▣ Dyspepsia (indigestion or pain and discomfort
when eating a meal)
▣ Weight loss
▣ Upper abdominal mass
▣ Gastrointestinal haemorrhage, or unexplained iron
deficiency anaemia.
▣ Partial obstruction
▣ Assessment of site of perforation it is essential to
use Gastrografin or L O C M
Barium Meal Contraindications
▣ Complete large bowel obstruction.
▣ Methods:
1) Double contrast it is the method of choice to
demonstrate mucosal pattern.
2) Single contrast uses:
- Children – since it usually is not necessary to
demonstrate mucosal pattern
- Very ill adults to demonstrate gross
pathology only.
Contrast medium
▣ 100- 150 ml Barium sulphate suspension
Patient Preparation
▣ Fasting for 6 hours prior to examination.
▣ Smoking should be avoided on the day of the
examination since it increases gastric motility
▣ It should be ensured that there are no
contraindications to pharmacological agents used.
Preliminary films
▣ None
▣ A gas producing agent is swallowed.
▣ The patient then drinks the barium whilst lying on
his/her left side; this prevents the barium from reaching
the duodenum too quickly and so obscuring the greater
curve.
▣ The patient then lies supine and slightly on his/her right
side and to bring the barium up against the gastro
oesophageal junction,
▣ this manoeuvre is ‘screened’ to check for reflux and the
patient is asked to cough or swallow water while in this
position to encourage reflux,
▣ Spot films are taken if reflux occurs; this will detect the
level to which the reflex ascends.
▣ An I.V. injection of a smooth muscle relaxant is given
(20 mg of bascopan or glucagon 0.3 mg)
▣ The administration of bascopan has been shown not to
affect the detection of gastro-oesophageal reflux or
hiatus hernia.
▣ The patient is then asked to roll onto his/her right side
and then completely over in a a complete circle to
finish in a R AO position; this is done to fully coat the
stomach wall.
Position Demonstrates
Supine RAO Antrum and greater curve
Supine Antrum and body
Supine LAO Lesser curve
Supine Left Lateral,
Fundus
(head up 45 degree)
▣ From the left lateral position the pt returns to a supine
position
▣ Then rolls onto his left side again and over into a
prone
position.
▣ This sequence of movement is required to avoid barium
flooding into the duodenal loop
▣ Which could occur if the pt were to roll onto his right side
to achieve a prone position.
Prone
The pt lies on a compression pad to
prevent barium from flooding into
Duodenal loop
the duodenum
Prone, RAO (1),
Supine, LAO , Duodenal Cap series
Erect RAO, LAO
Erect (2) Fundus
▣ (1) RAO done for the anterior wall of the
duodenal loop.
▣ (1)From prone position, the patient lies on the left
side first the supine then to the right side to
prevent barium flooding into the duodenum
▣ (2) erect position suspicion of a fundal lesion.
▣ Pyloric stenosis: a severe narrowing of the
pyloric sphincter, with a thickening around the
sphincter due to hypertrophy of the muscles of
the sphincter, most often seen in babies at
around 4 - 6 weeks.
▣ Peptic ulcer: an ulcer occurring in the
oesophagus, stomach and or first part of the
duodenum due to the action of the digestive
secretions on unprotected mucosa. Most often
found in the first part of the duodenum and the
lesser curve of the stomach.
▣ Perforation: usually occurs as a result of
ulceration or diverticula and can occur along
the whole length of the gastrointestinal
tract.
▣ Haemorrhage, frequently occurs at the
site of ulceration.
▣ Tumours, mainly benign tumours such as
lipoma and fibromas are found in the stomach.
▣ Malignant tumours, mainly
adenocarcinomas and found predominantly
on the lesser curve, the pyloric and cardiac
regions.
▣ Polyps: are outgrowths of the mucosal
lining and may become malignant.
▣ Carcinoma of the head of pancreas will cause
classic enlargement of the diameter of the first
part of the duodenum.
▣ Atrophic gastritis: Radiographic findings
of atrophic gastritis include loss of rugal folds
and a tubular, featureless narrowed stomach
▣ The motility of the stomach results in its
very varied radiological appearance in
barium meal investigations.
▣ the rugae of the walls leads to remnants
of barium remaining trapped in the folds
of the walls of an otherwise empty
stomach.
▣ This varies according to the time
between swallowing the fluid mixture
and taking the image.
▣ As each radiograph represents a view of
a dynamic structure, it is important to
appreciate that each film you see will
show slightly different features.
▣ Then the barium has entered the
stomach and can be observed to fill
the whole structure.
▣ In an erect position, the stomach will
appear 'J' shaped.
▣ The trapped barium has become
trapped within the rugal folds of the
stomach (1) caused by the folded nature
of the organ's walls.
▣ Further barium is the seen leaving the
stomach and entering into the
duodenum.
▣ The duodenum is 'C' shaped (2)
and has folded walls due to their
muscular structure, giving rise to a
corrugated appearance on an
x-ray.
▣ These radiographic films are normally
taken to diagnose pathology in the
stomach and duodenum such as ulcers
or malignancies.
▣ The various anatomical regions of the
stomach should now be identified.
▣ You should note the
curvature (3) on the convex side
greater
the stomach
of
▣ and the lesser curvature (4)
on the
concave edge.
▣ The upper part of the stomach is
called the fundus (5) which
contains
normallya small bubble of gas.
▣ Below this can be seen the body (6) of
the stomach
▣ which in turn becomes the
region (7) which adjoins
pyloric
duodenum.
the
▣ The pylorus is the site of a sphincter
which holds the stomach contents
within the stomach until digestive
processes make them ready to enter
the duodenum.
▣ Anatomically. the duodenum has four
parts. The second part of the
duodenum can be seen on the films
it
as descends down to the right of the
lower part of the stomach (8).
▣ The white arrow points to the center of the
ulcer, the blue arrow points radiating folds of
the ulcer
▣ patient should be able to go home as soon as the test is finished.
▣ Some people feel a little sickly for a few hours afterwards.
▣ The patient should be warned his bowel motions will be white for a
few days,
▣ some centres advise a mild laxative for 48 hr’s to encourage the
passage of ‘barium’ and reduce the possibility of impaction.
▣ The patient can eat normally straight after any barium test.
▣ The barium may cause constipation. Therefore, to help prevent
constipation:
◾ Have lots to drink for a day or so to flush the barium out.
◾ Eat plenty of fruit for a day or so.
◾ The patient should see the doctor if he hasn't passed any
faeces
(stools) after three or four days.
▣ If the patient had an injection to relax the muscles, it may can
cause
some blurring of the vision for an hour or so. If this happens it
is best
not to drive.
▣ The barium does not get absorbed into the body. Therefore, it is rare
for a barium test to cause any other complications or side-effects.
▣ Leakage of ‘barium from unsuspected
perforation
▣ Aspiration
▣ Obstruction, as result from the conversion of a
partial large bowel obstruction into a complete
obstruction by the impact of barium.
▣ Barium appendicitis. If the Ba impacts the
appendix.
▣ Side effects of any other drugs used.
▣ It must be emphasized that there are many
variations in technique, according to individual
preference.
▣ And the best way of becoming familiar with
the sequence of positioning is actually to
perform the procedure oneself.
