Hypotonic duodenography is an x-ray procedure that produces images of the duodenum, the first part of the small intestine. It may be used to detect tumors of the pancreas or areas where pancreatic and bile ducts meet the small intestine. During the procedure, a catheter is inserted into the stomach and duodenum and a contrast agent is administered to highlight the area on x-rays. It takes 30-60 minutes and patients are required to fast beforehand. Potential risks are minimal but include abdominal cramping and reactions to agents used during the procedure.

1. MAAJID MOHI UD DIN MALIK
LECTURER COPMS,
ADESH UNIVERSITY, BATHINDA PUNJAB
HYPOTONIC DUODENOGRAPHY

2. HYPOTONIC DUODENOGRAPHY
Hypotonic duodenography is an x-
ray procedure that produces images
of the duodenum. The duodenum is t
he first part of the small intestine.

3. PURPOSE
Hypotonic duodenography may be ordered to
detect tumors of the head of the pancreas or
the area where the pancreatic and bile ducts
meet the small intestine. Lesions causing up
per abdominal pain may be demonstrated by
duodenography, and the procedure can aid in
the diagnosis of chronic pancreatitis.

4. PRECAUTIONS
Some patients with narrowing of the tubes in the upper gas
trointestinal tract should not receive duodenography.
Patients with certain heart disorders and glaucoma are
cautioned against receiving an agent called anticholinergic,
which is administered during the procedure to lessen
intestinal muscle spasms. A hormone called glucagon may
also be used to relax the intestines, but its use is not
recommended in patients with most forms of diabetes.

5. DESCRIPTION
 Hypotonic duodenography is also referred to as x ray of the
duodenum or simply as duodenography. The patient is seated
while the radiologist places a catheter in the nose and down in
to the stomach. Then the patient lies down and the tube is
continued to the duodenum. The radiologist is guided in this
placement by a fluoroscopic image. (Fluoroscopic equipment
shows an immediate x ray. In this case, the x ray shows the
location of the catheter as it is moved into the stomach and
duodenum.) Next, either the glucagon is administered
intravenously.

6. After several minutes, the physician will
administer barium through the catheter.
Barium is a contrast agent that will help
highlight the area on the fluoroscopy screen
and x rays. After a few films are taken, some
of the barium is withdrawn and air is sent in
through the catheter. Additional images are
acquired and the catheter is then removed.
The procedure takes from 30-60 minutes.

7. PREPARATION
Patients are required to fast from midnight
before the test until after the test, or about 6-
12 hours. Just prior to the exam, patients
should remove dentures, glasses, and other
objects that may interfere with the procedure.
The patient may be instructed to empty his
or her bladder just prior to duodenography.

8. AFTERCARE
The barium should be expelled within two to three days
. Extra fluids and/or an agent given by the physician to
help encourage bowel movement may aid in barium
elimination. Physicians and patients should watch for
possible reactions to the anticholinergic or glucagon. If
an anticholinergic is used, patients are advised to
empty their bladder within a few hours after the exam
and to wait two hours for clearing of vision or have so
meone drive them home. Patients will notice that their
stools are chalky white from the barium for one to three
days following the procedure.

9. RISKS
 Abdominal cramping may occur when the physician instills air
into the duodenum, but aside from the discomfort, there are
few risks associated with this procedure. Side effects from
the contrast, hormones or agents may occur. Those patients
with diabetes, heart disease, or glaucoma run the highest risk
of reaction and should not receive anticholinergic or glucagon
, depending on their specific conditions. Elderly patients or
those who are extremely ill, must be closely monitored during
the procedure for possible return of fluid, or gastric reflux.

10. NORMAL RESULTS
The linings of the duodenum and
surrounding tissues will look
smooth and even. The shape of
the head of the pancreas will a
ppear normal and near the d
uodenal wall.

11. ABNORMAL RESULTS
Any masses or irregular nodules on the wall of
the duodenum may indicate tumors or abnorm
ality of tissue. Tumors of the head of the pancre
as or of the opening into the intestine from the
pancreatic and bile ducts may be seen. Chronic
pancreatitis may be indicated on the x rays. In
many instances, follow-
up laboratory or imaging studies may be
ordered to further study the abnormal findings
.

12. HYPOTONIC DUODENOGRAPHY

13. HYPOTONIC DUODENOGRAPHY DISCLOSED THE
DIVERTICULUM WITH A FILLING DEFECT CORRESPONDING
TO THE PAPILLA

14. HYPOTONIC DUODENOGRAPHY. A FILLING DEFECT
IS SHOWN IN THE THIRD PORTION OF THE
DUODENUM (ARROWS)

15. THANK YOU