فحوصات 6

• What is the focus of Lecture 4 by Dr. Samir Ali?

  Special radiological procedures of the gastrointestinal tract and bones
• What are the indications for a barium swallow examination?

  • Suspected oesophageal pathology
  • Endoscopy negative dysphagia or odynophagia
  • Motility disorders
  • Globus sensation
  • Assessment of tracheo-oesophageal fistulae
  • Failed upper GI endoscopy
  • Timed barium swallow to monitor achalasia therapies
• Are there any contraindications for a barium swallow examination?

  No, there are none.
• What are the types of contrast medium used in barium examinations?

  1. E-Z HD 200%–250% or Baritop 100% w/v
  2. Water-soluble contrast agent if perforation is suspected
  3. LOCM (approx. 300 mg I mL−1) is safest if there is a risk of aspiration
  4. Gastrografin should not be used for tracheo-oesophageal fistula investigation
  5. Barium should not be used initially if perforation is suspected
• What is the purpose of using water-soluble contrast agents in barium examinations?

  To use if perforation is suspected
• What equipment is required for a barium swallow examination?

  Rapid fluoroscopy images, rapid exposures, or video recording
• What is the initial patient position for a barium swallow examination?

  The patient starts in the erect position, right anterior oblique (RAO)
• What is the technique for performing a barium swallow examination?

  1. Patient in erect RAO position
  2. Swallow barium and observe under fluoroscopy
  3. Further mouthfuls with spot exposure for the whole oesophagus
  4. Dynamic coned views of the hypopharynx
  5. Patient placed semiprone in LPO position for distended view
  6. Modifications may be required based on clinical indication
• What is the purpose of using a CT with quadruple strength oral contrast if perforation is suspected?

  It is more sensitive and provides improved anatomical location of perforation
• What are the complications associated with barium swallow examinations?

  1. Leakage of barium from an unsuspected perforation
  2. Aspiration
• What modifications may be required during a barium swallow examination?

  Modifications may be required depending on clinical indication
• What should be done if dysmotility is suspected during a barium swallow examination?

  Barium should be mixed with bread or marshmallow bolus
• What are the methods used in barium meal examinations?

  1. Double contrast: method of choice for mucosal pattern
  2. Single contrast: used for children and gross pathology
• What are the indications for a barium meal examination?

  Failed upper gastrointestinal endoscopy or patient unwilling to undergo endoscopy
• What is a contraindication for a barium meal examination?

  Complete large-bowel obstruction
• What is the technique for a double contrast barium meal examination?

  1. A gas-producing agent is swallowed
  2. Patient drinks barium while lying on the left side
  3. Patient lies supine and slightly on the right side
  4. An injection of a smooth muscle relaxant may be given
  5. Patient rolls onto the right side and then into an RAO position
• What are the spot exposures taken during a barium meal examination?

  1. RAO to demonstrate the antrum and greater curve
  2. Supine to demonstrate the antrum and body
  3. LAO to demonstrate the lesser curve
  4. Left lateral tilted to demonstrate the fundus
• Why is it important to avoid barium flooding into the duodenal loop during a barium meal examination?

  To prevent diagnostic confusion
• What modifications are made for young children during barium examinations?

  • Identify causes for vomiting
  • Single-contrast technique using 30% w/v barium sulphate
  • Small volume of barium to fill the fundus
  • Child turned semiprone into LPO or RAO position
• What is the main indication for barium examinations in young children?

  To identify a cause for vomiting
• What is the purpose of demonstrating the position of the duodeno-jejunal flexure in young children?

  To identify gastro-oesophageal reflux, pyloric obstruction, and malrotation
• What is done once malrotation has been diagnosed or excluded in young children?

  A further volume of barium is administered until the stomach is reasonably distended
• What are the three major causes of vomiting identified in the study material?

  Gastro-oesophageal reflux, pyloric obstruction, and malrotation
• Why is it essential to demonstrate the position of the duodeno-jejunal flexure?

  To accurately identify the causes of vomiting
• What is the single-contrast technique used in the examination?

  • Use 30% w/v barium sulphate
  • No paralytic agent
  • Small volume of barium to fill the fundus
• What position is the child turned into after administering barium?

  Semiprone into a left posterior oblique (LPO) or right anterior oblique (RAO) position
• How does the imaging technique differ when barium passes through the pylorus?

  An image is taken as barium passes through the pylorus
• What happens once barium enters the duodenum?

  The infant is returned to the supine position for a second image
• What is done after diagnosing or excluding malrotation?

  A further volume of barium is administered until the stomach is reasonably full
• What is the purpose of rotating the child 180 degrees during the examination?

  To elicit gastro-oesophageal reflux
• What can confirm the diagnosis of upper intestinal obstruction in newborn infants?

  Injecting 20 mL of air down the nasogastric tube
• What should be done if the diagnosis remains in doubt?

  It can be replaced by a positive contrast agent
• What are the aftercare instructions for patients post-examination?

  • Do not drive until vision blurring from Buscopan resolves (usually within 30 minutes)
  • Bowel motions will be white for a few days and may be hard to flush
  • Eat and drink normally with extra fluids to avoid barium impaction
• What are the complications associated with the procedure?

  1. Leakage of barium from perforation
  2. Aspiration
  3. Conversion of partial obstruction to complete obstruction
  4. Barium appendicitis (rare)
  5. Side effects of pharmacological agents
• What are the methods used in small bowel follow-through?

  1. Single contrast
  2. Addition of an effervescent agent
  3. Addition of a pneumocolon technique
• What are the indications for a small bowel follow-through?

  1. Pain with weight loss
  2. Diarrhoea
  3. Transfusion-dependent anaemia
  4. Partial obstruction
  5. Malabsorption
  6. Small bowel adhesive obstruction
• What are the contraindications for a small bowel follow-through?

  1. Complete or high-grade obstruction
  2. Suspected perforation
• What is the contrast medium used in small bowel follow-through?

  1. Z Paque 100% w/v or Baritop 100% w/v
• How is the transit time through the small bowel improved?

  By adding 10 mL of Gastrografin to the barium
• What is the patient preparation for a small bowel follow-through?

  • Metoclopramide 20 mg may be given to enhance gastric emptying
  • A plain abdominal film should be performed if vomiting occurs