2.
<ul><li>Barium meal is radiological study of esophagus, stomach, duodenum. </li></ul><ul><li>Done by oral administration of contrast media barium sulphate </li></ul>

3.
<ul><li>Gastric or duodenal obstruction </li></ul><ul><li>Malignancies of gastro esophageal junction, stomach, duodenum </li></ul><ul><li>Upper abdominal mass </li></ul><ul><li>Motility disorders </li></ul><ul><li>Systemic diseases like Tb </li></ul><ul><li>Git hemorrhage </li></ul>

4.
<ul><li>Epigastric pain suggestive of peptic ulceration </li></ul><ul><li>Anorexia </li></ul><ul><li>Weight loss </li></ul><ul><li>Vomiting </li></ul><ul><li>Anemia </li></ul><ul><li>Heart burn </li></ul><ul><li>Dyspepsia </li></ul>

5.
<ul><li>CAUSE OF VOMITING: </li></ul><ul><li>Gastro esophageal reflex </li></ul><ul><li>Pyloric obstruction </li></ul><ul><li>Mal rotation </li></ul>

6.
<ul><li>1.Complete large bowel obstruction </li></ul><ul><li>2.Suspected perforation (unless water soluble contrast medium used) </li></ul><ul><li>PATIENT PREPARATION : </li></ul><ul><li>1. NPO after midnight(6 hrs) </li></ul><ul><li>2.abstain from-smoking, chewing gum or antacids- </li></ul><ul><li>->dec fluid in stomach which impairs barium coating. </li></ul>

7.
<ul><li>1.Hypotonic agent Buscopan(hyoscine butyl bromide,20 mg i.v) or 0.1-0.2 mg i.v glucagon is injected intravenously -relax stomach and suspend peristalsis. </li></ul><ul><li>A packet of effervescent granules swallowed with small amount of water- releases CO2 and gastric distension.(approx 400ml CO2) </li></ul><ul><li>High density barium is swallowed(120 ml- 250% w/v) and double contrast views of oesophagus is obtained standing RAO. </li></ul>

8.
<ul><li>Patient faces Xray table,lowered to horizontal </li></ul><ul><li>Then turned onto left side and finally supine. </li></ul><ul><li>Patient rolled from side to side so as barium coats mucosal surfaces properly-washes over the mucus . </li></ul><ul><li>Sequences of films of stomach obtained— </li></ul>

9.
<ul><li>Typical Film Series </li></ul>Position Demonstrates Supine RAO Antrum and greater curve Supine Antrum and body Supine LAO Lesser curve Supine Left Lateral Fundus Prone Duodenal loop Prone,RAO,Supine,LAO Erect RAO, LAO Duodenal Cap series Erect Fundus

10.
<ul><li>When barium enters duodenum, patient is turned RAO – fills duodenum with gas, DC films are taken. </li></ul>

11.
<ul><li>Under fluoroscopic guidance, on the compression views-filling defects or abnormal collections are detected. </li></ul><ul><li>Note: young children- main indication identify cause of vomiting eg:-pyloric obstruction, malrotation,and GOR.single contrast technique preferred(30% w/v Barium sulfate with no paralytic agent). </li></ul><ul><li>Flow technique identifies-subtle mucosal abnormalities. </li></ul>

12.
<ul><li>Note : kV range double contrast- 70-120 kV. </li></ul><ul><li>single contrast-120-150kV . </li></ul><ul><li>Note: If partial gastrectomy or drainage procedures (eg; pyloroplasty or gastrenterostomy), begin with prone swallow using high density barium. Reaching duodenum or Genterostomy-turned supine for DC films.DC of stomach and esophagus follows. </li></ul>

13.
<ul><li>ADVANTAGES: </li></ul><ul><li>Pylorospasm, Fistulae, Enlarged Gastric Rugae Are Best Seen </li></ul><ul><li>Filling Defect Due To Large Mass Easily Identifiable </li></ul><ul><li>DISADVANTAGES: </li></ul><ul><li>Lack of sensitivity of small erosion linear ulceration sup gastric ca subtle mucosal abnormalities </li></ul>

