 Alimentary Canal

› Mouth
› Pharynx
› Esophagus
› Stomach
› Small / Large
Intestine
 Accessory
glands
› Liver
› Gallbladder
› Salivary
glands
› Pancreas
 Originates around
C-6
 In thorax, it is
anterior to spine,
posterior to
trachea and heart
 Passes through
diaphragm through
esophageal hiatus
 Inferior to diaphragm
curves sharply left
 Increases in diameter
 Joins stomach at
esophagogastric
junction
 At level of xyphoid tip
 4 layers of the
esophagus
› Outermost - fibrous
› Muscular
› Submucosal
› Innermost - Mucosal
 Dilated saclike
portion of digestive
tract
 Composed of
same 4 layers as
esophagus
› Outermost - fibrous
› Muscular
› Submucosal
› Innermost - Mucosal
 Divided into 4 parts
› Cardia
› Fundus
› Body
› Pyloric portion
 Entrance to stomach
is cardiac orifice
› Controlled by cardiac
sphincter
 Exit is the pyloric
orifice
› Controlled by pyloric
sphincter
 Contains same four
layers as stomach and
esophagus
 Mucosa contains
projections called villi
to facilitate digestion
and absorption
 Divided into 3 parts:
› Duodenum
› Jejunum
› Ileum
 8 - 10 inches in length

 Widest portion of small intestine

 Follows a C-shaped course

 Contains 4 regions
› Superior, descending,
horizontal, ascending
› 1st region is known as
the duodenal bulb
› 4th portion joins
jejunum and is
supported by
ligament of Trietz
› Head of pancreas is
contained in
duodenal loop -
second portion
 Jejunum
› Upper remaining 2/5 of small
bowel
 Ileum
› Terminates at ileocecal
valve
 Both are gathered into
freely movable loops (gyri)
 Attached to posterior
abdominal wall by
mesentary
 Generally found in central
and lower part of abd.
cavity within arch of large
intestine
 DEFENISI :
Pemeriksaan radiologis dengan
menggunakan kontras media untuk
memvisualisasikan saluran pencernaan
bagian atas secara dinamik dengan
fluoroskopi dan radiografi.
 Menggunakan kontras media positif
( kontras ) dan negatif (udara) untuk
menilai abnormalitas pergerakan,
lumen dan mukosa .
 Kontras : Barium Sulfat dan
menggunakan evervescent untuk
menghasilkan udara.
 Penilaian : esofagus –gaster- duodenum.
 Kelainan mobilitias
 Kelainan mukosa (ulkus, divertikel,
inflamasi)
 Keganasan
 Degeneratif
 Kelainan kongenital
 Kelainana obstruktif
 Perforasi
 Alergi kontras
 Obstruksi total upper GI
 Anamnese pasien adanya obstruksi
 Puasa selama 6 jam sebelum
pemeriksaan
 Persiapan kontras barium , esofagus 1: 1
dan saluran cerna yang lain 1: 3
 Bila curiga perforasi atau fistel
menggunakan kontras water soluble
 Kontras diminumkan mll oral ( 1; 1) ,
untuk mengisi esofagus sambil dilakukan
fluoroskopi
 Lalu kontras Barium sulfat (1 : 3 )
diminumkan mll oral , namun untuk
mengisi udara di lambung, pasien
menggunakan evervescent .
 Posisi pasien supine
 Pasien diminta untuk berputar,
terlentang , miring , telungkup , miring
kontralateral dilakukan 2 kali. Lakukan
fluoroskopi untukmelihat kelainan.
 Setelah full filling , dapat dinilai mulai
gaster, duodenum saat bulbus terbuka
dan terisi pars descendens dan
ascendens duodenum
 Varises esofagus
 Achalasia esofagus
 Striktur esofagus
 Atresia esofagus
 Esofagitis
 Tumor esofagus
 Fistula esofagus
 Divertikulum dan spasme esofagus
 Congnital : hernia diafragmatika, sliding
hernia, etc
 Gastritis
 Gastric Ulcer plg sering terjadi pada :
minor curvature , anthrum pyloricum,
corpus, fundus, cardia
 Tumor , mis : adeno ca, leiomiosarkoma
 Congenital : atresia duodeni, spasme
duodeni
 Duodenitis
 Tumor : polip, divertikulum benign
maligna : filling defek irreguler , umbrella
sign
 Tumor Caput Pancreas : enlarge C loop
Barium Swallow, Single Contrast

Cricopharyngeus
Muscle
At level of C5-C6,
Part of upper
esophageal
sphincter (UES)

