X-ray (Radiography)

Upper GI Tract
What is Upper Gastrointestinal
(GI) Tract Radiography?
Upper gastrointestinal tract radiography,
also called an upper GI, is an x-ray
examination of the pharynx, esophagus,
stomach and first part of the small intestine
(also known as the duodenum) using a
special form of x-ray called fluoroscopy and
an orally ingested contrast material
Fluoroscopy adventage
Fluoroscopy makes it possible to see
internal organs in motion. When the upper
GI tract is coated with barium, the
radiologist is able to view and assess the
anatomy and function of the esophagus,
stomach and duodenum.
What are some common uses of the procedure?

An upper GI examination helps evaluate

digestive function and can detect:
ulcers
tumors
inflammation of the esophagus, stomach and
duodenum
hiatal hernias
scarring
blockages
abnormalities of the muscular wall of GI tissues
The procedure is also used to help diagnose the cause
of symptoms such as:

difficulty swallowing
chest and abdominal pain
reflux (a backward flow of partially digested
food and digestive juices)
unexplained vomiting
severe indigestion
blood in the stool (indicating internal GI
bleeding)
How should I prepare?
To ensure the best possible image quality, your
stomach must be empty of food. Therefore,
patien you not to eat or drink anything
(including any medications taken by mouth,
especially antacids) and to refrain from chewing
gum after midnight on the day of the
examination.
remove some or all of your clothes and to wear
a gown during the exam.
remove jewelry, dentures, eye glasses and any
metal objects or clothing that might interfere
with the x-ray images.
What does the x-ray equipment look like?

The equipment typically used for this examination

consists of a radiographic table, an x-ray tube and
a television-like monitor that is located in the
examining room or in a nearby room.
When used for viewing images in real time (called
fluoroscopy), the image intensifier (which converts
x-rays into a video image) is suspended over a
table on which the patient lies.
Cassete fill film
BaSO4 mixed with water ratio 1 : 4 2 : 4
Cup , spoon , straw
Prepare equipment
X-ray unit with Radiograph
flouroscopy flouroscopy
 BaSO4 mixed with
BaSO4 water
How is the procedure
performed?
2 general procedures :
1. Single Contrast
2. Double contras
3. Biphasic
4. Hypotonic duodenography
Single contrast method
How is the single contrast
procedure performed?
Take a prelimminary radiograph
As the patient drinks the liquid barium,
the radiologist will watch the barium pass
through the patients digestive tract on a
fluoroscope monitor.
The exam table will be positioned at
different angles and the patient's abdomen
may be compressed to help spread the
barium.
DOUBLE CONTRAST
Advantage :
Small lesion are less easily obscured and
the mucosal lining of the stomach can be
more cleary visualized.
procedure
Just before the examination the patient may be
given glucagon to relax GI Tract.
Make spot plain radiograph
Place the patien on the flouroscopy table in the up
right position or recumbent position
Give the patient a gas producing substance on the
form powder , crystall, pill or a carbonated
beverage
Give the patient barium mixed water . For even
coating stomach walls.
Place the patient in recumbent and instruct to roll
over a few times.
Biphasic exam
Incorporation the adventage of both single
and double MC UGI examination.
The first undergoes a double contrast when
complete the patient is given barium 1 : 4
for single contrast perform.
Hypotonic duodenography
Required intubation and used for evaluation of
postbulbar dudenal lesion and detection
pancreatic disease.
A newer tubeless technique requires temporary
drug induced duodenal paralysis soperform
without interference from perisaltic activity.
During atonic state when doudenum is
distended with the CM to 2 or 3 times its
normal size, it presses againts and outlines any
abnormality in the contour of head of the
pancreas.
Take radiograph
PA
Ap
Oblique
Lateral
PA projection
PA projection
Structur shown :
Barium filled stomach and
doudenal bulb is demonstrated.
The Up right shown size, shape,
position of the stomach but not
adequate filled fundic.
The pyloric canal and duodenal
bulb are well demonstrated in
patiens with an sasthenic or a
hyposthenic habitus.
PA AXIAL
PA Axial
Structure shown
At the hypersthenic type stomach for
demonstrated of the greater dan lesser
curvature , antral portion on the stomach
RAO position
RAO projection
Structure shown :
Doudenal Loop
Best image of the
pyloric and
doudenal bulb
LPO Position

