The document discusses barium examinations of the GI tract. Barium sulfate is commonly used as a contrast medium as it is radioopaque and coats the walls of hollow organs, allowing visualization on x-ray. Examinations include barium swallow to examine the esophagus, barium meal for stomach and duodenum, small bowel follow through, and barium enema for the large bowel. Indications, techniques, findings, and limitations are described for each examination. Common abnormalities that can be detected include ulcers, strictures, masses, and cancers.

1. Ba examination of GIBa examination of GI
tracttract
Dr R S GuptaDr R S Gupta
PCMSRCPCMSRC

2. Materials opaque to X-rays can be introduced inMaterials opaque to X-rays can be introduced in
hollow organs. This means that there ishollow organs. This means that there is
‘contrast’ between the contents of the cavity and‘contrast’ between the contents of the cavity and
the wall. The cavity shows up as white in an X-the wall. The cavity shows up as white in an X-
ray image.ray image.
In some organs we can also introduce air or aIn some organs we can also introduce air or a
gas so that it shows up as black.gas so that it shows up as black.
These two modes are sometimes described asThese two modes are sometimes described as
positive or negative contrast.positive or negative contrast.
Materials thus introduced for this purpose areMaterials thus introduced for this purpose are
called contrast media.called contrast media.

3. A contrast medium must satisfyA contrast medium must satisfy
certain criteria :certain criteria :

It must be inert (non-reactive) non-toxic.It must be inert (non-reactive) non-toxic.

It must not be absorbed or retained by the body.It must not be absorbed or retained by the body.

It must be easily excreted.It must be easily excreted.

4. Barium sulphateBarium sulphate

Calcium group of elements,Calcium group of elements,

““heavier”, atomic mass of 137heavier”, atomic mass of 137

insoluble in water and hydrochloric acid,insoluble in water and hydrochloric acid,
hence nonabsorbablehence nonabsorbable
It is mixed with water to form aIt is mixed with water to form a
suspensionsuspension

5. Ba studyBa study
Ba swallow – for oesophagusBa swallow – for oesophagus
Ba meal of stomach and duodenumBa meal of stomach and duodenum
Ba meal follow through – for smallBa meal follow through – for small
intestineintestine
Small bowel enteroclysisSmall bowel enteroclysis
Ba enema for large bowelBa enema for large bowel

6. TechniqueTechnique
Patient will need to be NPO after midnightPatient will need to be NPO after midnight
before the exambefore the exam
The patient will have to swallow a contrastThe patient will have to swallow a contrast
agent.agent.
May also swallow sodium bicarbonate forMay also swallow sodium bicarbonate for
double contrast barium swallowdouble contrast barium swallow
X-ray tech will have the patient performX-ray tech will have the patient perform
various maneuvers so that the barium canvarious maneuvers so that the barium can
coat the GI tractcoat the GI tract

8. Ba swallowBa swallow
IndicationIndication

OdynaphagiaOdynaphagia

DysphagiaDysphagia

repeated aspiratation in childrepeated aspiratation in child

12. AchalasiaAchalasia

13. StricturesStrictures

14. Diffuse Esophageal SpasmDiffuse Esophageal Spasm

15. CarcinomaCarcinoma

16. CarcinomaCarcinoma

17. ESOPHAGEAL VARICESESOPHAGEAL VARICES

20. LimitationsLimitations
Not good for evaluating small ulcersNot good for evaluating small ulcers
Cannot test for H. pylori or take biopsies ofCannot test for H. pylori or take biopsies of
ulcersulcers
Not specific for diagnosis of esophagitisNot specific for diagnosis of esophagitis
Not possible to provide interventions forNot possible to provide interventions for
any lesionsany lesions

21. Ba meal stomach andBa meal stomach and
duodenumduodenum
• The passage of the barium
through the esophagus,
stomach and duodenum is
monitored on the
fluoroscope.
• Additionally, some patients
are asked to swallow sodium
bicarbonate crystals to create
gas and further improve the
images; this procedure has
the modified name of "air-
contrast" or "double-contrast
upper GI."
Upper GIUpper GI

22. IndicationIndication
Abdominal pain
Haematemesis
Palpable mass
Unexplained weight lossUnexplained weight loss

23. supine
Antrum
Angular
Incisur
e
Cardiac
Incisur
e
Normal findingsNormal findings

24. double-contrast upper GI

25. benign gastric ulcerbenign gastric ulcer
1. Crater : Barium collection within the ulcer crater1. Crater : Barium collection within the ulcer crater
Profile view(A): Penetration of the ulcer projecting beyond theProfile view(A): Penetration of the ulcer projecting beyond the
normal barium-filled gastric lumen (arrow)normal barium-filled gastric lumen (arrow)
En-face view(B): Round or oval barium collection on dependentEn-face view(B): Round or oval barium collection on dependent
part (arrow)part (arrow)

26. Radiation of smooth thickened foldsRadiation of smooth thickened folds (arrow)(arrow) extendingextending
directly to the edge of the craterdirectly to the edge of the crater (arrowhead)(arrowhead) on profilon profil
e view(A) and en-face view (B)e view(A) and en-face view (B)
Radiographic appearances of benign gastric ulcerRadiographic appearances of benign gastric ulcer

27. Radiographic appearances ofRadiographic appearances of
benign gastric ulcerbenign gastric ulcer
Incisula defectIncisula defect :smooth,:smooth,
deep, narrow, sharp inddeep, narrow, sharp ind
entation on greater curventation on greater curv
ature(green arrow) oppoature(green arrow) oppo
site a crater (white arrowsite a crater (white arrow
) on lesser curvature: s) on lesser curvature: s
pastic contraction of circpastic contraction of circ
ular muscleular muscle

