Download Upper Gastrointestinal Series

Upper
Gastrointestinal
Series
Upper GI Series
•
Gastrogram
– positive contrast
– double contrast (not practical)
– negative contrast
•
•
Small intestine
Not for evaluation of large intestine
The cheapest GI special
procedure
The cheapest GI special
procedure – opposite lateral
Upper GI Series
Indications
•
•
Morphology
Function
•
•
•
•
•
Acute or chronic
vomiting
Hematemesis
Anorexia
SI diarrhea or
melena
Suspect obstruction
•
•
•
•
Suspect linear
foreign body
Cranial abdominal
mass lesion
Position of intestinal
tract
Suspect perforation
1
Contra-indications
(relative)
•
•
•
•
Survey radiographs show obstruction
Known or suspected perforation
Prior use of motility altering drugs
Food in stomach or feces in colon
Complications
•
Survey SI obstruction
Aspiration of contrast
Complications
•
Aspiration of contrast
– Problematic with barium in diseased lungs
– Problematic with ionic non-sterile oral
iodinated preparations
Complications
•
Leakage of contrast into peritoneal cavity –
OK if rapidly (<12 hours) flushed, otherwise
adhesions and granulomatous reactions
Patient Preparation
•
Important!
– especially for functional studies
•
•
Fast for 12-24 hours
Warm water enemas
2
Supplies: Contrast Media
•
Gastric Perforation
Barium sulfate
suspension
– 30% weight/weight
– 6 ml/lb
•
Iodinated contrast
– 1-2 ml/lb diluted
with tap water to
make 6 ml/lb
Gastric Perforation
Gastric Perforation
Iodinated contrast
Barium
Supplies
Technique
•
Survey radiographs
– evaluate need for study
– ensure proper preparation
– establish radiographic technique
•
Sedation?
– Dogs: acepromazine
– Cats: ketamine/valium
3
Technique
•
•
Common Technical Errors
Administer contrast via orogastric tube
Obtain serial radiographs (2 views)
•
•
Poor patient preparation
Inadequate dose of contrast
– Dog: 0, 15, 30, 60, hourly
– Cat: 0, 15, 30, 45, 60, then Q30-60 min
•
When to end study?
–
–
–
–
Contrast reaches colon
Stomach is empty
Most contrast in distal small intestine
No further progression of contrast
Common Technical Errors
•
•
•
Poor patient preparation
Inadequate dose of contrast
Improper radiographic technique
Common Technical Errors
•
•
•
•
•
Normal Interpretation
Poor patient preparation
Inadequate dose of contrast
Improper radiographic technique
Two few radiographs
Administration of barium coated meal
Normal Interpretation
Delayed gastric emptying
Dog (hrs)
Cat (hrs)
Complete gastric emptying
2 (0.5-3)
0.5 (0.25-1)
SI transit time
1 (0.5-2)
0.75 (0.5-1)
SI emptying time
3.5 (3-5)
–
–
–
–
–
Stress!
Inadequate contrast dose
Poor preparation
Medications
Sedation
4
Normal Interpretation
•
•
•
•
•
Gastric emptying
Rugal folds
Continuous, rope-like, uniform column
Smooth or finely fimbriated mucosa
Thin, uniform intestinal wall
Symmetric peristaltic waves
Immediate
20 minutes
40 minutes
90 minutes
5
Normal variations
Fimbriation
• fringing at the
barium-mucosal
interface –
“brush border”
due to villi
Normal Variations
Normal Variations
Pseudoulcers
– young dogs
– square or conical outpouchings
– antimesenteric
border
Negative contrast
gastrogram
“String of pearls”
– duodenum of cats
– strong muscular
contractions
– “pseudostring” sign
Negative contrast
gastrogram
Abnormal Interpretation
Identification of lesions
– repeatable
– persistent
6
Abnormal Interpretation
•
•
•
•
•
•
•
Stomach - intramural
Classify lesions as intraluminal, intramural,
or extramural
Luminal diameter
Barium-mucosal interface
Wall thickness
Distensibility
Filling-defects
Displacements
Stomach - intramural
Stomach intramural/intraluminal
Stomach - intraluminal
Chronic Pyloric
Obstruction
Pronounced delayed
emptying
– “beak” sign
– “string” sign
– peristaltic pouch
7
4 mo, M, Boxer: chronic vomiting
4 mo, M, Boxer: chronic vomiting
SI - intraluminal
SI - intraluminal
SI - intraluminal
SI - intraluminal
8
Ulceration (intramural)
•
•
Out-pouchings from the lumen
Benign or malignant
Radiographic Diagnosis of Abdominal Disorders in the Dog and Cat,
O’Brien, W.B. Saunders Co, 1978
Radiographic Diagnosis of Abdominal Disorders in the Dog and Cat,
O’Brien, W.B. Saunders Co, 1978
SI – intramural (diffuse)
SI – intramural (diffuse)
SI- intramural (apple core)
SI - extramural
9
Case Example: 4 month old, M, Boxer
4 days of vomiting, known to eat things
•
Survey Radiographs
Case Example: 4 month old, M, Boxer
4 days of vomiting, known to eat things
•
Upper GI: 60 min
Case Example: 9 year old, MN, Shar-pei
diarrhea and melena x 2 mo, vomiting x 1 mo
•
Upper GI: 20 min
Case Example: 4 month old, M, Boxer
4 days of vomiting, known to eat things
•
Upper GI: immediate
Case Example: 9 year old, MN, Shar-pei
diarrhea and melena x 2 mo, vomiting x 1 mo
•
Survey radiographs
Case Example: 9 year old, MN, Shar-pei
diarrhea and melena x 2 mo, vomiting x 1 mo
•
Upper GI: 90 min
10
Case Example: 9 year old, MN, Shar-pei
diarrhea and melena x 2 mo, vomiting x 1 mo
•
Upper GI: 225 min
11