Structure shown :
Fundic portion
Because of the effect of gravity the
pyloric and duodenal bulb are not
filled with barium
Lateral Projection
Lateral projection
Structure shown ;
Anterior and
psoterior aspects of
the stomach,
pyloric , duodenal
bulb .
The right lateral
projection
commonly affords
the best image of
the pyloric an
duodenal bulb in
the hypherstenic
AP projection
AP PROJECTION
Structure shown :
Stomach shows awell
filled fundic , pyloric an
duodenum.
Because of the
elevation and superior
displacement of the
stomach this projection
affords the best Ap
projection of the
retrogastric portion of
the doudenum an
jejenum
What will I experience during and
after the procedure?
Occasionally, patients find the thick
consistency of the barium unpleasant and
difficult to swallow.
The liquid barium has a chalky taste that
may be masked somewhat by added flavors
such as strawberry or chocolate.
Being tilted on the examination table and
having pressure applied to the abdomen
can be uncomfortable for some patients.
The examination may also make you feel
bloated.
The barium may color your stools gray or
white for 48 to 72 hours after the
procedure.
Sometimes the barium can cause
temporary constipation, which is usually
treated by an over-the-counter laxative.
Drinking large quantities of fluids for
several days following the test can also
help.
What are the benefits vs. risks?

Benefits
Upper GI tract radiography is an extremely safe,
oninvasive procedure.
The results of the upper GI series usually lead to
accurate evaluation of the esophagus, stomach
and duodenum.
Because barium is not absorbed into the blood,
allergic reactions are extremely rare.
No radiation remains in a patient's body after an
x-ray examination.
X-rays usually have no side effects in the
diagnostic range.
Risks
Occasional patients may be allergic to the
flavoring added to some brands of barium.
There is a slight chance that some barium could
be retained, leading to a blockage of the
digestive system.
Therefore, patients who have a known
obstruction in the GI tract should not undergo this
examination.
Women should always inform their physician or x-
ray technologist if there is any possibility that
they are pregnant.
Small intestine

Radiographic
procedure
Looked this
Ba Follow - through
Indication :
1. Pain
2. Diarrhoea
3. Bleeding
4. Partial obstruction
.Contra indication :
1. Complet obstruction
2. Perforation suspected.
 ..next
BaSO4 preparation :
1. By mouth
2. By reflux filling with large volume Ba
enema
3. By direct injection into bowel throught
intestinal tube ( enterolysis / small
intestine enema )
Preparation for examination
The patient to have a soft or low residue diet
for 2 day.
A cleansing enema may be administered to
clear colon however an enema is not always
recommended for electrolysis because enema
fluid may be retained in the small intestine
The patiens bladder should be empty before
during the procedure to avoid displacing or
compressing the ilium.
Metoclopramide 20mg orally 20 min before
exam
Oral method examination
The aim is to deliver a single of the barium into the
small bowel.
This achieved by lying the patien on right side
after the barium has been ingested
The first small intestine flouroscopy is usually
taken 15 m after the patien drink barium
The interval to the next exposure varies 15 30
until colon is reached .
A glass of ice water be given to the patient with
hypomotility after 3 -4 hr for accelerate peristalsis
The exam completed when the barium is
visualized in the cecum
Film radiograph
PA prone
Structure shown :
Demonstrated small intestine progressively
filling until reached ileocecal
Additional film
1. To separated loop of small bowel :
Oblique
With axial caudal
With table tilt head down.
2. To Diverticula
Erect position.
Complete reflux examination
Patien filled by administering a barium
enema.
Before exam glucagon may be
administeredto relax intestine.
Diazepam may also be given to deminish
patien discomfort.
procedure
A retention enema tip is used .
Patient is placed in the supine position
The barium suspension is allowed to flow
until it is observed in the duodenal bulb.
The enema bag is then lowered to the floor
to drain the colon befor radiographs.
Enteroclysis prosedure
Enteroclysis ( the injected of nutriens or
medicinal liquid into the bowel ) is
radiographic procedure in which contras
medium is injected into duodenum under
flouroscophy control for examination small
intestine.
Prepare patient
Before the procedure is begun , the patient
colon must be throughly cleansed.
Enemas are not recommended as
preparation for entrolysys because some
enema fluid may be retained in the small
intestine.
Procedure
Under flouroscopy control . A bilbao or
sellink tube with a stiff guide wire is
advance to the end of the doudenum at
duodenojejunal flexure.
Barium instilled throught the tube at rate of
approximately 100 ml / minute
Air or methylcellulose is injected into small
intestine after contrast fluid has reached
the cecum
Radiograph requested
AP
PA
Obliques
Lateral
tugas
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