Fluoroscopic Investigations

Of The Gastrointestinal Tract

Pharynx , Oesophagus and

stomach
References
• Radiographic procedures: By Stephen Chapman
• Positioning in Radiography: By k.C.Clarke.
• Text book of radiographic positioning and related
anatomy;bykenneth L.Bontrager.

Websites
• http://www.e-radiography.net/
Learning
Objectives
With the end of these lectures the student
will be able to:
 List common indications for ordering Ba swallow
/meal exam
 Explain Ba swallow/meal exam limitations
 Explain the contraindications for using barium
sulphate in the examination of the oesophagus
and stomach.
 Describe the anatomy of the oesophagus and
stomach and explain their function
 Describe room preparation and identify supplies
for Ba swallow and barium meal series
 Describe how to perform barium swallow / meal
 Explain patient care, after completing the
barium procedures
 Critique Ba swallow /meal radiographs in term of
What is the function of esophagus?
Transport of food by peristalsis.
Barium Swallows –Indications
 Pain on swallowing
 Fistulae between trachea &
oesophagus
 (non-ionic c/a
Assessment preferred)
of action of oesophagus
following a stroke
 Oesophageal varices / Diverticula
 As part of a barium meal
 investigation
Dysphagia
 Carcinoma / obstruction /Hiatus
hernia
 Hemetemesis
 Barium Swallow - Technique
 a series of plain films or uses
fluoroscopy to identify any
 pathology
Patient is placed in the erect RAO
position
 Ample mouthful of barium is swallowed
& spot films are taken (rapid sequence)

 Spot films of the upper & lower

oesphagus are taken
 May need rapid serial radiography
sequence
Barium Swallow - Typical film
series
Position Demonstrates

Erect RAO (35-40 degree) Esophagus between

vertebral column & heart

Erect LAO Esophagus between hilar

region of lung & Thoracic
spine

Erect AP Esophagus through

superimposed thoracic
vertebrae

Lateral Entire esophagus between

thoracic spine & Heart
 Barium Swallow - Technique
FollowingBarium Swallow upper GI series
may performed to diagnose pathology in
the, stomach, and duodenum

Limitations
Not good for evaluating small ulcers
Not specific for diagnosis of esophagitis
Barium Swallow
(Normal Films)
 Figure2 Figure1

Figure1: Shows the lower end of a normal esophagus with a

smooth connection
between the lower esophagus and stomach.
Figure 2: Shows the lower end of the esophagus with a small
hiatus hernia, which
occurs when a small portion of the stomach pushes
up into the chest.
Barium Swallow

AP RAO
 Aftercare of the patient
 Patient given tissue to wipe & clean
mouth
 Patient aware of where & when to
obtain results.
 Patient given the chance to ask any
questions.
The patient should drink plenty of fluids and
may need a laxative after the test because
the barium can be constipating
 Barium Swallow
(Pathology Films)
Achalasia
 ACHALASIA

Distended esophagus with distil stricture

due to Achalasia - Failure of distil sphincter
to relax – causing obstruction.
Strictures Esophageal Spasm
Carcinoma
Tracheo - oesophageal fistula

Leaks of
Normal contrast
Swallow into the
trachea
 Stomach
Barium meal
 Stomach Anatomy

 J-Shaped
 Continuous with
Oesophagus &
duodenum
 Three sections
 Fundus
 Body
 Pyloric Antrum
 Barium Meal
Indications
 Dyspepsia / reflux / Upper abdomen pain/ Nausea/ Weight loss
 Fullness or distension
 Peptic ulceration (defects
( in mucosa extending through muscularis
mucosae)
 Gastritis ( Inflammation of the stomach)
 Polyps
 Upper abdominal mass
 Gastrointestinal haemorrhage
 Pyloric / cardiac stenosis
 Hiatus hernia ( Slipping of the upper portion of the stomach through the
oesophageal hiatus
 Partial bowel obstruction
 Assessment of site of perforation ( What type of contrast to use?)
Contra-indications:
 Complete bowel obstruction
 Barium meal
Contrast media & patient
 High density,preparation
low viscosity barium
 Nil orally for 6 hours prior
 Explanation of procedure
 Physical & psychological preparation
 No smoking (>gastric motility)
 Check for contra-indications to pharmacological
agents

( What are the contra indication for Buscopan?)

 Barium Meal Investigation
 Can perform double (CO2 & Barium) or
single contrast examinations
 Single contrast examinations are used
in paediatrics & grossly ill patients
 Double contrast examinations -
demonstrate mucosal pattern
 Equipment should contain ability to
perform spot film images.
 Barium meal - Technique
 Gas producing agent swallowed (eg. Carbex)
 Patient drinks barium whilst lying on left side
 Patient lies supine & slightly on their right
side
 Check for reflux
 Smooth muscle relaxant given to the patient
Buscopan (20mg iv) or Glucagon (0.3mg iv)
 Patient rolls onto their right side & quickly
over in a complete circle - finish in a RAO
position
 This has the effect of coating the gastric
mucosa with barium
 Barium meal - Typical film
RA
series
O
Stomach
Stomach and C-loop of the duodenum with duodenal bulb
in profile
 Barium meal - Typical film
series
PA (Prone)
Duodenal loop + duodenal with body and pylorus
filled with barium
 Barium meal - Typical film
series
Right
lateral
Retro gastric
space
 Barium meal - Typical film
series
AP (supine)
Entire stomach and duodenum + Fundus of stomach filled
with barium
 Barium meal - Typical film
LP series
O
Duodenum Bulb without superimposition with the
pylorus + Fundus of stomach filled with barium

LA
O
Lesser curve
Prone , RAO, LAO , Supine, Erect
Duodenal Cap series
Note : In the erect position the Fundus of the stomach is filled with air
Barium meal ( Normal
anatomy)
 Barium meal ( Normal
anatomy)

 (3) greater curvature (4) lesser curvature (5) fundus (6) small bubble
of gas. (7) pyloric region (8) second part of the duodenum
( Patholo
gy)

PYLORIC STENOSIS
( Patholo
gy)

GASTRIC CARCINOMA
 ( Patholo
gy)

*Note distended
distil esophagus with
herniation of gastric
fundus into chest
through esophageal
hiatus.

DIA
PHR
AGM

Hiatus
Normal
Hernia
( Patholo
gy)

DUODENAL ULCER
Any Questions ?
Thank
you