Upper Gastrointestinal Series

Upper
Gastrointestinal
Series
The cheapest GI special
procedure
Upper GI Series
• Morphology
• Function
Upper GI Series
• Gastrogram
– positive contrast
– double contrast (not practical)
– negative contrast
• Small intestine
• Not for evaluation of large intestine
The cheapest GI special
procedure – opposite lateral
Indications
• Acute or chronic
vomiting
• Hematemesis
• Anorexia
• SI diarrhea or
melena
• Suspect obstruction
• Suspect linear
foreign body
• Cranial abdominal
mass lesion
• Position of intestinal
tract
• Suspect perforation
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Contra-indications
(relative)
• Survey radiographs show obstruction
• Known or suspected perforation
• Prior use of motility altering drugs
• Food in stomach or feces in colon
Complications
• Aspiration of contrast
– Problematic with barium in diseased lungs
– Problematic with ionic non-sterile oral
iodinated preparations
Complications
• Leakage of contrast into peritoneal cavity –
OK if rapidly (

Supplies: Contrast Media
• Barium sulfate
suspension
– 30% weight/weight
– 6 ml/lb
• Iodinated contrast
– 1-2 ml/lb diluted
with tap water to
make 6 ml/lb
Gastric Perforation
Iodinated contrast
Gastric Perforation
Gastric Perforation
Barium
Supplies Technique
• Survey radiographs
– evaluate need for study
– ensure proper preparation
– establish radiographic technique
• Sedation?
– Dogs: acepromazine
– Cats: ketamine/valium
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Technique
• Administer contrast via orogastric tube
• Obtain serial radiographs (2 views)
– Dog: 0, 15, 30, 60, hourly
– Cat: 0, 15, 30, 45, 60, then Q30-60 min
• When to end study?
– Contrast reaches colon
– Stomach is empty
– Most contrast in distal small intestine
– No further progression of contrast
Common Technical Errors
• Poor patient preparation
• Inadequate dose of contrast
• Improper radiographic technique
Normal Interpretation
Dog (hrs) Cat (hrs)
Complete gastric emptying 2 (0.5-3) 0.5 (0.25-1)
SI transit time 1 (0.5-2) 0.75 (0.5-1)
SI emptying time 3.5 (3-5)
Common Technical Errors
• Poor patient preparation
• Inadequate dose of contrast
Common Technical Errors
• Poor patient preparation
• Inadequate dose of contrast
• Improper radiographic technique
• Two few radiographs
• Administration of barium coated meal
Normal Interpretation
Delayed gastric emptying
– Stress!
– Inadequate contrast dose
– Poor preparation
– Medications
– Sedation
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Normal Interpretation
• Rugal folds
• Continuous, rope-like, uniform column
• Smooth or finely fimbriated mucosa
• Thin, uniform intestinal wall
• Symmetric peristaltic waves
Gastric emptying
Immediate 20 minutes
40 minutes 90 minutes
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Normal variations
Fimbriation
• fringing at the
barium-mucosal
interface –
“brush border”
due to villi
Normal Variations
“String of pearls”
– duodenum of cats
– strong muscular
contractions
– “pseudostring” sign
Negative contrast
gastrogram
Normal Variations
Pseudoulcers
– young dogs
– square or conical outpouchings
– antimesenteric
border
Negative contrast
gastrogram
Abnormal Interpretation
Identification of lesions
– repeatable
– persistent
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Abnormal Interpretation
• Classify lesions as intraluminal, intramural,
or extramural
• Luminal diameter
• Barium-mucosal interface
• Wall thickness
• Distensibility
• Filling-defects
• Displacements
Stomach - intramural
Stomach - intraluminal
Stomach - intramural
Stomach -
intramural/intraluminal
Chronic Pyloric
Obstruction
Pronounced delayed
emptying
– “beak” sign
– “string” sign
– peristaltic pouch
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4 mo, M, Boxer: chronic vomiting 4 mo, M, Boxer: chronic vomiting
SI - intraluminal SI - intraluminal
SI - intraluminal SI - intraluminal
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Ulceration (intramural)
• Out-pouchings from the lumen
• Benign or malignant
Radiographic Diagnosis of Abdominal Disorders in the Dog and Cat,
O’Brien, W.B. Saunders Co, 1978
Radiographic Diagnosis of Abdominal Disorders in the Dog and Cat,
O’Brien, W.B. Saunders Co, 1978
SI – intramural (diffuse) SI – intramural (diffuse)
SI- intramural (apple core) SI - extramural
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Case Example: 4 month old, M, Boxer
4 days of vomiting, known to eat things
• Survey Radiographs
Case Example: 4 month old, M, Boxer
4 days of vomiting, known to eat things
• Upper GI: 60 min
Case Example: 9 year old, MN, Shar-pei
diarrhea and melena x 2 mo, vomiting x 1 mo
• Upper GI: 20 min
Case Example: 4 month old, M, Boxer
4 days of vomiting, known to eat things
• Upper GI: immediate
Case Example: 9 year old, MN, Shar-pei
diarrhea and melena x 2 mo, vomiting x 1 mo
• Survey radiographs
Case Example: 9 year old, MN, Shar-pei
diarrhea and melena x 2 mo, vomiting x 1 mo
• Upper GI: 90 min
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Case Example: 9 year old, MN, Shar-pei
diarrhea and melena x 2 mo, vomiting x 1 mo
• Upper GI: 225 min
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