Upper GI Series Flashcards
Special radiographic examination of the distal esophagus, stomach and duodenum.
Upper GI Series
3 stomach body habitus
Eutonic or Normotonic Habitus
Hypotonic Habitus
Steer Horn Habitus
A stomach habitus where the Incisura angularis and pylorus are about the same level.
Eutonic or Normotonic Habitus
A stomach habitus where pylorus is higher than incisura angularis more than 1 cm.
Hypotonic Habitus
A stomach habitus where Inisura angularis is higher than the pylorus more than 1 cm.
Steer Horn Habitus
2 Variations of Stomach
Infantile stomach
Cascade stomach
Stomach is transverse, duodenal
bulb is hidden from view.
Infantile Stomach
Upper posterior wall is pushed
forward creating an upper
portion that fills until sufficient
volume is present to spill into the
pyloric antrum.
Cascade Stomach
In an upright position, stomach moves downward for how many inches?
3-6 inches
Stomach moves downward 3-6 inches.
Upright
Stomach moves superiorly.
Supine
Stomach moves slightly downward.
Prone
Stomach moves forward.
Pylorus closer to lumbar spine.
Right lateral recumbent
Stomach moves backward.
Pylorus closer to abdominal wall.
Left lateral upright
Position that offers most displacement
of the stomach.
SUPINE
Position of the fundus of the stomach in a supine position
at the lowest part
In what position will barium fills the fundus part of the stomach
Supine
In a supine position, air will fill what part of the stomach?
Pylorus
In a prone position, the fundus is in what position?
highest position
In a prone position, barium fills what part of the stomach?
Pylorus
What position will air reside in the fundus part of the stomach?
Prone
Air – Fundus
Barium – Pylorus
Air-Barium in a straight line
ERECT
Upper GI Series Patient Preparation
Light evening meal
NPO 8-9 hours
No smoking, chewing gum, antacid medications before examination
No breakfast
Report early in the xray department
Two general procedures are
routinely used to examine the
stomach:
- single-contrast method
- double-contrast method.
Barium meal” normally reaches
the ileocecal valve in ____
hours and the last portion in ___
2 to 3 hours
4 to 5 hours
The barium usually reaches the
rectum within ___ hours.
24
In the single-contrast method, begin the examination with the patient in what position?
upright position
Fluoroscopy is performed with the patient in the _____ positions while the body is rotated and the table is angled so that all aspects of the esophagus, stomach, and duodenum are demonstrated.
upright and recumbent positions
If esophageal involvement is suspected, a study is usually made with a ___ suspension.
thick barium
The principal advantages of this
method over the single-contrast
method are that small lesions are
less easily obscured and the
mucosal lining of the stomach
can be more clearly visualized.
Double CM for Upper GI
In a double CM, barium suspensions have
weight/volume ratios of up to
250%
In the single-contrast method - what percentage is the weight/volume range
30-50%
PATIENT PREPARATION
1. Infant under 1 year
4 hours NPO
Patient preparation
2. Children older than 1 year
6 hours NPO
BARIUM PREPARATION
1. Newborn – 1 year
2. 1-3 years old
3. 3 – 10 years old
4. Older than 10 years old
2 – 4 oz
4 to 6 oz
6-12 oz
12-16 oz
Stomach is high and transverse level of T9-T12.
Pyloric portion level of T11-T12, at midline.
Duodenal bulb is at the level of T11-T12 to right of midline.
HYPERSTHENIC
Stomach T10-L2.
Pyloric portion level of L2 near
midline.
Duodenal bulb L2 near midline.
STHENIC
J-shaped stomach, low
and vertical, T11-L4.
Pyloric portion level of L3-L4
to left of midline.
Duodenal bulb at the level
of L3-L4.
HYPOSTHENIC, ASTHENIC
Supine
MSP center to MLT
CR perpendicular to IR at level of
1. Hypersthenic– 2 inches above L1
2. Sthenic– level of L1
3. Asthenic – 2 inches below L1
AP Projection
The stomach moves superiorly and to
the left in this position.
Serves as a scout film
Demonstrate the fundus filled with
barium
Best AP projection of the retrogastric
portion of the duodenum and jejunum.
