Upper GI Imaging

Question 1

Contrast media and adjunct drugs

Answer 1

• barium sulphate
• Gastrografin
• Carbex granules
• Buscopan
• Maxalon

Question 2

Barium sulphate

Answer 2

• needs to be fluidic as it is being swallowed and have some viscosity to coat mucosa
• needs to be flavoured

Question 3

Gastrografin (iodinated water soluble contrast )

Answer 3

• needs to be flavoured

- Used for paeds and suspected perforations and when barium sulphate is contraindicated

Question 4

Carbex granules and solution (CO2)

Answer 4

• needed to produce gas in the stomach - for double contrast

Question 5

Buscopan

Answer 5

smooth muscle relaxant that stops bowel cramps and movement to improve image quality

Question 6

Maxalon - (Metoclopramide)- oral solution

Answer 6

Antiemetic - speeds up bowel transit times - used if bowel transit is slow in patients baFT (barium follow through)

Question 7

Barium Swallow

Answer 7

• To image the pharynx, oesophagus and proximal section of the stomach.
• uses a contrast agent to coat and outline the structures
• used in fluoroscopy
• can use barium or water-soluble contrast according to patient presentation

Question 8

Barium swallow indications

Answer 8

• Dysphagia
• Globus sensation
• motility issues
• anaemia
• Assessment of fistulae
• Failed upper GI endoscopy
• Barrret’s Oesophagus

Question 9

Barium swallow complications

Answer 9

• leakage of barium from unknown perforation
• Aspiration
• barium appendicitis (rare)
• obstruction

Question 10

Barium swallow

Answer 10

……

Question 11

why is a barium swallow used?

Answer 11

• it demonstrates the presence of an abnormality
• Look at the initiation of deglutition to the clearance of barium from the
  hypopharynx
  • Image the distended oesophagus, gastro-oesophageal junction and
  gastric fundus
  • Is the motility normal?

Question 12

Fluoroscopy unit needs to be capable of:

Answer 12

• imaging at greater than 6fps
• video recording
• grab loops of fluoroscopy screening
• tilting

Question 13

Barium swallow patient prep

Answer 13

• patient is NBM
• remove any artefacts - patient changes from waist upwards into gown.
• Explanation/reassurance throughout
• ID patient
• verbal consent
• warn patient about moving equipment and tilting table
• Handles for patient stability
• Patient may sit on step / chair
• Pillow for supine / prone views
• Assistance with drink/cup

Question 14

Barium swallow technique

Answer 14

• table is tilted
• patient stands on the step
• RAO to start (oesophagus clear of spine)
• patient holds cup in left hand
• patient is asked to swallow a mouthful - dynamics are observed
• further swallows to record entire oesophagus
• Dynamic coned views of hypopharynx AP & lateral

Question 15

barium swallow: LPO