Ba examination of gi tract

Ba examination of GI Ba examination of GI tracttract

Dr R S GuptaDr R S GuptaPCMSRCPCMSRC

Materials opaque to X-rays can be introduced in Materials opaque to X-rays can be introduced in hollow organs. This means that there is hollow organs. This means that there is ‘contrast’ between the contents of the cavity and ‘contrast’ between the contents of the cavity and the wall. The cavity shows up as white in an X-the wall. The cavity shows up as white in an X-ray image.ray image.In some organs we can also introduce air or a In some organs we can also introduce air or a gas so that it shows up as black.gas so that it shows up as black.These two modes are sometimes described as These two modes are sometimes described as positive or negative contrast. positive or negative contrast. Materials thus introduced for this purpose are Materials thus introduced for this purpose are called contrast media.called contrast media.

A contrast medium must satisfy A contrast medium must satisfy certain criteria :certain criteria :

It must be inert (non-reactive) non-toxic.It must be inert (non-reactive) non-toxic. It must not be absorbed or retained by the body. It must not be absorbed or retained by the body. It must be easily excreted.It must be easily excreted.

Barium sulphate Barium sulphate Calcium group of elements, Calcium group of elements, ““heavier”, atomic mass of 137heavier”, atomic mass of 137 insoluble in water and hydrochloric acid, insoluble in water and hydrochloric acid,

hence nonabsorbable hence nonabsorbable

It is mixed with water to form a It is mixed with water to form a suspensionsuspension

Ba study Ba study

Ba swallow – for oesophagusBa swallow – for oesophagusBa meal of stomach and duodenumBa meal of stomach and duodenumBa meal follow through – for small Ba meal follow through – for small intestineintestineSmall bowel enteroclysisSmall bowel enteroclysisBa enema for large bowelBa enema for large bowel

TechniqueTechnique

Patient will need to be NPO after midnight Patient will need to be NPO after midnight before the exambefore the examThe patient will have to swallow a contrast The patient will have to swallow a contrast agent.agent.May also swallow sodium bicarbonate for May also swallow sodium bicarbonate for double contrast barium swallowdouble contrast barium swallowX-ray tech will have the patient perform X-ray tech will have the patient perform various maneuvers so that the barium can various maneuvers so that the barium can coat the GI tractcoat the GI tract

Ba swallowBa swallow

IndicationIndication OdynaphagiaOdynaphagia DysphagiaDysphagia repeated aspiratation in childrepeated aspiratation in child

AchalasiaAchalasia

StricturesStrictures

Diffuse Esophageal SpasmDiffuse Esophageal Spasm

CarcinomaCarcinoma

CarcinomaCarcinoma

ESOPHAGEAL VARICES ESOPHAGEAL VARICES

LimitationsLimitations

Not good for evaluating small ulcersNot good for evaluating small ulcersCannot test for H. pylori or take biopsies of Cannot test for H. pylori or take biopsies of ulcersulcersNot specific for diagnosis of esophagitisNot specific for diagnosis of esophagitisNot possible to provide interventions for Not possible to provide interventions for any lesionsany lesions

Ba meal stomach and Ba meal stomach and duodenumduodenum

• The passage of the barium through the esophagus, stomach and duodenum is monitored on the fluoroscope.

• Additionally, some patients are asked to swallow sodium bicarbonate crystals to create gas and further improve the images; this procedure has the modified name of "air-contrast" or "double-contrast upper GI."

Upper GIUpper GI

Indication Indication

Abdominal pain HaematemesisPalpable massUnexplained weight lossUnexplained weight loss

supine

Antrum

Angular Incisure

Cardiac Incisure

Normal findings Normal findings

double-contrast upper GI

benign gastric ulcerbenign gastric ulcer

1. Crater : Barium collection within the ulcer crater1. Crater : Barium collection within the ulcer craterProfile view(A): Penetration of the ulcer projecting beyond the normal bariuProfile view(A): Penetration of the ulcer projecting beyond the normal barium-filled gastric lumen (arrow) m-filled gastric lumen (arrow) En-face view(B): Round or oval barium collection on dependent part (arrow)En-face view(B): Round or oval barium collection on dependent part (arrow)

Radiation of smooth thickened folds Radiation of smooth thickened folds (arrow)(arrow) extending dire extending directly to the edge of the crater ctly to the edge of the crater (arrowhead)(arrowhead) on profile view( on profile view(A) and en-face view (B)A) and en-face view (B)

Radiographic appearances of benign gastric ulcerRadiographic appearances of benign gastric ulcer

Radiographic appearances of bRadiographic appearances of benign gastric ulcerenign gastric ulcer

Incisula defectIncisula defect :smooth, d :smooth, deep, narrow, sharp indeeep, narrow, sharp indentation on greater curvatntation on greater curvature(green arrow) opposiure(green arrow) opposite a crater (white arrow) te a crater (white arrow) on lesser curvature: spon lesser curvature: spastic contraction of circuastic contraction of circular musclelar muscle

Duodenal UlcerDuodenal Ulcer

: More than 95% occ: More than 95% occur in the duodenal buur in the duodenal bulblb

