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Learn Barium Meal & Follow Through
The document discusses the use of barium meal and follow-through examinations in radiology to visualize the gastrointestinal tract, highlighting the advantages and disadvantages of barium sulfate as a contrast medium. It outlines techniques, patient preparation, indications, contraindications, and methods for performing these procedures, alongside anatomical details of the stomach and small intestine. Potential complications and alternative pharmacological agents are also addressed, emphasizing the importance of effective imaging in diagnosing gastrointestinal conditions.
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Introduction to barium meal study, importance of contrast medium, and use of barium sulphate.
In-depth discussion on barium's taste, coating properties, cost-effectiveness, and advantages as a radiopaque material.
Complications and disadvantages of using barium, including high morbidity; alternative use of gas agents.
Use of pharmacological agents like Hyoscine and Glucagon to assist in gastrointestinal imaging.
Anatomy of the stomach and duodenum relevant to barium meal studies, including detailed descriptions and dimensions.
Methods of Barium Meal (double and single contrast), with indications and contraindications for the procedure.
Preparation of patients before the barium meal examination, including fasting and medication history.
Step-by-step procedure for double contrast barium meal examination, including positioning and filming.
Details on different imaging views taken during the barium meal exam, examining normal anatomy with barium.
Modified approach for barium meal in young children, indicating the use of single contrast.
Aftercare instructions for patients post-barium examination regarding bowel activity and hydration.
Overview of barium follow through to assess small bowel anatomy from duodenum to ileocecal region.
Indications and contraindications specific to barium follow-through examinations.
Methods for conducting barium follow-through, including use of effervescent agents and imaging schedule.
Technical aspects for imaging small bowel, including assessment of loops and diameter measurements.
Details of mucosal patterns in small intestine, comparison between jejunum and ileum during imaging.
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Learn Barium Meal & Follow Through
- 1. Dr. Santosh Atreya Resident(Phase- A) Radiology & Imaging BSMMU,Dhaka from Nepal BARIUM MEAL & FOLLOW THROUGH
- 2.
- 3. • The studyis called so because it is performed following barium meal INTRODUCTION • The thin walled alimentary canal does not have sufficient density to be demonstrated through surrounding structures, so its radiographic demonstration requires the use of artificial contrast medium (Barium)
- 4. Contd… • Barium sulphateis the radiopaque contrast media used for the gastrointestinal system. • Barium examinations require use of high KVp technique to penetrate barium (not <90).
- 5. Taste • Chalky Taste(Real Taste ) • Different flavour these days – Banana Vanilla Pineapple lemon etc
- 6. Excellent coating ofmucosa Cost effective High density Provides a positive contrast in x-ray Advantages of barium sulphate Radiopaque material Insoluble material Not absorbed or metabolized Eliminated from the body
- 7. Disadvantages High morbidity associatedwith barium in the peritoneal cavity Subsequent CT and US are rendered difficult Complication Perforation Aspiration Intravasation
- 8. Why iodine isnot used ? Water soluble Diminish blood volume 8
- 9. Gas agents Carbondioxide CO₂ is administered orally , in the form of effervescent granules • Production of adequate volume of gas • Non interference with barium coating • No bubble production • Rapid dissolution • Easily swallowed • Low cost • Carbon dioxide -cause less abdominal pain Properties of this agent
- 10. Other pharmacological agents Hyoscine-N-butyl bromide ( Buscopan) • antimuscarinic agent • inhibits both intestinal motility and gastric secretion Glucagon • smooth muscle relaxation Metoclopramide • stimulates gastric emptying and small intestinal transit
- 11. Anatomy of thestomach Divided into two parts: -Cardiac and pyloric part Cardiac -Fundus and body Pyloric -Pyloric antrum and pyloric canal
- 12. Duodenum: • C-shaped tube •25 cm long & width 3.75-4 cm • Joins stomach to jejunum • The first & shortest part of small intestine 12 •The widest & most fixed part Curves around the head of Pancreas . •Begins at pylorus on right side & ends at duodenojejunal junction on left side . Partially retroperitoneal
- 13. BARIUM MEAL Methods: 1. Double contrast – the method of choice to demonstrate mucosal pattern. 2. Single Contrast – uses : a) Children -since it usually is not necessary to demonstrate mucosal pattern b) Very ill adults – to demonstrate gross pathology only Indications 1.Dyspepsia 2.Weight loss 3.Upper abdominal mass 4.Gastrointestinal haemorrhage or unexplained iron deficiency anaemia
- 14. Contd… 5. Partial obstruction 6.Assessment of site of perforation – it is essential that water soluble contrast medium e.g. Gastrografin or Dionosil aqueous is used. CONTRAINDICATIONS : • Complete large bowel obstruction. CONTRAST MEDIUM : •120 ml of high density barium 250 % W/V (Double contrast) •Sufficient 100 % W/V ( Single Contrast )
- 15. Patient Preparation Patientsfast for 6 hrs prior to the examination Should abstain from smoking Should ensure that no contraindications to the pharmacological agents used H/O previous surgery
- 16. Procedure - Thedouble contrast method Patient swallows effervescent agent (tablet form known from gastro) High density barium(250% w/v) is swallowed while lying on the left side Then to the supine position. If reflux is observed spot films are taken A hypotonic agent –Buscopan(20 mg I.V )or glucagon (0.1-0.2 mg) is administered Patient rolled from side to side so barium coats mucosal surfaces by washing mucus from the gastric mucosa
- 17. Sequences of filmsfor barium meal examination
- 18. Patient supine position-APview inferior portion of the body
- 19. Normal barium mealanatomy of stomach Area gastricae-2-4 mm polygonal islands ,varies from fine reticular pattern to coarse nodularity Longitudinal folds or rugae Transient fine transverse folds Gastric cardia –shows a rosette of short folds radiating from esophageal orifice
- 20. Supine –body andantrum
- 21. Right lateral position- fundus
- 22. Spot films forduodenal loop
- 23. Spot film ofthe abdomen with the patient in prone position
- 24. DUODENAL CAP Symmetric andtriangular Shows fine velvety pattern when coated with barium - when distended A fold pattern is seen in the inferior bend between the 1st and 2nd parts of the duodenum.When the duodenal cap is undistended ,a fold pattern is seen. • The major papillae of vater • minor papilla (of Santorini) Barium meal appearance of the duodenum
- 25. The normal duodenalcap seen by double contrast surface coating almost homogenous Fine velvety reticular pattern
- 26. Transient fine transversemucosal folds A: Antrum C:duodenal cap
- 27. Double contrast bariummeal supine right anterior oblique view The papilla of Vater (white arrow) has a longitudinal (arrowhead) and two oblique folds (black arrows) extending below it
- 28. Additional view ofthe fundus Spot films of the oesophagus
- 29. Modification technique foryoung children Indication • Vomiting Technique • Single contrast • 30 % barium sulphate • No paralytic agent
- 30. Aftercare Patient shouldbe told that the bowel will be white for few days Patient should be advised to drink adequate water Patient should not leave the department until blurring of vision has resolved
- 31.
