upper GI Barium series

1. Gastrointestinal Tract
Special Procedure
BY
Roshan shah
B.Sc.MIT 2nd year
3rd Batch

2. Definition:-
 It is an x-ray examination of the
esophagus, stomach, duodenum,
small intestine & large intestine.
 Diagnostic test
- GI-series
- CT-scan
- MRI
- Endoscopy
- Endoscopic USG etc.

3. Contrast examination:-
 Barium sulphate is the best CM for demonstrating the GI-tract.
- Single CM is used to outline the structure.
- Double CM is used for detail viewing of the mucosal
pattern.
 Water soluble CM is used in some cases such as perforation, small
bowel obstruction, pediatric patient.

4. Characteristic of barium:-
 High density with low viscosity.
 Particles size 0.1 to 0.3 µm
 pH = 5.3
 Inert compound with no adverse reaction
Route: Orally & Rectally
Method: Single contrast & double contrast

5. Difference?
Single contrast
medium
Double contrast
medium
Only barium is given. 60-100%
w/v
Barium with gas producing agent
is given. 200-250% w/v
To outline the structures, lumen
and large abnormalities.
For detail viewing of the mucosal
pattern, making it easier to see
narrowed areas (strictures),
diverticula or inflammation.

6. Cont…

7. GI-series:-
1. Barium swallow
2. Barium meal
3. Barium follow-through
4. Small bowel enema
5. Barium enema

8. Barium swallow
 Indication:-
1. dysphagia
2. anaemia
3. pain
4. assessment of tracheo-oesophageal fistula
5. assessment of site of perforation
 Patient preparation:-
-NPO for 6 hours prior to the examination.
-Smoking should be avoided on the day of examination.
- Muscle relaxants before the procedure
 Contrast medium:-
-Double contrast 200-250%w/v, 100ml/ more according to need.
-Water soluble contrast agent if perforation is suspected (Gastrograffin).
-LOCM(approx 300 mgI /ml) incase of aspiration.

9. Technique:-
 AP or PA Projection:-
• Pt. supine or prone
• Center midsagittal plane to
cassette
• Bottom of cassette should be
placed just below tip of
xiphoid
• Pt. drinks contrast before
exposure and continues
drinking during exposure.
• Shield!

10. Cont..,
 RAO or LAO Positions:-
• To throw the esophagus clear
of the spine.
• Pt should be rotated 35 - 40
degrees
• Center about 2 inches lateral
to MSP
• Bottom of cassette below
xiphoid.

11. Cont…
 Lateral projection:-
• Place pt in lateral position.
• Center midcoronal plane to
cassette.
• Bottom of cassette below
xiphoid process.
• Pt must drink continuously
before and during exposure.
• Use shielding!

12. Cont…

13. Barium meal
 indication:-
-dyspepsia
-weight loss
-upper abdominal mass
-partial obstruction
-GI hemorrhage
 Contraindication:-
-complete large bowel obstruction
 Patient preparation;-
-Pt. should follow a low residue diet for 2 days prior to exam
-NPO for 6 hours prior to the examination.
 Contrast medium:-
-E-Z HD 250%w/v, 135ml

14. Technique:-
• A gas producing agent is
swallowed. The patient drinks
barium while lying on the left
side.
• The patient then lies supine &
slightly on the right side .
• Ask to roll onto the right side &
then quickly over in a complete
circle, to finish in an RAO
position.

15. Single vs double contrast:-
 Single contrast:-
• Shows size, shape, and
position of stomach.
• Examines changing
contour of stomach during
peristalsis.
• Observe filling and
emptying of duodenal
bulb.
 Double contrast:-
• Mucosal lining is well
visualized
• Small lesions are less
easily obscured

16. Compare Single and Double Contrast:-

17. Compare AP & PA projection:-

18. LATERAL PROJECTION:-
 Position:-
• Lateral recumbent - right side
 CR:-
• Level of L1-L2
• Between midcoronal and anterior
of abdomen

19. Film technique:-
• RAO: to demonstrate antrum & greater curve
• Supine: antrum & body
• LAO: lesser curve
• Left lateral tilted, head up: fundus
 From the left lateral position the patient returns to a supine position
& then rolls onto the left side & over into a prone position.
-Prone
-RAO
-Supine
-LAO

20. Barium follow-through:-
 Methods:-
-single contrast.
-with the addition of an effervescent agent.
-with the addition of a pneumocolon technique.
 Indication:-
-Diarrhoea
-Anaemia
-Partial obstruction
-Malabsorption
-Abdominal mass
 Contraindication:-
-Complete obstruction
-Suspected perforation

21. Cont…
 Contrast medium:-
-E-Z paque 100% w/v 300ml
 Patient preparation:-
-Low residue diet for 2 days prior when possible
-NPO after midnight before exam.
-Metoclopramide (maxolon) 20 mg orally may be given before or
during the examination.

22. Technique:-
 Prone PA film of the abdomen
are taken every 15-20min
during the first hour.
 And subsequently every 20-30
min until the colon is reached.
 Spot film of the terminal ileum
are taken in supine.

23. Film series:-
Immediate 15 minutes

24. Cont…
30 minutes 1 hour

25. Aftercare:-
The patient should be warned that his bowel
motion will be white for a few days after the
examination and may be difficult to flush away.
The patient should be advised to eat and drink
normally to avoid barium impaction. Laxative may
be taken if required.
The patient must not leave the department until
any blurring of vision produced by the Buscopan
has resolved.

26. Complications:-
• Leakage of barium from an unsuspected
perforation.
• Aspiration of stomach content due to the Buscopan.
• Conversion of partial obstruction into a complete
obstruction by the impaction of barium.
• Barium appendicitis, if barium impact in the
appendix.