Dr Mohamed El Safwany, MD.

The student should learn at the end of this lecture radiographic imaging aspects of barium meal.

Barium meal is radiological study of esophagus, stomach, duodenum. Done by oral administration of contrast media barium sulphate


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Gastric or duodenal obstruction Malignancies of gastro esophageal junction, stomach, duodenum Upper abdominal mass Motility disorders Systemic diseases like TB GIT hemorrhage

       Epigastric pain suggestive of peptic ulceration Anorexia Weight loss Vomiting Anemia Heart burn Dyspepsia .

 CAUSE OF VOMITING: Gastro esophageal reflex Pyloric obstruction Mal rotation .

1. NPO after midnight(6 hrs)  2.Suspected perforation (unless water soluble contrast medium used) PATIENT PREPARATION :  1.abstain from-smoking.Complete large bowel obstruction  2.  . chewing gum or antacids->dec fluid in stomach which impairs barium coating.

.Hypotonic agent Buscopan(hyoscine butyl bromide.2 mg i.v) or 0.   1.1-0.20 mg i. A packet of effervescent granules swallowed with small amount of water.v glucagon is injected intravenously -relax stomach and suspend peristalsis.(approx 400ml CO2) High density barium is swallowed(120ml) and double contrast views of oesophagus is obtained standing RAO.releases CO2 and gastric distension.

Sequences of films of stomach obtained .    Patient placed on table. Patient rolled from side to side so as barium coats mucosal surfaces properly-washes over the mucus . lowered to horizontal Then turned onto left side and finally supine.

LAO Erect RAO.Supine. Typical Film Series Position Supine RAO Supine Supine LAO Supine Left Lateral Prone Demonstrates Antrum and greater curve Antrum and body Lesser curve Fundus Duodenal loop Prone.RAO. LAO Duodenal Cap series Erect Fundus .

. When barium enters duodenum. Duodenal Cap films are taken. patient is turned RAO – fills duodenum with gas.

 ADVANTAGES: Pylorospasm. Fistulae. Filling Defect Due To Large Mass DISADVANTAGES: Lack of sensitivity of small ulceration . Enlarged Gastric Rugae.

sup carcinoma . bile reflex gastritis. ulcers. recurrent carcinomas DISADVANTAGES:  Misses some polyp. erosion . marginal ulceration.ADVANTAGE:  highly accurate detecting abnormalities following gastric surgery.

  Barium given with gas forming powder in last few mouthfuls HYPOTONIC DUODENOGRAPHY .

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SINGLE CONTRAST DOUBLECONTRAST FUNDUS BODY PRONE SUPINE ERECT OR PRONE RT SIDE DOWN SUPINE WITH 60 HEAD END ELEVATION ANTRUM.C LOOP DOWN PRONE RT SUPINE RT SIDE UP SUPINE RT SIDE UP PRONE RT SIDE DOWN D4 SUPINE . PRONE RT DOWN PYLORUS D1.

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COMPLICATION.  Peritonitis  Aspiration pneumonia  Impaction.-convert partial obstruction into complete obstruction  Gastric dilatation  Barium embolisation if bleeding ulcer is present .

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By histology. no evidence of Malignancies was observed.X-ray showing Gastric ulcer With symmetrical radiating Mucosal folds. X-ray showing Extensive carcinoma involving the cardia & Fundus Pyloric stenosis .

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  David Sutton’s Radiology Clark’s Radiographic positioning and techniques .

. Two students will be selected for assignments.

 Role of Buscopan injection in barium meal? .

 Thank You .

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