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Enteric contrast media

• It is a contrast agent such as barium sulfate


& diatrizoate sodium-meglumine
(Gastrografin) that are deemed safe for use
in the gastrointestinal tract only.
• It may be administered orally or rectally.
• It is used to visualize any abnormalities in
the gastrointestinal tract.
BARIUM SULPHATE
• Barium suspension is made from pure barium sulphate
which is heavy soluble material made from barite
• It is high atomic number materials that strongly absorb
X-rays and are therefore seen as dense white on
radiography
• The particles of barium must be small (0.1-3 μm), since
this makes them more stable in suspension
• A non-ionic suspension medium is used, for otherwise
the barium particles would aggregate into clumps. The
resulting solution has a pH of 5.3, which makes it
stable in gastric acid.
• There are many varieties of barium suspensions in use
but most situations the preparation may be diluted
with water to give a lower density
TYPES OF BARIUM CONTRAST IMAGING

Barium • pharynx and esophagus


swallow
• Lower esophagus, stomach and
Barium meal duodenum

Barium follow • Small intestine


through

Barium enema • large intestine and rectum


Barium swallow Barium meal Barium follow
through
INDICATION

• Dysphagia
• Upper abdominal mass
• Weight loss
• Gastrointestinal Hemorrhage
• Partial Obstruction
• Assessment of perforation
ADVANTAGE & DISADVANTAGE

ADVANTAGE DISADVANTAGE

• Excellent coating. • Taste


• Low cost • High morbidity
• Widely available associated with barium
in the peritoneal cavity.
• Subsequent abdominal
CT and US are
rendered difficult to
interpret.
• Constipation &
abdominal pain
CONTRAINDICATION & COMPLICATIONS
• Contraindication
– Suspected of perforation
– Allergy to barium or its component

• Complication
– Barium peritonitis : The escape of barium into the
peritoneal cavity is extremely serious, and will
produce pain and severe hypovolemic shock
– Aspiration : pneumonitis and granuloma formation
– Intravasation : barium pulmonary embolus
BARIUM MEAL
Method:
1. Patient to fast for at least 6 hours prior to the
examination.
2. Swallow barium then gas-producing agent,
3. IV short-acting smooth muscle relaxant
4. IV smooth muscle relaxant.
5. Various positions (erect and lying flat).
BARIUM SWALLOW
• Patient swallows a gas-producing agent to
distend the oesophagus,
• Patient swallow barium, and its passage down
the oesophagus is observed on a television
monitor.
• Films are taken with the oesophagus both full
of barium to show the outline, and following
the passage of the barium to show the
mucosal pattern.
BARIUM FOLLOW THROUGH
Method:
1. Single contrast
2. With the addition of an effervescent
3. With the addition of pneumocolon technique
BARIUM ENEMA
• the bowel is prepared by means of aperients or
washout to rid the colon of faecal material, which
might otherwise mask small lesions and cause
confusion by simulating polyps.
• Barium is run into the colon under gravity
through a tube inserted into the rectum.
• Air is then blown in to push the barium around
the colon with the result that the colon is
distended with air and the mucosa coated with
barium, giving the ‘double-contrast’ effect.
• Films are taken in various projections
GASTROGRAFIN
GASTOGRAFFIN

• Mixture of sodium amidotrizoate and


meglumine amidotrizoate
• A iodinated contrast agent
• In perforation →reabsorbed back into the
vascular system → excreted by the kidneys
Indication

Suspected
Meconium ileus
perforation

To distinguish
bowel from other
structures on CT
CONTRAINDICATION & COMPLICATIONS
• Contraindication
– Hyperthyroidism
– Pregnancy and lactation
– Patients with fluid and electrolyte imbalances

• Complication
– Pulmonary oedema if aspirated
– Allergic reactions - due to absorbed contrast
media
REFERENCE
• A Guide to Radiological Procedures by Stephen Chapman
& Richard Nakielny , FOURTH EDITION
• http://www.radiologyinfo.org/en/info.cfm?pg=safety-
contrast
• Diagnostic Imaging (7th edition), Rockall, Andrea, hatrick
Andrew, Amstrong, Peter, Wastie
• A guide to Radiological Procedure (4th edition), Stephen
Chapman, Richard Nakielny
• Imaging for Students © 2012 David A Lisle, Hodder
Arnold