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PERFORMING A BARIUM MEAL Department of Diagnostic Radiology 23 March 2012 M. Pieters Anatomy of the stomach J-shaped Varies in size and shape Stomach in situ Anatomy of the stomach Anatomy of the stomach Layers of the stomach Three muscle layers, three mucosal layers Arterial supply Coeliac artery Common hepatic artery Posterior relations Posterior relations Anterior relations Lesser sac Venous drainage Lymph drainage of the stomach Stomach innervation Barium meal Indications Dyspepsia Weight loss GIT haemorrhage Failed upper GIT endoscopy Assessment of perforation site Upper abdominal mass Unexplained iron deficiency anaemia Partial obstruction Contra-indications Complete large bowel obstruction Complications Aspiration Intra-peritoneal leakage Ba appenticites Contrast agents Barium Sulphate eg. E-Z HD 250% Carbex granules Patient preparation NPO 6hrs prior History – no pharmacological contra-indications Technique (Double contrast) Position Film Action Reasoning Visualization Erect/sitting - Pt drinks fizzing agent To distend the stomach - On left side Screen Pt drinks barium Delays passage to duodenum Greater curve Supine, tilted to the right side Screen Cough or swallow H2O Ba flows to GE-junction Observe for reflux Unchanged - IV muscle relaxant - - Roll to right, complete circle, end supine, left tilt - Coating of the gastric mucosa Technique (Stomach Spot Films) AP Position Film Action Reasoning Visualization Supine, tilted to the left RAO - - Antrum and greater curve Supine PA - - Antrum and body Supine, tilted to the right LAO - - Lesser curve en face On right side, head up 45o Left lateral - - Fundus Technique (Duodenal Spot Films) Position Film Action Reasoning Visualization Return to supine, on left side, then prone AP Pt on compression pad Avoid Ba flooding duodenal loop AP of the Duodenal loop Roll to right side, RAO supine, then supine tilted to the left - Avoid Ba flooding duodenal loop RAO of the Duodenal cap Turn supine (shortest route) PA - - PA of the Duodenal cap Lie supine and tilted to the right LAO - - LAO of the Duodenal cap Technique (Erect Views) Fundal lesion suspected Position Film Visualization Erect PA Fundus Erect RAO Duodenal cap and Fundus Erect LAO Duodenal cap and Fundus Technique (Oesophageal views) Barium swallow to conclude exam Either spot films or dynamic screening Position Film Visualization Erect RAO Oesophagus Bibliography A Guide to Radiological Procedures 5th ed - Aitchison Diagnostic and Surgical Imaging Anatomy: Chest.Abdomen.Pelvis - Federle Anatomy for Diagnostic Imaging 3rd ed – Ryan Atlas of Human Anatomy 5th ed – Netter Atlas of anatomy – Gilroy Web references: http://www.Instantanatomy.net http://www.Dartmouth.edu http://www.individual.utoronto.ca/ecolak/gi_techniques/techniques /ugi/frame_set.htm