28. Duodenal UlcerDuodenal Ulcer
: More than: More than
95% occur in the du95% occur in the du
odenal bulbodenal bulb
: Associated: Associated
withwith H. pyloriH. pylori
infection in >95% oinfection in >95% o
f casesf cases
: Almost always: Almost always
duodenal ulcers areduodenal ulcers are
benignbenign

29. Duodenal UlcerDuodenal Ulcer
Chronic duodenal ulcerChronic duodenal ulcer : Deformity of the duodenal bulb from fibrotic healing: Deformity of the duodenal bulb from fibrotic healing
- Cloverleaf deformity- Cloverleaf deformity (A)(A) : symmetric narrowing of the midportion of the bulb: symmetric narrowing of the midportion of the bulb
with dilatation of the inferior and superior recesses at the base of the bulbwith dilatation of the inferior and superior recesses at the base of the bulb (arrow(arrow
))
- Pseudodiverticulum- Pseudodiverticulum (B)(B) : asymmetric narrowing of the bulb: asymmetric narrowing of the bulb

30. malignant gastric ulcermalignant gastric ulcer
5% of gastric ulcers are malignant5% of gastric ulcers are malignant
Radiographic appearances:Radiographic appearances:
1. Intraluminal ulcer (not project1. Intraluminal ulcer (not project
beyond the expected margin of thebeyond the expected margin of the
stomach )stomach ) (arrow)(arrow)
2. Irregular, nodular mass2. Irregular, nodular mass
(arrowhead)(arrowhead) surrounding thesurrounding the
ulcerulcer
3. Irregular or nodular thickened3. Irregular or nodular thickened
folds that radiate to the massfolds that radiate to the mass
4. Carman meniscus sign :4. Carman meniscus sign :
semicircular or meniscoid ulcerssemicircular or meniscoid ulcers
(arrow)(arrow) with its inner marginwith its inner margin
convex toward the lumenconvex toward the lumen

31. Gastric cancerGastric cancer
Focal constricting lesionFocal constricting lesion::
localized infiltratinglocalized infiltrating
carcinoma or localized sccarcinoma or localized sc
irrhous carcinomairrhous carcinoma
Annular filling defectAnnular filling defect
(arrow)(arrow)

32. Focal constrictingFocal constricting
lesionlesion
: localized infiltrating: localized infiltrating
carcinoma orcarcinoma or
localizedlocalized
scirrhous carcinomascirrhous carcinoma
- circumferential- circumferential
irregular narrowingirregular narrowing
ofof
the lumen withthe lumen with
rigidityrigidity
Gastric cancerGastric cancer
bodyantrumbulb
fundus

33. Gastric cancerGastric cancer
Linitis plastica patternLinitis plastica pattern
- tumor invasion of the- tumor invasion of the
gastric wallgastric wall
- diffuse irregular- diffuse irregular
narrowing and rigiditynarrowing and rigidity
of the stomachof the stomach

34. Extrinsic lesionExtrinsic lesion
MASS

35. Small bowel follow-throughSmall bowel follow-through
• The passage of the barium through the stomach, and small intestine
is monitored on the fluoroscope.
• The test usually takes around three to six hours.

36. • X-rays are initially taken at 15-minute intervals until the barium
reaches the colon (the only way to be sure the terminal ileum is
fully seen is to see the colon or ileocecal valve).
• The interval may be increased to 30 minutes, or even one hour if
the barium passes slowly.

37. IndicationIndication
Abdominal pain, distensionAbdominal pain, distension
VomitingVomiting
MalenaMalena
Palpable massPalpable mass
Chronic diarrheaChronic diarrhea

41. Tuberculous enterocolitisTuberculous enterocolitis
Ileocecal area (80-90%)Ileocecal area (80-90%)
Radiographic findings :Radiographic findings :

1. Irregular thickened bowel wall1. Irregular thickened bowel wall
(white arrow)(white arrow) resulting in narrowing ofresulting in narrowing of
the lumenthe lumen (coned cecum)(C)(coned cecum)(C)

2. Thickened ileocecal valve2. Thickened ileocecal valve

3. Wide gap of patulous ileocecal valve3. Wide gap of patulous ileocecal valve
4. Thickened wall of terminal ileum4. Thickened wall of terminal ileum (I)(I)

5. Deep ulcer with/without sinus tract5. Deep ulcer with/without sinus tract
or fistulaor fistula
C
I

43. A tube is placed down through
the stomach into the small
intestine, often under
fluoroscopic control.
EnteroclysisEnteroclysis

44. A barium enema is given in
order to perform an x-ray
examination of the large
intestine
During the procedure, a well
lubricated enema tube is
inserted gently into the
rectum.
The barium is then allowed
to flow into the colon.
A small balloon at the tip of
the enema tube may be
inflated to help keep the
barium inside.
Air may be puffed into
the colon to distend it
and provide better
images –
Barium enemaBarium enema

45. IndicationIndication
abdominal pain,
bleeding from the rectum or melena
change in bowel habit,
chronic diarrhoea or constipation
palpable mass

46. Single contrast barium enema
BariumBarium EnemaEnema
Double contrast barium enema

47. ascendingcolon
transverse colon
sigmoid colon
hepatic flexure
descendingcolon
splenic flexure
rectum
BariumBarium EnemaEnema

48. PolypPolyp

49. Colonic DiverticulosisColonic Diverticulosis

51. Colonic CarcinomaColonic Carcinoma