- 32. Anatomy of smallintestine length = 6-7 m (approx) Extent- From Pylorus to ileo-caecal valve Proximal 2/5th constitute the jejunum and distal 3/5th constitute the ileum The Valvulae conniventes -2 mm thick in jejunum and 1 mm thick in ileum.
- 33. JEJUNUM & ILEUM •Jejunum begins at duodenojejunal flexure (L2) & ileum ends at ileocecalJunction. • Jejunum & ileum = 6 to 7 m long (jejunum 2/5, ileum 3/5) 33 • Coils of jejunum & ileum are suspended by mesentery from posterior abdominal wall & freely movable.Most jejunum lies in left upper quadrant & most ileum lies in right lower quadrant
- 34. Wall of smallintestine is made of the following layers : a) Serosa coat b) Muscular coat c) Submucosa coat d) Mucosa coat 34
- 35. Introduction – BariumFollow Through • Barium Follow Through is designed to demonstrate the small bowel from the duodenum to the ileoceacal region encompassing the duodenum , jejunum and ileum including the junctions superiorly with the stomach and inferiorly with the ascending colon. • Also known as barium meal follow through (BMFT) & small bowel follow through (SBFT) 35
- 36. Indications Contraindications Complete obstruction Suspected perforation Pain Diarrhoea Anemia Gastrointestinalbleeding Malabsorption Abdominal mass
- 37. Methods Single contrast With additionof effervescent agent Contrast medium 300 ml of 100% w/v Barium suspension
- 38. Patient preparation NPO overnight Aprokinetic agent metoclopramide(20 mg ) is given orally,atleast 30 mins before the study starts. Plain abdominal radiograph if perforation is suspected Preliminary film
- 39. Procedure A lowerdensity barium suspension (50-100% w/v is ideal) 300 ml of 100% w/v barium suspension diluted with equal volume of water Patient lies on the right side after barium has been ingested Films Prone PA films of the abdomen are taken every 20 mins during the first hour Then every 30 mins until the colon is reached Spot films of the terminal ileum are taken supine
- 40. Compression ismandatory To separate the bowel loops Assess mobility Define mucosal pattern • Done by prone inflatable paddle
- 41. Additional films To separateloops of small bowel Oblique view With X-ray tube angled into the pelvis With patient tilted head down To demonstrate diverticula Erect-will reveal any fluid level
- 42. Appearance of smallbowel • No reliable radiological demarcation between jejunum and ileum • Luminal diameter decreases along the length of the small bowel • Jejunal diameter should not exceed 3.5 cm on barium follow-through and 4.5 cm on enteroclysis • Small bowel wall should not measure more than 1-2 mm thick when distended
- 43. Interpretation Jejunum Ileum Constitutes proximal 2/5thof small intestine 3/5th Position Upper left and periumblical region Lower right hypogastric and pelvic region Max. diameter 4 cm 3 cm Number of folds 4-7 per cm 3-5 per cm Pattern Feathery mucosa Less feathery or maybe absent Fold thickness 1-2mm 43
- 44. Mucosal pattern ofsmall intestine The appearance of the mucosal folds depends upon the diameter of the bowel • When distended the folds are seen as lines traversing the barium column known as Valvulae conniventes • When relaxed folds appear feathery Mucosal folds are largest and most numerous in the jejunum and tend to disappear in the lower part of the ileum
- 45. Normal enteroclysis (smallbowel enema). This technique gives good mucosal detail
Editor's Notes
- #17 To produce 400 ml of co2 to distend the stomach.to prevent the barium from flooding into the duodenum and obscuring the greater curvature.which brings the ba up against the gej.to assess the level uptu which the refulx occurs.adequate coating is achieved if areaea gastricea is visiblr in the antrum.
- #20 Transient fine transverse folds –caused by contraction of the muscularis mucosa
- #25 projects into the lumen on the inner side of the second part of the duodenum Occasionally the minor papilla (of Santorini) is seen on the anterior wall 2cm proximal to the major papilla
- #26 DC=RAO LAO
- #27 Transient fine transverse mucosal fold-prone view
- #30 Vomiting causes is pyloric stenosis,malrotation,gord.
- #31 and difficult to wash away
- #33 Most distal is the terminal ileum. Normally small intestine is collapsed or in partially collapsed state Caliber diminishes distally. The Valvulae conniventes circular configuration. They may b absent in the terminal ileum giving it a featureless appearance.