Do We Know For Sure:
Multidisciplinary Approach
Quiz 2
1. List 5 indication of barium meal?
2. With aid of diagram explain the
parts of duodenum.
3. Mention 5 condition in which
single contrast can be used
4. What is odynophagia
