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Swallowing X-Rays

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Swallowing X-Rays Swallowing X-Rays Document Transcript

  • Swallowing X-Rays & Related Tests Certain X-rays may be helpful in determining whether function of the mouth and throat muscles is adequate for safe and effective feeding. These include upper GI (gastro-intestinal) series, nuclear scintiscan, and a video feeding study. An upper GI series can evaluate the structure of the esophogus and stomach, screen for GE reflux and give limited information about mouth (oromotor) and swallowing function. A small swallow of barium is given to and a series of X-rays are taken to visualize the pathway that the barium takes to get to the stomach. The scintiscan is a nuclear medicine study which can evaluate reflux that occurs through the gastroesophogeal spinchter (the inlet of the stomach), the rate of gastric emptying through the pyloric sphincter (the outlet of the stomach), and check for aspiration into the lungs. Radioisotope is either swallowed by the patient or placed by nasogastric tube into the stomach, and its' return into the esophagus, appearance in the lungs, and rate of disappearance from the stomach is assessed. The video feeding study is a diagnostic test that incorporates the skills of both the radiologist and the feeding therapist. The patients ability to handle foods is evaluated under X-ray (fluoroscopy) while the therapist feeds the patient a variety of foods and liquids of different textures. The different types of food and liquid are observed as they pass through the mouth, throat and esophagus, and into the stomach. It is primarily a demonstration of oromotor and swallowing function, and is very helpful in determining the thickness and texture of foods that the patient can safely handle. Barium Meal A barium meal is an x-ray examination of your stomach and your oesophagus (gullet). Often pictures of the first part of your small intestine (the duodenum) are also taken. For the test to be successful your stomach should be as empty as possible and so you will probably be asked not to eat or drink anything for six hours before the examination. When you have the examination you will be asked to swallow some fizzy tablets or granules, with a little water. These will expand your stomach with gas which makes it easier to get a clear view of things. It is very important that you do not belch once you have taken these. Sometimes you are also given an injection of a drug to relax the stomach and stop it moving while the x- rays are taken (this can cause some blurring of your vision for an hour or so and if this happens it is best not to drive).
  • You will then be given a cup of barium to drink. This is often fruit flavoured and is not at all unpleasant. The barium shows up on the x-rays and outlines your gullet and stomach. A number of x-ray pictures will then be taken. This is completely painless. The examination is usually completed within 30 minutes. You can eat and drink quite normally once the test is completed. The barium will be passed out with your bowel motions during the next few days, it may make your motions paler in colour than normal. The results of the examination will usually be available a few days later. Barium Meal A barium meal is an x-ray examination of your stomach and your oesophagus (gullet). Often pictures of the first part of your small intestine (the duodenum) are also taken. For the test to be successful your stomach should be as empty as possible and so you will probably be asked not to eat or drink anything for six hours before the examination. When you have the examination you will be asked to swallow some fizzy tablets or granules, with a little water. These will expand your stomach with gas which makes it easier to get a clear view of things. It is very important that you do not belch once you have taken these. Sometimes you are also given an injection of a drug to relax the stomach and stop it moving while the x- rays are taken (this can cause some blurring of your vision for an hour or so and if this happens it is best not to drive). You will then be given a cup of barium to drink. This is often fruit flavoured and is not at all unpleasant. The barium shows up on the x-rays and outlines your gullet and stomach. A number of x-ray pictures will then be taken. This is completely painless. The examination is usually completed within 30 minutes. You can eat and drink quite normally once the test is completed. The barium will be passed out with your bowel motions during the next few days, it may make your motions paler in colour than normal. The results of the examination will usually be available a few days later. Barium Swallow What Is It? Videofluoroscopy (Modified Barium Swallow Test-MBS) is a radiographic study of swallowing recorded on videotape. A swallow study is useful in evaluating how food moves from the mouth to the esophagus. A physician requests this study to evaluate specific swallowing problems.
