OMD

( OESOPHAGUS MAAG
DUODENI ) /BARIUM MEAL

Departemen Radiologi
FK UNDIP
 Anatomy Of Digestive System

⦿ Alimentary Canal
› Mouth
› Pharynx
› Esophagus
› Stomach
› Small and Large
Intestine
 Anatomy Of Digestive System

⦿Accessory
glands
› Liver
› Gallbladder
› Salivary glands
› Pancreas
 Esophagus
⦿ Originates around C-6
⦿ In thorax, it is anterior
to spine, posterior to
trachea and heart
⦿ Passes through
diaphragm through
esophageal hiatus
 Esophagus
⦿ 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
 Stomach
⦿ Dilated saclike portion
of digestive tract
⦿ Composed of same 4
layers as esophagus
› Outermost - fibrous
› Muscular
› Submucosal
› Innermost - Mucosal
 Stomach
⦿ 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
 Small Intestine
⦿ 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
Duodenum
⦿8 - 10 inches in length

⦿Widest portion of small intestine

⦿Follows a C-shaped course

 Duodenum
⦿ 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 And Ileum
⦿ 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
 OMD/BARIUM MEAL

⦿DEFINISI :
Pemeriksaan radiologis dengan menggunakan
kontras media untuk memvisualisasikan
esofagus,gaster dan duodenum secara dinamik
dengan fluoroskopi dan radiografi.
 BATASAN

⦿Menggunakan kontras media positif

( kontras ) dan negatif (udara) untuk menilai
abnormalitas pergerakan, lumen dan mukosa .
⦿Kontras : Barium Sulfat dan menggunakan
effervescent untuk menghasilkan udara.
 INDIKASI
⦿Kelainan mobilitias
⦿Kelainan mukosa (ulkus, divertikel, inflamasi)
⦿Keganasan
⦿Degeneratif
⦿Kelainan kongenital
⦿Kelainan obstruktif
⦿Corpus alienum
 KONTRA INDIKASI

⦿Perforasi
⦿Alergi kontras
⦿Obstruksi total upper GI
 PROSEDUR

⦿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 melalui oral ( 1; 1) , untuk
mengisi esofagus sambil dilakukan fluoroskopi
⦿Lalu kontras Barium sulfat (1 : 3 ) diminumkan
melalui 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
KELAINAN ESOFAGUS

⦿Varises esofagus
⦿Achalasia esofagus
⦿Striktur esofagus
⦿Atresia esofagus
⦿Esofagitis
⦿ Tumor esofagus
⦿Fistula esofagus
⦿Divertikulum dan spasme esofagus
 KELAINAN GASTER

⦿Congenital : hypertrophy pyloric stenosis (HPS),

hernia diafragmatika, sliding hernia, etc
⦿Gastritis
⦿Gastric Ulcer plg sering terjadi pada : minor
curvature , anthrum pyloricum, corpus, fundus,
cardia
⦿Tumor , mis : adeno ca, leiomiosarkoma
 KELAINAN DUODENUM

⦿Congenital : atresia duodeni, spasme duodeni

⦿Duodenitis
⦿Tumor : polip, divertikulum→ benign
maligna : filling defek irreguler , umbrella sign
⦿Tumor Caput Pancreas : enlarge C loop
Single Contrast

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

Esophagus
Single Contrast
 Double Contrast

Double Contrast

Identation of A.A

Indentation of
L.main bronchus

Single Contrast
 Single Contrast

Double Contrast

L.
A
Heart .
L.
V.
Double Contrast

Indentation of
L.main bronchus

Double Contrast

Single Contrast
 Single Contrast

Ampulla
Normal Varient

Fundus

Body
Single Contrast

Aortic Arch
 Double Contrast

Narrowing:
Could be peristalsis
So other shot is advised
 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 outer
Antrum border

Ileum

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

DJJ:
Normal Position= Left side
2nd Part of
Duodenum

3rd Part of
Duodenum
 Single Contrast

Esophagus

Proximal
Dilatations

Narrowing
(Stricture)

Bird Peak Sign

DDx: Achalasia
 Single Contrast
Lower Esophagus

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

Proximal
Dilatations

Distal
Narrowing
 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
 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
 Single Contrast
Well Defined Contrast
Filled left cervical
(Oblique)
level sac

Pharyngeal Pouch
(Zenker's Diverticulum):
occurs in an area of anatomic weakness
known as Killian's dehiscence
 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 irregular and spiculated.
Single Contrast

Irregular Multiple
Filling Defects
(Esophageal Varices)
Double Contrast

Contrast Filled
Speculated Lesion
(Gastric Ulcer)
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

Stomach
 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)

CORPUS ALIENUM

Coin in esophagus. Frontal view of the neck and upper chest shows a
round metallic foreign body (white arrow) that lies in the midline just
above the aortic knob (red arrow).
Coins in the esophagus are round in appearance on the frontal view
whereas coins in the trachea are usually seen on end and are linear in
shape
ESOPHAGITIS

Penyebab utama esofagitis adalah Gastroesophageal Reflux

Air-contrast esophagram shows thick esophageal mucosal
folds (arrows) and an ulcer (arrowhead) due to GERD.
Single contrast esophagram shows stricture (arrow) and
sliding hiatus hernia
On the left Irregular stricture (arrowhead) and
erosions (arrows) due to GERD.
Infectious esophagitis
Candida esophagitis
a patient with an infectious esophagitis due to candida.
The barium study shows numerous fine erosions and small plaques
due to Candida albicans in immunocompromised patient.
 PEMERIKSAAN PANORAMIC

= Orthopantomogram

•Pemeriksaan Radiologi menggunakan

X Ray yang dapat melihat struktur tulang
mandibula, maksila serta seluruh
jaringan gigi dalam satu film
 INDIKASI
1.Melihat lesi pada tulang
2.Melihat kondisi gigi sebelum pembedahan
3.Sebelum melakukan perawatan gigi,
untuk melihat keadaan gigi dan benih gigi
4.Melihat ada atau tidaknya fraktur
THANK YOU...