Esophagus
 Barium Swallow, Single Contrast

Main Indication:
Dyshagia
 Barium Swallow, Double Contrast

Double
Contrast

Identation of
A.A

Indentation of
L.main bronchus

Single Contrast
 Barium Swallow, Single Contrast

Double Contrast

Heart
Barium Swallow, Double Contrast

Indentation of
L.main bronchus

Double Contrast

Single Contrast
 Barium Swallow, Single Contrast

Ampulla
Normal Varient

Fundus

Body
Barium Swallow, Single Contrast

Aortic
Arch
 Barium Swallow, Double Contrast

Narrowing:
Could be peristalsis
So other shot is
advised
 Barium Meal, Double Contrast
(Supine Position) Supine Position:
Note Barium Distribution
in the Fundus due to
gravity

Angular Notch
Incisura
Angularis

Antrum Body
 Barium Meal + Follow-Through
(Erect Position)
DJJ: Barium Meal
Normal Position= Left
side
Angular Notch
Incisura Angularis
Duodenal Cap

Pyloric Canal

2nd Part of
Duodenum

3rd Part of Body Jejunum:

Duodenum Plica Circularis on the
Antrum outer border

Ileum

Barium
Follow-Through
 Barium Follow-Through to Cecum
(Erect Position)

DJJ:
Normal Position= Left
2nd Part of side

Duodenum

3rd Part of
Duodenum
 Small Bowel Enema

A Modified Follow-Through which is called Small Bowel Enema note that the bowel
is more distended here
This procedure involves inserting a thin tube through the mouth, esophagus and past the stomach to inject barium,
methylcellulose and water into the small bowel. This allows for better visualization of the small bowel than can be
seen during a small bowel follow-through
 Barium Swallow, Single Contrast

Esophagus

Proximal
Dilatations

Narrowing
(Stricture)

Bird Peak Sign

DDx: Achalasia
 Barium Swallow, Single Contrast

Benign Stricture:
The transitional Zone
looks smooth and free
of filling defects

Proximal
Dilatations

Distal
Narrowing
 Barium Swallow, Single Contrast

Malignant Stricture:
-The transitional Zone looks
Irregular & ill defined
- Presence of many filling
defects

DDx:
Adeno CA
Sq. Cell CA

Filling Defect

It shows an irregularity that almost looks like an apple core lesion in the esophagus. This is typical in
carcinoma of the esophagus
 Barium Swallow, Single Contrast
(Oblique)

Filling Defect

Malignant
Stricture

Long Irregular
Narrowing

It shows an irregularity that almost looks like an apple core lesion in the esophagus. This is typical in
carcinoma of the esophagus
Barium Swallow, Single Contrast
(Oblique)

Irregular Wall & Dilatation:

Tertiary Contraction (Pathological non-propulsive
Contraction)

Funnel Shape
(Achalasia)

Barium swallow in this patient with achalasia reveals a smooth

distal tapering caused by the hypertensive lower esophageal
sphincter that straddles the diaphragm, and multiple non-
Peristaltic contractions throughout the body of the esophagus.
This radiographic appearance sometimes has been called
"vigorous achalasia". This term has little value, however, because
recent studies suggest that patients with so-called vigorous
achalasia cannot be distinguished clinically from non-vigorous
 Barium Swallow, Single Contrast
Well Defined
Contrast Filled left
(Oblique)
cervical level sac

Pharyngeal Pouch
(Zenker's Diverticulum):
occurs in an area of anatomic
weakness known as Killian's
dehiscence
 Barium Swallow, Single Contrast

Irregular Multiple
Filling Defects

Differential Diagnosis Multiple

Esophageal Filling Defects:
1. Fungal Infx
2. Polyps
3. Esophageal Varices
(irregular)
4. Food Particles

Varices Barium swallow examination: AP view: Numerous rounded and elongated smooth-contoured
filling defects are present in the inferior two thirds of the esophagus. The contour of the esophagus is
Barium Swallow, Single Contrast

Irregular Multiple
Filling Defects
(Esophageal
Varices)
Barium Meal, Double Contrast

Contrast Filled
Speculated Lesion
(Gastric Ulcer)
Barium Meal, Double Contrast

Rugae

Contrast Filled
Outpouching at the
Greater Curviture
(Malignant Gastric
Ulcer)
 Barium Meal + Follow-Through

Contrast Filled
Speculated Lesion
1st Part of (Duodenal Ulcer)
duodenum

2nd Part of
duodenum

4th Part of
duodenum

3rd Part of
duodenum
Barium Meal, Double Contrast

Speculated
Mass

Ulcer

Pylorus

Stomac
h
 Barium Meal, Double Contrast
(Erect Position)

DDx:
Pyloric Stenosis

Mushroom’s Sign
(or apple core Sign)

String’s Sign

Shoulder’s Sign

For further information refer to “Pediatric Abdomen Radiology” Slides (37-46)