f Post graduate mcqs and discussion : BARIUM MEAL STUDY

Thursday, March 29



1. Gastric ulcer—shows a niche which is the ulcer crater, a notch which is due to spasm of circular muscle on the greater curvature.

 2. Chronic duodenal ulcer—shows absence or defor med duodenal cap (due to spasm of 1st part of duodenum, barium will not stay and so cap will not be formed).

3. Gastric outlet obstruction—the cause may be chronic duodenal ulcer with pyloric stenosis or carcinoma pylorus. Features are: Enormous dilatation of stomach. Greater curvature below the level of iliac crest. Absence of duodenal cap. No fi lling of dye in 2nd part of duodenum. Mottled appearance of stomach because of retained food particles. Evidence of gastritis.

x- Rays 

4. Carcinoma stomach—irregular fi lling defect.

5. Pseudocyst of pancreas—widened vertebrogastric angle.

6. Stomal ulcer in previous gastrojejunostomy.

 7. In chronic duodenal ileus (Wilkie’s syndrome)—shows dilatation of stomach, 1st and 2nd part of duo denum, proximal portion of 3rd part of duodenum.

8. Others—gastric volvulus, duodenal diverticula, trichob￾ezoar, gastric fi stulas, diaphragmatic hernias when stomach is the content.

9. Carcinoma of head of pancreas shows “pad sign”; in periampullary carcinoma—reverse “3’ sign. Frostberg’s reverse ‘3’ sign (inverted ‘3’ sign). Rose thorn duodenum in carcinoma head of pancreas.

10. Hiatus hernia.

Procedure :

Barium sulphate solution is used [Barium is neurotoxic, but in sulphate media it will not get absorbed and so barium sulphate is used (Barium phosphate is not used)].

About 300 ml solution is given to the patient to drink and its fl ow down to the stomach is observed under fl uoroscopic guidance. Films are taken as required. Commonly oblique views are taken.

 Microcrystalised barium sulphate (Microbar solution) is better as it does not get precipitated.

Complication :

It may precipitate intestinal obstruction.