Itis Radiographic examination of upper gastrointestinal tract and proximal small bowel Barium swallow is performed to diagnose structural or functional abnormalities of the esophagus, stomach and duodenum by using the barium sulphate contrast Media. It may be performed as a single or double contrast study in radiology department. The barium meal examination may be performed by two methods- » Single contrast study- evaluate stomach and duodenum disorders and abnormality > Double contrast study- evaluate the mucosal details Anatomy- e The stomach is a J shaped muscular organ located on the left side of the upper abdomen. The inner wall of stomach lined with mucosa that’s secretes digestive enzymes and gastric acid. The stomach is divided into four sections 1, The Cardia -from where the stomach receives food from the esophagus through a muscular valve called the lower esophageal sphincter. 2. The fundus-upper part of stomach, 3. The body - central part of the stomach and 4. The pylorus-it connects the duodenum, It is divided into two parts, 1. the antrum, which connects to the body of the stomach, and 2. the pyloriccanal- it contains pyloric sphincter which connects the duodenum. Pyloric sphincter is a muscular valve that allows the food to pass from the stomach to duodenum. The duodenum is the first part of the small intestine itis @ C-shaped shaped structure. It divides into four parts 1. D1-connect with from the pylorus, 2. D2- pancreatic duct and common bile duct enters in D2 part. . 3. D3 and 4, D4-it connects the jejunum at the duodenojejunal flexure. Indication- « Lack of appetite (anorexia) e Epigastric pain e Heartburn e Dyspepsia Suspected gastric or duodenal obstruction e¢ Upper abdominal mass e = Mairotation Gastroesophageal Reflux Disease Suspected pyloric obstruction e Weight loss e Anemia e Suspected hiatus hernia Contraindication- Complete large bowel obstruction e Suspected perforation e Suspected fistula e Recent biopsy of GIT e Suspected pregnancysiti Re icated, If perforation and fistula is suspected or where barium is contraind: ee e C1 e Ronionic water-soluble iodinated contrast media is used to perform th €xainination. Equipments- Fluoroscopic unit with Tilting table attached image intensifier or spot film device/ high-speed cassettes Thin density of Barium sulphate suspension for single contrast study Thick density of Barium sulphate suspension for double contrast study Effervescent powder (gas producing agent) for double contrast study Preparation- Ask the patient to take low residue Diet for two days prior to the examination Laxative may be given to the patient, the night before examination. Instruct the patient, not to smoke or chew gum because it Prevent proper coating of Barium sulphate on the mucosa Fasting may be employed for 4 hours. Ask the patient not to eat or drink after midnight, Procedure- On the day of examination describe the whole procedure to patient. Technologist should obtain consent from patient for permission of procedure. Ask the patient to remove clothing and wear Hospital Gown Single contrast study- 1. Place the patient in the upright position with head turn, behind the Fluoroscopic screen. The patient is instructed to take 10 to 15 ml Barium sulphate (one mouthful) and swallow it. The passage of Barium is examined by radiologist under fluoroscopy machine.Sy Nelerae ion ins Ciricam rome 2. After the fluoroscopic examination of esophagus, place the patient in supine position on the fluoroscopic table and 150 ml thin density Barnum sulphate is given. Then rotate the patient in clockwise for coating of ¢ flow of barium on the stomach mucosa. The radiologist observes th Barium sulphate in the stomach under fluoroscopy: 3. Then place the patient in prone position, in this position the barium enters in the duodenum through the pylorus of the stomach when the barium enters in the duodenum spot film is taken. The patient is turned to right t side down) anterior oblique position (Patient prone right 1 duodenal bulb, - 4. In RAO position when barium fills the pylorus and the the spot film is taken. > Additional filming for single contrast study- {. For evaluation of fundus and Duodenum fourth part (D4) radiographs is ~ taken in supine AP position. 2. For determination of hiatus hernia place the patient in Trendelenburg position (Supine head down) Apply compression on abdomen and radiographs is taken. 3. To evaluate the duodenal bulb and retro gastric space Place the patient in right lateral position and radiographs ts taken 4, For evaluation of greater and lesser curvatures of stomach radiographs | > Double contrast study- Place the patient in upright position, hypotonic agent buscopan or glucagon | is given to the patient to suspend peristalsis moment’s then100 ml high density Barium sulfate mixed with effervescent powder given to the patient and asked to swallow. The patient should not burp after swallowing. passage of Barium is examined by the radiologist under fluoroscopy(Ere TnI VISE Then rotate the patient in clockwise (8-10 time) for good coating on the stomach mucosa. the radiologist observes the flow of Barium sulfate and air in The stomach under fluoroscopy. Then tum the patient in left posterior oblique position (supine with the Right side up) in LPO position, When the air is filled in the pylorus and duodenal buib, the double contrast spot film is taken Additional filming- |. For the air filled study of the duodenal bulb Place the patient in Left lateral Position the gas filled in duodenal bulb, double contrast spot film is taken. bo For the air filled Study of the upper body of stomach Place the patient in supine with table tilt in head up position, then, double contrast spot film is taken, Biphasic study- During the biphasic study, both single contrast and double contrast study are performed. 1. The biphasic study begins with a single contrast study by giving 150 ml thin density Barium sulfate to the patient. After the contrast admini stration rotates the patient in clockwise for good coating on the mucosa of stomach then place the patient in prone position and turn into right anterior oblique. When barium fills the pylorus and the duodenal bulb, the spot film is taken, 2. Then turn the patient into the supine position and buscopan or glucagon is given to suspend peristalsis moments of GIT, After the injection 15 ml, thick density Barium sulfate and the Gas producing agent is given to the patient. Then place the patient in an LPO position. When the air is filled in the pylorus and duodenal bulb, the double contrast spot film is taken.0 Aftercare- Patients will be allowed to leave the examination room after the completion of the examination Ask the patient to increase flutd intake to avoid constipation i Fe for jays. Inform the patient about feces will be whitish for two day fl Sequential Filming for Barium Meal,