Barium Swallow and Upper GI Flashcards
concentration of esophagus study
30-50%
concentration of upper GI series study
30-50%
concentration of small intestine: small bowel series study
40-60%
concentration of large intestine: barium enema study
12-25%
concentration of GI for CT study
12-25%
which studies are administered orally
esophagus, stomach, small intestine and GI for CT
which procedures have naso-duodenal administration
small intestine
which procedures are rectally administered?
large intestine
patient prep for esophagus?
none
patient prep fr stomach
NPO after midnight before exam
patient prep for small intestine
Low residue diet eaten for 2 days prior to exam
patient prep for large intestine
Large amount of fluids day before exam. NPO after midnight before exam. Cleansing enema prior to exam
patient prep for GI for CT
NPO after midnight before exam
what is barium sulphate?
- positive or radiopaque
- chalklike substance
indications for water soluble iodinated contrast media
- perforated viscus
- presurgical procedure
contraindications for water soluble iodinated contrast media
- hypersensitivity to iodine
what is double contrast?
- barium sulfate (positive contrast)
- carbon dioxide gas or room air (negative contrast)
pathological indications for esophagram
- Anatomic anomalies
- Esophageal reflux
- Esophageal varices
- Foreign body obstruction
- Impaired swallowing mechanism
- Stroke patients
- Congenital anomalies
- Small lesions and ulcerations
- Gastroesophageal Reflux Disease (GERD)
slide 10
know luminal indentations of the esophagus
technologist responsibilities
- Prepare fluoro room - Equipment set up - Contrast, supplies
- Ensure aprons for all staff are available
- Obtain clinical history
- Explain procedure
- Observe and support patient throughout
- Introduce and assist the fluoroscopist
- Assist the patient
deglutition
the act of swallowing
peristalsis
Greatest motility in stomach and proximal portion of small intestine
- Peristaltic activity decreases along the intestinal tract
techniques
- Shorter exposure times for upright and hypermotile pts
- Slightly longer for recumbent and normally motile pts
- Make exposures of the stomach and esophagus at the end of expiration
contraindications to contrast
- allergy to contrast
- perforation
- high risk of aspiration
- uncooperative patient
equipment for contrast studies
- Straws, spoons, K- basin, cotton balls or marshmallows, cups, Kleenex, damp cloth
- Contrast (follow department protocols and manufacturer’s instructions)
- Glass of water
esophagus procedure
- Fluoro with patient erect
- Administer Barium
- Drink by hand (thin), fed by spoon (thick)
- Place patient horizontal (drink with straw)
- Phonation or breathing maneuvers
recumbent studies esophagus used for
demonstration of esophageal varices
use of coughing during esophageal studies
reflux through cardiac sphincter
when would you use trendelenburg for esophagus
hiatus hernia or reflux
AP and PA Esophagram
- AP/PA projection
- CR to T5-T6
- No rotation
Lateral esophagram
- true lateral
- CR to T5-T6
- Esophagus midway between spine and heart
- arms not superimposing esophagus
general evaluation criteria
- Entire esophagus from lower part of neck to entrance of the stomach
- Esophagus filled with barium
- Penetration of the barium
RAO esophagram
RAO 35-40 oblique
- CR to T5-T6 (1 in. inferior to sternal angle)
- esophagus between the spine and the heart
AP or PA Evaluation Criteria
esophagus through the superimposed thoracic vertebrae with no rotation
lateral evaluation criteria
- patient’s arms not interfering with proximal esophagus
- ribs superimposed/no rotation
diagnosis of esophageal reflux
- valsavla manuver
- the water test
- compression paddle technique
- the toe-touch test
valsalva maneuver
deep breath and hold while bearing down
- increases venous pressure; can demonstrate esophageal varices
Müller maneuver
exhale then tries to inhale against closed glottis
