1. Fluoroscopic Investigations Of The Gastrointestinal Tract
Pharynx , Oesophagus and stomach

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

3. With the end of these lectures the student will be able to:
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 positioning ,image quality, radiographic anatomy ,and pathology

4. Transport of food by peristalsis.
What is the function of esophagus?
Transport of food by peristalsis.

5. Barium Swallows –Indications
Pain on swallowing
Fistulae between trachea & oesophagus
(non-ionic c/a preferred)
Assessment of action of oesophagus following a stroke
Oesophageal varices / Diverticula
As part of a barium meal investigation
Dysphagia
Carcinoma / obstruction /Hiatus hernia
Hemetemesis

6. 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

7. Barium Swallow - Typical film series
Demonstrates
Position
Esophagus between vertebral column & heart
Erect RAO (35-40 degree)
Esophagus between hilar region of lung & Thoracic spine
Erect LAO
Esophagus through superimposed thoracic vertebrae
Erect AP
Entire esophagus between thoracic spine & Heart
Lateral

8. Barium Swallow - Technique
Following Barium 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

9. Barium Swallow
(Normal Films)

10. between the lower esophagus and stomach.
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.

11. Barium Swallow AP
RAO

12. 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

13. Barium Swallow
(Pathology Films)

14. Achalasia

15. ACHALASIA Distended esophagus with distil stricture
due to Achalasia - Failure of distil sphincter to relax – causing obstruction.

16. Esophageal Spasm
Strictures

17. Carcinoma

18. Tracheo - oesophageal fistula
Normal Swallow
Leaks of contrast
into the trachea

19. Stomach
Barium meal

20. Stomach Anatomy J-Shaped Continuous with Oesophagus & duodenum
Three sections
Fundus
Body
Pyloric Antrum

21. 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

22. Contrast media & patient preparation
Barium meal
Contrast media & patient preparation
High density, 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?)

23. 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.

24. 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

25. Barium meal - Typical film series
RAO
Stomach and C-loop of the duodenum with duodenal bulb in profile

26. Barium meal - Typical film series
PA (Prone)
Duodenal loop + duodenal with body and pylorus filled with barium

27. Barium meal - Typical film series
Right lateral
Retro gastric space

28. Barium meal - Typical film series
AP (supine)
Entire stomach and duodenum + Fundus of stomach filled with barium

29. Barium meal - Typical film series
LPO
Duodenum Bulb without superimposition with the pylorus + Fundus of stomach filled with barium
LAO
Lesser curve
Prone , RAO, LAO , Supine, Erect
Duodenal Cap series
Note : In the erect position the Fundus of the stomach is filled with air

30. Barium meal ( Normal anatomy)

31. 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

32. ( Pathology)
PYLORIC STENOSIS

33. ( Pathology)
GASTRIC CARCINOMA

34. ( Pathology) Normal Hiatus Hernia
*Note distended distil esophagus with herniation of gastric fundus into chest through esophageal hiatus.
DIAPHRAGM
Normal
Hiatus Hernia

35. ( Pathology)
DUODENAL ULCER

36. Any Questions?
Thank you