  • A barium swallow or "upper GI series" is an x-ray test used to examine the upper digestive tract (the esophagus, stomach, and small intestine). Because these internal organs are normally not visible on x- rays, you will be asked to swallow a liquid that does show up on x-rays (barium). The barium will temporarily coat the inside lining of the esophagus, stomach, and intestine, allowing the outline of these organs to be visible on the x-ray pictures. Swallowing can be viewed as it occurs, including the movement of the bolus (food that is formed into a ball after chewing) from the pharynx to the esophagus, a phase that cannot be viewed at bedside. Both radiology and speech therapy are involved in assessing the results of the study: identifying the location of the difficulty, if aspiration is occurring and why it is occurring. They also make recommendations for further radiologic studies, posture, food consistency and therapy techniques to eliminate aspiration and/or improve the efficiency of the swallow. Typically, initial swallowing evaluations are ordered by a physician and conducted at bedside by a speech-language pathologist (also referred to as speech therapist). During the bedside evaluation, the speech therapist reviews the case history, including the diagnosis, respiratory status and mental status. The therapist examines the patient to determine the function and strength of the swallowing mechanism by having the patient swallow their own saliva and then may introduce foods or liquids of various consistencies. Based on the information secured, the speech therapist will determine whether a disorder is present, and will make recommendations regarding oral intake and the consistency of foods. A MBS is ordered when dysphagia (difficulty swallowing) and aspiration are found during the bedside swallow evaluation. Periodic reevaluation, including videofluoroscopy, is important with all patients to determine if the swallowing disorders are improving or deteriorating. Why would I need this procedure? These problems may include a sensation of food sticking in the throat after eating, choking on liquids or solids, or food collecting in the mouth, sometimes resulting in an inability to swallow. The 3-phase swallow study may be completed following surgery or illness. It is useful in providing information on when to resume eating, the easiest and safest foods to eat, and in identifying treatment techniques that will improve safety during eating. This test may be repeated to evaluate progress and to guide changes in treatment plans and food choices.
  • How do I prepare for the test? You will be given instructions to stop eating and drinking on the night before your test. This is important because food in your stomach or intestine could prevent the doctors from seeing a clear outline of these structures when they are examining the x-rays. Usually, it isn't a problem for you to take your regular pills, but you should check this with your doctor. Make sure that your doctor and the x-ray technicians know if you could be pregnant. If you have diabetes and take insulin, discuss this with your doctor before the test What happens when the test is performed? A 3-phase swallowing study is not difficult or painful. The test is completed in the Department of Radiology by a speech-language pathologist and radiologist. You may be asked to bring samples of foods that have been difficult to swallow at home. You will be asked to change into a hospital gown for the test. Right at the start of the test, you will be asked to drink barium, a liquid that looks like a milkshake but unfortunately does not taste nearly as good (most patients say it tastes like chalk). You will be given both thin and thick liquid barium by spoon or cup, followed by small amounts of barium-coated food, which may include pudding, apple sauce, fruit cocktail and/or cookie. During the evaluation, the speech-language pathologist may ask you to change your posture or to use specific swallowing techniques to determine if they will improve your swallow. You might also be given some tablets to swallow that "fizz" causing air-bubbles to be released in your stomach. This might make you feel like burping, but try not to. You will get better pictures if you can keep yourself from burping. A video recording of swallowing will be made as you eat and drink tested items. Most often, the actual x- rays pictures are taken while you lie on your back on a table. The x-ray machine or the table will be moved a few times so it can take pictures of all of the internal structures. The x-ray technician may ask you to stand or lie in different positions over the next few minutes, because it is helpful to spread around the liquid you have swallowed. You will be asked to hold your breath for each picture so that your breathing movement does not blur the image. The test is generally completed in less than 20 minutes. What happens after the test is completed? The speech-language pathologist and the radiologist will review the video tape once the study is completed. A diagnosis is made and the results, with recommendations, will either be discussed with you that day, or, at times, the physician requests the test report to discuss with you and your family during a follow-up appointment.
