barium meal / special investigation

barium meal

method

1. Double contrast - This method is used to look for mucosl patterns. 
2. Single contrast- 

• Children- Because it is not necessary to display mucosal pattern in children. 
• Very ill adult- Only gross pathology is seen. 

Indication

1. Dyspepsia - Loss of Thirst 
2. Weight loss
3. Upper abdominal mass
4. Gastrointestinal haemorrhage (or unexplained iron-deficiency anaemia)
5. Partial obstruction
6. Assessment of site of perforation - To find out the site of perforation. For this, it is necessary to use water soluble contrast media like Gastrografin or LOCM.

Contraindication - Complete large bowel obstruction.

Contrast medium- 

1. EZ HD 250% w / v 135ml. It is fed to the patient. 
2. Carbex grannule (For double contrast technique) These produce CO2 gas which produces double contrast effect. 

Patient preparation- 

1. The patient should not be fed anything 6 hours before the exam. (Nil orally for 6 hr prior to the examination).
2. Patients are advised not to smoke during the procedure as it increases gastric motility. 

Preliminary film- None 

Technique-

1. Patient is said to swallow gas producng agent. 
2. The patient is brought to his left side and then the patient is fed barium in this condition. In this case, barium does not quickly enter the duodenum. 
3. The patient is slightly supine to the supine right side so that the barium rises upward and reaches the gastro-oesophageal junction. In this case, reflux is checked, for this, the patient is asked to swallow some water or cough. If reflux is visible then the spot film is taken. 
4. After this, the patient is called to roll in his right side and the circles are completed at the RAO position. It forms a coat by sticking it on the barium gastric mucosa. 

Films- 

1. spot films of stomach- 

• RAO (right anterior oblique) to demonstrate the antrum and greater curve.
• Supine- to demonstrate the lower curve.
• LAO (Left anterior oblique) - to demonstrate the lower curve.
• Left lateral tilted, head up 45 ° - to demonstrate the fundus.

      2. Spot film for duodenal loop (Lying) -

• The prone-patient is placed on a compression pad so that barium does not quickly enter the duodenum. 

      3. Sopt film for duodenal cap (Lying) - 

• Prone
• RAO
• Supine
• LAO

Aftercare- 

1. The patient should be told that due to barium, his bowel motions will be white for a few days and there may be problems in flushing. 
2. The patient should be advised to drink sufficient amount of water to prevent barium from freezing. Laxatives can be taken if required. 

Complication- 

1. Barium leakage from unsuspected leakage | 
2. Changes in partial large bowel obstruction of patient due to the deposition of barium into complete large bowel obstruction. 
3. Barium appendicitis due to the accumulation of barium in the appendix.