Upper Gi Flashcards
What imaging test are used in the upper GI tract?
Contrast swallow – barium swallow
Video swallow/fluoroscopy
Contrast meal – barium meal
Endoscopy
GI tract imaging and what it’s good for?
Contra studies are good for showing anatomy and function
Endoscopy shows fine mucousal detail and biopsies can be taking for further investigation
Upper GI tract pathology – signs and symptoms?
Dysphagia
Pain
Vomiting
Heartburn
Indigestion
Regurgitation
Acid taste in mouth/ bad breath
Hoarseness/chronic cough
Haematemesis/Maleana
Anaemia
What information do we need to make the patient aware of?
Appointment details
Contact telephone number for department
What to do if it’s unsuitable
Preparation for the exam – fasting/undressing
What will happen during the examination
Instructions for afterwards – when and where to get results
Special considerations for patients?
Medication
Diabetes
LMP/pregnancy
What is the patient preparation for imaging?
No smoking six hours prior to the study
Fast for six hours prior To study continue with medication
 check patient compliance
Removal of jewellery hearing aid…
Removal of clothing
Radiolucent gown
What contrast media can be used?
Barium sulphate – but not if perforation is suspected
Water-soluble contrast example Gastrografin – a perforation suspected but not if there’s a chance of aspiration
Low osmolar contrast medium – LOCM – known as non-ionic contrast – opitray /niopam, if aspiration is a risk
Contrast swallow – why would we do it?
Patient cannot tolerate endoscopy
Dysphagia – CVA for SALT assessment (stroke patient)
Suspicion of minor distal Oesophageal stricture on endoscopy
Assessment of anatomy/drainage following surgery
Recent upper GI surgery – check for anastomotic leak
Assessment of tracheoesophageal fistula – water-soluble contrast
Mortality disorders of the oropharynx – these can be caused by trauma motoneuron disease, MS and the ageing process
Sensation of lump in throat - globus
Gastro-oesophageal reflux
Contrast swallow - contraindications?
There are none however:
Always use water soluble contrast medium if suspicious of leak/perforation or known aspiration during ingestion
Stroke patient or difficulty swallowing -  must always have suction on hand
What is barium sulphate?
It’s a powdered chocolate substance
Mixed with water before ingestion 2 to 1
Insoluble saw suspension
Relatively inert
Radiopaque
Safe if GI tract is intact
Escape of barium into peritoneal cavity Will cause inflammation and may lead to peritonitis
Can cause pain and hypovolaemic shock - 50% mortality rate
Why is a water-soluble contrast used when there is a risk of barium leaking into peritoneum?
water-soluble is absorbed by the peritoneum and excreted by the kidneys
Should always warn the patients of the bitter taste
What equipment is used?
 fluoroscopy video recording equipment
Required for assessment of laryngopharynx/upper oesophagus
Barium swallow technique:
Patient is erect on fluoroscopy table
Patient is asked to take normal size mouthful of contrast and hold in the mouth
Cup held and left hand out the way
Patient and equipment positioned
What is the imaging technique for a barium swallow?
AP to demonstrate Laryngopharynx
Lateral to demonstrate Laryngopharynx
RAO - to demonstrate oesophagus cleared of spine (patient is erect and right side raised so right side is closer to image receptor)
Prone RPO - To distend and better demonstrate oesophageal varices
Erect and supine
What is Trendelenburg barium swallow?
Head end of table tilted down – patient holds onto handles
Used to demonstrate Gastro oesophageal reflux
