Barium Meal study
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- 1. Barium Meal
2. Barium meal
- Identifies lower half of oesophagus, the stomach and all of duodenum.
- Method
- A)double contrast the method of choice to demonstrate mucosal pattern
- B)single contrast-used in children (not necessary to demonstrate mucosal pattern)
- And very ill adults (only gross pathology)
3. Indications
- 1)Dyspepsia
- 2)Weight
- 3)Upper abdominal mass
- 4)Gastro intestinal haemorrhage
- 5)suspected upper GI obstruction
- 6)assessment of the site of perforation(water
- soluble contrast is used)
4. Contra indications
- 1.Complete large bowel obstruction
- 2.Suspected perforation (unless water soluble contrast medium used)
- Patient preparation
- 1. NPO after midnight(6 hrs)
- 2.abstain from-smoking, chewing gum or antacids-
- ->dec fluid in stomach which impairs barium coating.
5. Technique
- 1.Hypotonic agent Buscopan(hyoscine butyl bromide,20 mg i.v) or 0.1-0.2 mg i.v glucagon is injected intravenously -relax stomach and suspend peristalsis.
- A packet of effervescent granules swallowed with small amount of water- releases CO2 and gastric distension.(approx 400ml CO2)
- High density barium is swallowed(120 ml- 250% w/v) and double contrast views of oesophagus is obtained standing RAO.
6.
- Patient faces Xray table,lowered to horizontal
- Then turned onto left side and finally supine.
- Patient rolled from side to side so as barium coats mucosal surfaces properly-washes over the mucus .
- Sequences of films of stomach obtained
7.
- When barium enters duodenum, patient is turned RAO fills duodenum with gas, DC films are taken.
- Biphasic examinationProne swallow of thin (125%w/vlow density) barium given after contrast view obtained to optimize compression views of stomach and duodenum
8.
- Under fluoroscopic guidance, on the compression views-filling defects or abnormal collections are detected.
- Note:young children- main indication identify cause of vomiting eg:-pyloric
- Flow technique identifies-subtle mucosal abnormalities.
- obstruction,malrotation,and GOR.single contrast technique preferred(30% w/v Barium sulfate with no paralytic agent).
9.
- Note : kV range double contrast- 70-120 kV.
- single contrast-120-150kV .
- Note:If partial gastrectomy or drainage procedues (eg; pyloroplasty or gastrenterostomy), begin with prone swallow using high density barium.Reaching duodenum or Genterostomy-turned supine for DC films.DC of stomach and oesophagus follows.
10. 11. 12. STOMACH
- Surface:reticular pattern multipleinterconnecting grooves.
- Divides- polygonal islands(2-4 mm)areae gastricae.distal 2/3rds.
- Presence- excludes diffuse atrophic gastritis
- >4mm sign of gastritis
- Fundus and body.- longitudinal folds or rugae.
13.
- Duodenum-
- Extends from pylorus to duodenojejunal flexure-cap,second part(descending horizontal,third part(ascending) and fourth part.
- Barium meal-cap-fine velvety reticular surface pattern by villi.
- Bariumcaught under mucosal pattern incomplete erosive duodenitis
14.
- Barium caught underfold between 1 stand 2 nd part of duodenum-ulcer pic
- Beyond cap-mucosal folds-narrow bands across whole width.
- Major papilla of Vater(2 NDPART)
- Central fold and 2 oblique folds
- Minor papilla(Santorini- 2 CM PROXIMAL)
15. 16. 17. 18.
- Frail and immobile, modification.
- Single contrast examination :
- 100%w/v barium oesophagus, stomach and duodenum
- Compression applied-lower stomach and duodenum. Approximates front and back walls with thin layer in between.
- Protruding lesion-radiolucent filling defect
- Depressed-eg:ulcer --focal extra density.
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