14.
<ul><li>ADVANTAGE: </li></ul><ul><li>highly accurate detecting abnormalities following gastric surgery, bile reflex gastritis, marginal ulceration, recurrent carcinomas </li></ul><ul><li>Abnormalities of efferent loop </li></ul><ul><li>DISADVANTAGES: </li></ul><ul><li>Misses some polyp, ulcers, erosion , sup carcinoma </li></ul>

15.
<ul><li>Barium given with gas forming powder in last few mouthfuls </li></ul><ul><li>HYPOTONIC DUODENOGRAPHY </li></ul>

17.
<ul><li>SINGLE CONTRAST </li></ul><ul><li>FUNDUS SUPINE </li></ul><ul><li>BODY ERECT OR PRONE </li></ul><ul><li>ANTRUM, PRONE RT DOWN PYLORUS </li></ul><ul><li>D1,C LOOP PRONE RT DOWN </li></ul><ul><li>D4 SUPINE </li></ul><ul><li>DOUBLECONTRAST </li></ul><ul><li>PRONE RT SIDE DOWN </li></ul><ul><li>SUPINE WITH 60 HEAD END ELEVATION </li></ul><ul><li>SUPINE RT SIDE UP </li></ul><ul><li>SUPINE RT SIDE UP </li></ul><ul><li>PRONE RT SIDE DOWN </li></ul>

22.
<ul><li>Surface: reticular pattern – multiple interconnecting grooves. </li></ul><ul><li>Divides- polygonal islands(2-4 mm)areae gastricae.distal 2/3rds. </li></ul><ul><li>Presence- excludes diffuse atrophic gastritis </li></ul><ul><li>>4mm sign of gastritis </li></ul><ul><li>Fundus and body.- longitudinal folds or rugae. </li></ul>

23.
<ul><li>Duodenum- </li></ul><ul><li>Extends from pylorus to duodenojejunal flexure-cap,second part(descending horizontal,third part(ascending) and fourth part. </li></ul><ul><li>Barium meal-cap-fine velvety reticular surface pattern by villi. </li></ul><ul><li>Barium caught under mucosal pattern – incomplete erosive duodenitis </li></ul>

24.
<ul><li>Barium caught underfold between 1 st and 2 nd part of duodenum-ulcer pic </li></ul><ul><li>Beyond cap-mucosal folds-narrow bands across whole width. </li></ul><ul><li>Major papilla of Vater(2 ND PART) </li></ul><ul><li>Central fold and 2 oblique folds </li></ul><ul><li>Minor papilla(Santorini- 2 CM PROXIMAL) </li></ul>

25.
<ul><li>Frail and immobile, modification. </li></ul><ul><li>Single contrast examination : </li></ul><ul><li>100%w/v barium – oesophagus, stomach and duodenum </li></ul><ul><li>Compression applied-lower stomach and duodenum. Approximates front and back walls with thin layer in between. </li></ul><ul><li>Protruding lesion-radiolucent filling defect </li></ul><ul><li>Depressed-eg:ulcer --focal extra density. </li></ul>

26.
<ul><li>warning about bowel motion white for sometimes </li></ul><ul><li>COMPLICATION; </li></ul><ul><li>Peritonitis </li></ul><ul><li>Aspiration pneumonia </li></ul><ul><li>Impaction,-convert partial obstruction into complete obstruction </li></ul><ul><li>Gastric dilatation </li></ul><ul><li>Barium embolisation if bleeding ulcer is present </li></ul>

28.
MALIGNANT BENIGN Irregular outline with necrotic or hemorrhagic base Round to oval punched out lesion with straight walls & flat smooth base Irregular & raised margins Smooth margins with normal surrounding mucosa Anywhere Mostly on lesser curvature Any size Majority<2cm Prominent & edematous rugal folds that usually do not extend to the margins Normal adjoining rugal folds that extend to the margins of the base

30.
X-ray showing Gastric ulcer With symmetrical radiating Mucosal folds. By histology, no evidence of Malignancies was observed. X-ray showing Extensive carcinoma involving the cardia & Fundus Pyloric stenosis