Barium swallow

Barium swallow

Contents

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

Normal radiological anatomy

Definition

Barium swallow is a special contrast radiological procedure of upper GIT(pharynx and esophagus)following ingestion of sulfate contrast done under fluoroscopy.

• Its for evaluation of anatomy and physiology of the pharynx and esophagus

Barium swallow is done virtually always done in conjunction with barium meal

Anatomy

• Recap………………….

Subdivision

Indications

• Dysphagia
• Esophagitis
• Assessment of tracheoesophageal fistula
• Assessment of site of perforation
• Assessment of esophageal carcinoma
• Assessment of gastro esophageal reflux disease
• Assessment of achalasia
• Assessment of foreign bodies
• Assessment of gastro esophageal varices
• Assessment of gastro esophageal diverticular
• Assessment of motility disorder
• Assessment of hiatus hernia

Assessment of generalized epigastric pain

Contraindications

• 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

• Patient identification 4 cheek pregnancy test
• Consert form should be signed.
• Patient is nil by mouth 6-8hrs before examination .

3p

Contrast recap ….

CM are Diagnostic agents used in radiology to; Enhance or create visual contrast in an image between the organ, vessel or tract in which they are present and the surrounding tissues in the body

Contrast medium used

• Barium sulphate
• 300g with 100 ml

Thick barium is used

It is more difficult to swallow but suited for use in the esophagus because it descend slowly and tend to the mucosal lining Gastrographin

• E-Z HD 250%/100l or( more as required )

LOCM(appro 350 mg/ml)

Notes

• For suspected of tracheoesophageal fistula use barium in children

For suspected of perforation use water soluble I.e. gastrographin should not be used for investigation of tracheoesophageal fistula or when aspiration is possibility Barium should not be used when perforation is suspected

Trolley set up

• Top shelf
• jug of water
• Clean glasses 2
• Barium
• Spoons
• Tissue paper
• Straw
• Lower shelf
• Emergency drugs

ADRENALINE

Procedure/technique

• Preliminary film
• A control film is advised..
• single Contrast or double contrast
• For double contrast. mucosa relief mucosa pattern…valsavre maneuver is advised
• mucosa
• submucosa
• muscularis mucosa(internal)
• muscularis external
• serosa

Effervescent agent(carbex granules)

Technique

1.the patient is in erect RPO position to throw the esophagus clear to the spine An ample mouth full of barium is swallowed and spot film of the upper and lower esophagus are taken For esophageal varices the prone position RAO..is taken as they will be more distended

prone

• Demonstrate peristaltic activity of esophagus
• Clear gastroesopgeal junction
• notes

Always start with meal followed by swallow or enema followed by meal

Rapid series

• Basic views
• PA or AP oblique to clear off the spine
• PA or AP
• Lateral ribs must be superimposed

The examination is concluded by further spot radiographs of the stomach

Radiographic anatomy

Normal Barium swallow

Normal hypopharynx after a mouthful of barium has been swallowed.

The large white arrow indicates a valleculum, and the lower white arrow points to the inferior recess of the pyriform sinus.

• Arrowheads mark the aryepiglottic folds. Circumvallate papillae (black arrows).

Note: There are a number of dental fillings.

Radiation protection

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

Shield should be used to sensitive organs

Complications

• aspiration of barium mixture
• Leakage of barium from unsuspected perforation

Constipation

Adverse effects

• Mild
• moderate and

severe

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

quiz

With the aid of diagram draw radiographic anatomy of the pharynx and esophagus indicate the view(s) which that diagram is taken Mention constrictors of esophagus

• Describe the technique of barium swallow
• What are contrast medium used for barium swallow

Classify contrast medium