: Associated with : Associated with H. H. pylori pylori infection in >9infection in >95% of cases5% of cases

: Almost always : Almost always duodenal ulcers are bduodenal ulcers are benignenign

Duodenal UlcerDuodenal Ulcer

Chronic duodenal ulcerChronic duodenal ulcer : Deformity of the duodenal bulb from fibrotic healing : Deformity of the duodenal bulb from fibrotic healing - Cloverleaf deformity - Cloverleaf deformity (A)(A) : symmetric narrowing of the midportion of the bulb wi : symmetric narrowing of the midportion of the bulb wi

th dilatation of the inferior and superior recesses at the base of the bulb th dilatation of the inferior and superior recesses at the base of the bulb (arrow)(arrow) - Pseudodiverticulum - Pseudodiverticulum (B)(B) : asymmetric narrowing of the bulb : asymmetric narrowing of the bulb

malignant gastric ulcermalignant gastric ulcer

5% of gastric ulcers are malignant5% of gastric ulcers are malignantRadiographic appearances:Radiographic appearances:

1. Intraluminal ulcer (not project 1. Intraluminal ulcer (not project beyond the expected margin of the beyond the expected margin of the stomach ) stomach ) (arrow)(arrow) 2. Irregular, nodular mass 2. Irregular, nodular mass (arrowhead) (arrowhead) surrounding the surrounding the ulcer ulcer 3. Irregular or nodular thickened 3. Irregular or nodular thickened

folds that radiate to the mass folds that radiate to the mass 4. Carman meniscus sign : 4. Carman meniscus sign : semicircular or meniscoid ulcers semicircular or meniscoid ulcers (arrow) (arrow) with its inner margin with its inner margin

convex toward the lumenconvex toward the lumen

Gastric cancer Gastric cancer

Focal constricting lesionFocal constricting lesion: loc: localized infiltrating carcinoalized infiltrating carcinoma or localized scirrhous ma or localized scirrhous carcinomacarcinoma

Annular filling defect (arroAnnular filling defect (arrow)w)

Focal constricting Focal constricting lesionlesion

: localized infiltrating : localized infiltrating carcinoma or localizcarcinoma or localiz

ed ed scirrhous carcinomascirrhous carcinoma - circumferential - circumferential irregular narrowingirregular narrowing

of of the lumen with the lumen with rigidityrigidity

Gastric cancerGastric cancer

bodyantrumbulb

fundus

Gastric cancerGastric cancer

Linitis plastica patternLinitis plastica pattern - tumor invasion of the - tumor invasion of the gastric wall gastric wall - diffuse irregular- diffuse irregular narrowing and rigiditynarrowing and rigidity of the stomach of the stomach

Extrinsic lesion Extrinsic lesion

MASS

Small bowel follow-throughSmall bowel follow-through• The passage of the barium through the stomach, and small intestine

is monitored on the fluoroscope.

• The test usually takes around three to six hours.

• X-rays are initially taken at 15-minute intervals until the barium reaches the colon (the only way to be sure the terminal ileum is fully seen is to see the colon or ileocecal valve).

• The interval may be increased to 30 minutes, or even one hour if the barium passes slowly.

Indication Indication

Abdominal pain, distensionAbdominal pain, distensionVomitingVomitingMalenaMalenaPalpable massPalpable massChronic diarrheaChronic diarrhea

Tuberculous enterocolitisTuberculous enterocolitis

Ileocecal area (80-90%)Ileocecal area (80-90%)Radiographic findings :Radiographic findings : 1. Irregular thickened bowel wall 1. Irregular thickened bowel wall (whit(whit

e arrow)e arrow) resulting in narrowing of the l resulting in narrowing of the lumen umen (coned cecum)(C)(coned cecum)(C)

2. Thickened ileocecal valve2. Thickened ileocecal valve 3. Wide gap of patulous ileocecal valve 3. Wide gap of patulous ileocecal valve

4. Thickened wall of terminal ileum 4. Thickened wall of terminal ileum (I)(I) 5. Deep ulcer with/without sinus tract o5. Deep ulcer with/without sinus tract o

r fistular fistula

C

I

A tube is placed down through the stomach into the small intestine, often under fluoroscopic control.

EnteroclysisEnteroclysis

A barium enema is given in order to perform an x-ray examination of the large intestine

During the procedure, a well lubricated enema tube is inserted gently into the rectum.

The barium is then allowed to flow into the colon.

A small balloon at the tip of the enema tube may be inflated to help keep the barium inside.Air may be puffed into the colon to distend it and provide better images – a a double contrast study double contrast study

Barium enemaBarium enema

Indication Indication

abdominal pain, bleeding from the rectum or melenachange in bowel habit, chronic diarrhoea or constipationpalpable mass

Single contrast barium enema

Barium Barium EnemaEnema

Double contrast barium enema

ascending colon

transverse colon

sigmoid colon

hepatic flexure

desc

endin

g

colon

splenic flexure

rectum

Barium Barium EnemaEnema

PolypPolyp

Colonic DiverticulosisColonic Diverticulosis

Colonic CarcinomaColonic Carcinoma