Barium Meal

BARIUM MEAL

Definition

• Indication
• Contraindications
• Describe technique of barium meal
• Adverse effects
• After care of the patient

Normal radiological anatomy (area of concentration)

Definition

Barium meal is a special contrast radiological procedure of the lower 1/3 of esophagus, stomach, duodenum following ingestion of sulfate contrast (barium sulphate) done under fluoroscopy.

Its for evaluation of anatomy and physiology and of the lower 1/3 esophagus, stomach, duodenum.

smoking should be avoided since it increase gastric motility.

Indications

• Dyspepsia
• Un explained Weight loss
• Upper abdominal mass
• Gastro intestinal hemorrhage
• Assessment of site of perforation
• Gastric volvulus
• Bezoar
• Gastric diverticulum
• Suspected gastric ulcer/duodenal
• Hiatus hernia
• Reflux esophagitis
• Pain full swallowing
• Heart burn
• Dysphagia
• odynophagia

retrostenal pain

Contraindications

• Complete bowel obstruction
• Perforation
• Obstruction(partial complete)
• Post operative
• Pregnancy
• Suspected perforation
• Suspected of tracheoesophageal fistula

Hypersensitive to barium

Equipment used

• 1.conventonal fluoroscopy
• Image intensifier
• Spot film device
• Television fluoroscopy

Fluoroscopic couch

Other accessories

• cassettes,
• Anatomical markers rt or lt.
• Foot rest
• Hand grips shoulder support

Lead aprons, gloves thyroid shield

Preparation of the patient 1

• Patient identification 4 cheek pregnancy test
• Consent form should be signed.
• Patient is nil by mouth 6-8hrs before examination .
• 3p
• Smooth Muscle relaxant (antispasmodic),buscopan(Hyoscine) should be given.
• Preliminary film
• A control film is advised.

Explain the whole procedure to the patient

Preparation of the patient 2

Before a barium meal examination is performed, the duodenum needs to be empty to allow clear visualization of structures.

A patient may be given a laxative for bowel preparation before the procedure to ensure the small bowel is empty at the time of the examination, which is usually performed on an empty stomach.

The patient is first asked to change into a hospital gown and remove all jewellery, dentures, glasses, metal objects and clothing as these items can interfere with imaging.

the barium contrast liquid is given to the patient to drink.

Contrast medium used

• 135ml Barium sulphate suspension 250% w/v of more high density barium suspension

Effervescent agent(carbex granules), Eno® For double contrast

Trolley set up

As for barium swallow…please make follow up at the department..

Procedure/technique

• Can be either single contrast or double contrast
• Method of choice characterization
• for double contrast to demonstrate the mucosa pattern.(mostly advised)
• Single contrast exceptional
• Children since it usually not necessary to demonstrate the mucosa pattern
• Very ill patient to demonstrate gross pathology only
• To precede small bowel series
• Assessment of gastric peristalsis

Post-pyloroplasty

double contrast

A gas producing agent is swallowed

The patient is then drinks the barium while lying on left side, supported elbow(this position prevents the barium from reaching the duodenum too quickly and so obscuring the greater curve of the stomach.

The patient is then lies supine and slightly on the rt side to bring the barium up against gastro esophageal junction(this maneuver is scanned t check for the reflux, which may be reveled by asking the patient to cough.) An iv injection of smooth muscle relaxant buscopan 20mg is given The patient is asked to roll onto rt side and quickly over in a complete circle to end in RAO (LPO) position.(this roll is performed to coat the gastric mucosa with barium, good coating has been achieved if areae gastriae in the antrum are visible.

Spot films taken

FILMS DEMOSTRATES

SUPINE RAO………ANTRUM&GREATER CURVE

SUPINE…………..ANTRUM &BODY

SUPINE LAO……LESSER CURVE

SUPINE LEFT LATERAL………FUNDUS

PRONE………………DUODENAL LOOP

PRONE,RAO,SUPINE,LAO..DUODENAL CAP SERIES

ERECT RAO,LAO………FUNDUS

Radiographic anatomy

RAO

• Anatomy Demonstrated: • Entire stomach and C-loop of

duodenum are visible.

prone

lateral

supine

• Alternative AP Trendelenburg, A partial Trendelenburg (head
• down) position may be necessary to fill the fundus on a thin
• asthenic patient
• . A full Trendelenburg angulation facilitates the demonstration

of hiatal hernia. (Install shoulder brace for patient safety.)

Mucosal pattern

area of concentration

abnormal anatomy

Barium Meal

gastric ulcer on the lesser curve showing as an out pouching of barium. Radiating folds can also be seen converging towards the ulcer crater.

ulcers

areae gastrica.

Gastritis

Enlarged Area gastricea in a patient with H.pylori Gastritis.

Perforated peptic ulcer

Pyloric stenosis.

Other imaging modalities

Read…….

Radiation protection

• Minimize the fluoroscopic time and current
• Collimate the x ray beam

Shield should be used to sensitive organs

Complications

• Aspiration of barium
• Barium impaction &large bowel obstruction
• Barium induced appendicitis
• Leakage of barium from unsuspected perforation

Constipation

After care

Patient is informed about possibility of constipation there fore is advised plenty of water/fluids and take mild laxatives Aspiration of barium is gradually clearly by the body but if there is immediate reaction the patient is treated accordingly Ensure patient understand the procedure for receiving better results

Adverse effects

• Side effect of drug used.

Mild-moderate-severe

Do We Know For Sure: Multidisciplinary Approach

Quiz 2

• List 5 indication of barium meal?
• With aid of diagram explain the parts of duodenum.
• Mention 5 condition in which single contrast can be used

What is odynophagia