Upper gi fluro

1. UPPER GI FLURO EXAM

2. FLUROSCOPY
• Real time X ray viewing
of a patient with High
temporal resolution.
• X ray image intensifier
coupled with a still/video
camera.
•

3. CONTRAST MEDIUM
• POSITIVE CM
Barium – barium sulphate
Iodinated -- gastrograffin

4. BARIUM
• Barium sulphate –finely ground particles -0.3 to 1 microm
• Non ionic suspension
• Ph 5.3
• Diluted in water

6. WHY Barium sulphate?
• High atomic number (56) –highly radiopaque
• Non absorbable , non toxic
• Better coating and better mucosal detail
• Inert to tissues
• Double contrast studies
• Low cost

7. DISADVANTAGES
• Subsequent abdominal CT – delayed upto 2 weeks
• complications

8. COMPLICATIONS
• Perforation (use water soluble contrast media)
Into peritoneal cavity-pain and severe hypovolemic shock
• aspiration
Relatively harmless
Pneumonitis
Granuloma
• intravasation

10. GASTROGRAFFIN
Iodinated contrast media
Ionic compound
HOCM

11. INDICATIONS
• Suspected perforation
• Suspected fistula
• recent biopsy
• Lower intestinal obstruction
• Meconium ileus
• Immediate post op

13. CONTRAST SWALLOW
• INDICATIONS – SUSPECTED OESOPHAGEAL PATHOLOGIES
• Endoscopy negative dysphagia/odynophagia
• Motility disorders
• Globus sensation
• Failed upper GI endoscopy
• Timed barium swallow to monitor achalasia therapies
• Assessment of mediastinal masses, left atrial enlargement

14. CONTRAST MEDIUM
• Barium sulphate
• Gastrografin – suspected perforation
• LOCM – risk of aspiration
• LOCM - Tracheo oesophageal fistula

15. EQUIPMENT
• High power/ frequency xray generator
• Rapid fluoroscopy images (6 frames /s)
• Video recording

16. PATIENT PREPARATION
• NONE

17. TECHNIQUE
• Erect position –
RAO
AP
• Hypopharynx – AP and lateral
• Semiprone/ recovery position – LPO – hernias, subtle mucosal rings,
varices

20. AP LATERAL OBLIQUE

22. PULL BACK NASOGASTRIC OESOPHAGOGRAM
• Tracheo-oesophageal fistula in infants
• Prone, arms up, head down
• LOCM
• Avoid aspiration from overspill

24. AFTER CARE
• Can take liquid and solids normally with extra fluids
• White colour stool

25. COMPLICATIONS
• Leakage from unsuspected perforation
• Aspiration

26. COMMON PATHOLOGIES

27. ACHALASIA
• Bird beak / rat tail sign
• Esophageal dilation
• Pooling /stasis of barium
• Incomplete esophageal
relaxation not coordinated with
contraction

29. ZENKERS DIVERTIVULUM
• A diverticulum arising from
midline of posterior wall of distal
pharynx near
pharyngoesophageal junction
• May be tranient
• Best in lateral view
• C5 –C6 level

31. CARCINOMA ESOPHAGUS
 Irregular stricture
 Prestricture with hold up
 shouldering of stricture

32. OESOPHAGEAL VARICES
• Longitudinal oesophageal
luminal filling defects

33. BARIUM MEAL
• METHODS
- DOUBLE CONTRAST
- SINGLE CONTRAST
children
gross pathology

35. INDICATIONS
• Failed /unwilling for upper GI endoscopy
• Upper abdominal mass
• GI haemorrhage
• Gastric/duodenal obstruction
• Malignancies
• Partial obstruction

36. CONTRAINDICATION
• Complete large bowel obstruction
• Suspicious aspiration, perforation, fistulas

37. CONTRAST MEDIUM
• E-Z HD 250% w/v 135 ml
• Carbex granules

38. PATIENT PREPARATION
• NPO for 6 hrs

39. TECHNIQUE
• Double contrast method
1. Gas producing agent is swallowed
2. Patient drinks barium- lies on left side supported by elbow
3. Lies on right side –check for reflux-cough/swallow (water siphon
test)
4. IV injection of smooth muscle relaxant - Buscopan

40. IMAGES
SPOT IMAGES OF THE STOMACH (lying)
• RAO- antrum and greater curvature
• SUPINE- antrum and body
• LAO- lesser curvature
• Left lateral tilted, head 45 degree up- fundus

41. SPOT IMAGES OF THE DUODENAL LOOP (lying)
Prone
RAO
SPOT IMAGES OF DUODENAL CAP (lying)
Prone
RAO
Supine
LAO

42. Additionally- erect (fundal lesion)

45. YOUNG CHILDREN - reflux
pyloric obstruction
malrotation
• Single contrast
• Smaller volume
• semiprone – LPO and RAO – Barium passes through pylorus
• Barium – duodenum – supine
• Second image – barium passes duodenojejunal flexure
• Reflux –more barium –rotated 180 degree

46. AFTERCARE
• Buscopan- blurring of vision
• White color stools
• Extra fluids

47. COMPLICATIONS
• Leakage
• Aspiration
• Conversion of partial to complete bowel obstruction
• Barium appendicitis

48. GASTRO ESOPHAGEAL REFLUX
• SIPHON TEST
A jet of barium shoots into water
column
• Distal esophagus – longitudinal
streaks

50. HIATAL HERNIA • High abdominal
pressure to
demonstrate
• Patient has to
strain
• Manual
compression
• Stomach has to be
well distended
• More prominent
when supine

52. THANK YOU