- R/O aspiration or incompetent valves
Water test
positive if barium regurgitates through esophagus
- LPO position, swallow water through a straw
compression paddle
- paddle inflated under stomach with patient in prone position
- pressure applied to stomach region to create reflux
toe touch maneuver
- effective to demonstrate reflux and hiatal hernia
modified barium swallow
- Done for dysphagia or rehabbing patients (strokes)
- Patient sitting or standing
- Drinks/eats various mixtures of Ba with liquids/solids - Thinnest to thickest or vice versa
- Lateral and AP fluoroscopy performed
Emptying time for stomach with Barium vs. Water soluble contrast
- Barium 2-3 hours
- Water soluble contrast 1-2 hours
upper GI studies evaluate
- Mouth and upper esophagus
- Distal esophagus
- Stomach
- Some of the small intestine
- Emptying time for stomach
Be able to label slide 35-41
GI anatomy
duodenum
- shortest and widest portion: C loop
- retroperitoneal
fundus
most posterior
body of stomach
anterior/inferior to fundus
pylorus
posterior/distal to body
hypersthenic GI anatomy
- stomach high and transverse
- duodenal bulb T11-T12 right od midline
- large intestine widely distributed
hyposthenic/asthenic GI Anatomy
- stomach J shaped and low
- Duodenal bulb L3-L4 at midline
- large intestine low near pelvis
sthenic GI Anatomy
- Stomach J-shaped and low
- duodenal bulb L1-L2 right of midline
- large intestine L colic flexure high
biphasic method
combination of single and double contrast methods
hypotonic duodenography
- mostly replaced by CT and biopsies
Indications of Stomach/Upper GI studies
- Dyspepsia
- Upper abdominal mass
- Bezoar
- Gastric cancer
- Polyps
- Diverticula
- Assessment perforation sites
- GERD
- Post duodenal bulb lesions and Pancreatic Disease
- Weight loss
- GI Hemorrhage
- Hiatal hernia
- Gastritis
- Ulcers
- Emesis – hematemesis
contraindications of contrast in upper GI
- complete large bowel obstruction
- perforations
- patients aspirating contrast instead of swallowing it
- contrast allergy
patient prep for upper GI
NPO 8-9 Hrs. - Small bowel – NPO after evening meal
- No smoking or chewing of gum after midnight - May stimulate gastric secretions
- Remove all clothing, hospital gown
- Sometimes laxative or enema to cleanse the large bowel
gastrics studies
- dehydration is a concern
- book early in day
- may require more time and assistance
paediatric gastrics
- parents don lead aprons to assist positioning
- usually performed recumbent
- infants may drink barium from bottle - increase hole in nipple
- minimal prep
slide 54
understand air distribution based on position
Upper GI PA
- recumbent
- body, pylorus and duodenal bulb are barium filled
- CR - L1-2 (3-6 inches lower if upright) - 1/2 way between vertebrae and left lateral border of body
- entire stomach and duodenum demonstrated
- air in fundus
Upper GI AP
- recumbent
- demonstrates barium filled fundus of stomach
- CR to L1
- trendelenberg for hiatus hernia or asthenic body type
Upper GI RAO 45
- more rotation for hypersthenic patients (40-70)
- CR to L1-2
- dynamic emptying of stomach
- pyloric canal and duodenal bulb with no superimposition
- body and pylorus barium filled
- duodenal bulb and C-loop in profile
Upper GI LPO 45
- varies from 30-60
- barium filled fundus
- DC body, pylorus and bulb are air filled
- shows entire stomach and duodenal loop
- CR to L1
- body and pyloric with double contrast visualization
- no superimposition of the pylorus and duodenal bulb
Upper GI Right Lateral
- images of the pyloric canal and the duodenal bulb (hypersthenic pt.)
- true lateral
- CR to L1
- entire stomach and duodenum demonstrated
- retrogastic space demonstrated
- vertebrae in true lateral perspective
compression studies of Upper GI
can use compression paddle to visualize the duodenal bulb in various stages of filling
slide 64
which is prone versus supine
post care
- white bowel movements
- to avoid impaction - plenty of fluids