  • What risks are there from the test? There are no significant risks to this test. You will be exposed to a small amount of radiation during the test, but the amount of radiation is too small to be likely to cause any health problems. Must I do anything special after the test is over? After the test, you can eat normally and do your normal activities. You should drink more water than usual to help clear out the barium and to prevent constipation, which might be a side effect of the test. Your stool may appear light in color for a couple of days. How long is it before the result of the test is known? It will take the x-ray department between 30 minutes and an hour to develop the pictures from your barium swallow, and it will take additional time for a doctor to examine the x-rays and to decide how they look. Typically you can get the results within a day or two of when the test was done. Special Diets may be recommended following a swallowing test. Barium X-Ray Exam What is a barium x-ray exam? A barium x-ray exam is a procedure in which the doctor examines certain organs, in this case your esophagus, stomach, and upper intestine, using a barium liquid and x-rays. Barium is a liquid that will show up on an x-ray image. A barium exam of these organs is also called an upper gastrointestinal (GI) barium study. When is it used? Reasons for doing this procedure are: • bleeding • problems swallowing • abdominal pain • suspected tumor in or near the GI tract. Examples of alternatives are to choose not to have treatment or try other diagnostic studies, depending on the problem and your condition. You should ask your doctor about these choices. How do I prepare for an upper GI barium study? Follow the instructions provided by the doctor or nurse. The night before the procedure, eat a light meal such as soup and salad. Do not have anything to eat or drink the morning of the procedure. What happens during the procedure? You will drink a barium liquid. The x-ray technologist will ask you to stand in front of an x-ray machine and later have you lie on an x-ray table. The technologist will take x-ray images of the barium liquid going down your throat, into your stomach, and perhaps going on through your small intestine.
  • What happens after the procedure? The radiologist may tell you what he or she found and send the complete report to the doctor. You should call your doctor in a few days to hear the whole report. You can go home after the test is completed. You may be constipated from the barium. If so, you may need to take a laxative. Your stools may be light or white colored for the next few days. Ask your doctor what other steps you should take and when you should come back for a checkup. What are the benefits of this procedure? This procedure will help the doctor make a more accurate diagnosis. What are the risks associated with this procedure? • You could become constipated. • You could inhale the barium into your lungs, which could cause breathing problems or pneumonia. You should ask your doctor how these risks apply to you. When should I call the doctor? Call the doctor immediately if: • Abdominal pain increases. • Constipation cannot be relieved. Call the doctor during office hours if: • You have questions about the procedure or its result. • You want to make another appointment. Percutaneous Endoscopic Gastrostomy Percutaneous Endoscopic Gastrostomy At A Glance • PEG is a surgical procedure. • PEG is a method of providing fluids and nutrition. • PEG is typically performed using local anesthesia. What is percutaneous endoscopic gastrostomy (PEG)? Percutaneous endoscopic gastrostomy (PEG) is a surgical procedure for placing a feeding tube without having to perform an open operation on the abdomen (laparotomy). A gastrostomy (a surgical opening into the stomach) is made percutaneously (through the skin) using an endoscope (a flexible, lighted instrument) to determine where to place the feeding tube in the stomach and secure it in place.
  • What is the purpose of PEG? The aim of PEG is to feed those who cannot swallow. Irrespective of the age of the patient or their medical condition, the purpose of PEG is to provide fluids and nutrition directly into the stomach. Who does PEG? PEG is done by a doctor. The doctor may be a general surgeon, an otolaryngologist (ENT specialist), a gastroenterologist (GI specialist), etc. Where is PEG done? PEP is performed in a hospital or outpatient surgical facility. How is PEG done? Local anesthesia (usually lidocaine or another spray) is used to anesthetize the throat. An endoscope (a flexible, lighted instrument) is passed through the mouth, throat and esophagus to the stomach. The surgeon then makes a small incision (cut) in the skin of the abdomen and pushes an intravenous cannula (an IV tube) through the skin into the stomach and sutures (ties) it in place. When can the PEG patient go home? The patient can usually go home the same day or the next morning. What are the possible complications with PEG? Possible complications include wound infection (as in any kind of surgery) and dislodging or malfunction of the tube. What are the advantages of PEG? PEG takes less time, carries less risk and costs less than a classic surgical gastrostomy which requires opening the abdomen. Therefore, when feasible, PEG is preferable to a classic gastrostomy.