AP Projection
Prone
MCP center to MLT
CR perpendicular to IR
1. Hypersthenic– 2 inches above L1
2. Sthenic– level of L1
3. Asthenic – 2 inches below L1
PA Recumbent Projection
Demonstrates the body and pylorus filled with barium and air in the fundus.
Best demonstrates the pyloric canal and duodenal bub in hyposthenic or asthenic patients.
PA Recumbent
Demonstrates the size, shape and relative position of the stomach, but
it does not give an adequate demonstration of the unfilled fundic portion ofthe organ.
PA erect
Semi – prone
Rotate body 40-70 degrees
Hypersthenic patients require a
greater degree of rotation than
do sthenic and asthenic patients.
CR perpendicular to IR at level
1. Hypersthenic– 2 inches
above L1
2. Sthenic– level of L1
3. Asthenic – 2 inches below L1
RAO Position, PA Oblique
Semi-Supine
Rotate body 30-60 degrees with left posterior
against IR
CR perpendicular to IR at level
1. Hypersthenic– 2 inches above L1
2. Sthenic– level of L1
3. Asthenic – 2 inches below L1
LPO Position, AP Oblique Projection
Demonstrates the fundus portion of the
stomach filled with barium.
Good position for double contrast of body, pylorus, and duodenal bulb.
LPO position, AP Oblique Projection
CR perpendicular to 2.5 – cm anterior to MCP at level of
1. Hypersthenic– 2 inches above L1
2. Sthenic– level of L1
3. Asthenic – 2 inches below L1
Upright left lateral
Demonstration of the left retrogastric space.
Right Lateral Recumbent Position
Demonstration of the right retrogastric space, duodenal loop, and duodenojejunal junction.
Demonstrates anterior and posterior aspects of the stomach, the pyloric canal, and the duodenal bulb
Best image of the pyloric canal, C-loop and duodenal bulb in patients with a hypersthenic habitus.
Demonstrates the pyloric-bulbar area
Stomach located higher in this position than in PA and RAO.
RIGHT LATERAL POSITION – LATERAL PROJECTION
Prone
CR 35-45 degrees
cephalad to 4 inches left
to pylorus
GORDON METHOD
Best demonstrates
pylorus and duodenal
bulb for hypersthenic
body habitus.
Best demonstrates and
open up high transverse
stomach for hypersthenic
patients.
Gordon Method
Prone
CR 20-25 degrees
cephalad
GUGLIANTINI MODIFICATION
Best demonstrates the
stomach for infants
GUGLIANTINI MODIFICATION
Semi - supine
LPO
Rotate body 45 degrees
to IR with left posterior
side against IR
CR perpendicular to level
of pylorus
HAMPTON’S MODIFICATION
Best modification to
demonstrate a leaf like
pattern of the pylorus and
duodenal bulb.
HAMPTON’S MODIFICATION
Supine
2 exposures
1. CR vertically directed
2. CR horizontally directed
Reference Point – level of
pylorus
POPPEL’S METHOD
Best demonstrate a right
angle view of the
stomach, retrogastric
space and pancreatic
mass
POPPEL’S METHOD
-A method that requires the use of a
semicylindrical radiolucent compression
device .
-Is a modification of the
Trendelenburg position
-The technique was developed for the
purpose of applying greater intra-
abdominal pressure than is provided by
body angulation.
Wolf Method
Helps fills fundus with barium
on thin asthenic patient.
Partial Trendelenburg
Demonstration of hiatal
hernia.
Full Trendelenburg
Requires the use of a 34 degree
angle board over which the patient
is flexed to place the trunk in a
trendelenburg position.
The superior edge of the angle
board is thickly padded to exert
pressure on the lower abdomen and
increase intra-abdominal pressure
CR perpendicular
to xiphoid process
Exposure is made
during Mueller
Maneuver
SOMMER-FOEGELLE
Demonstration of hiatal hernia.
SOMMER-FOEGELLE
Best demonstrates pyloric canal and the duodenal bulb in profile for sthenic
body habitus
RAO POSITION – PA OBLIQUE PROJECTION