Esophagography Overview

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Questions and Answers

What is the purpose of the Modified Valsalva maneuver?

To evaluate lung capacity

To test the elasticity of the hypopharynx and piriform (correct)

To assess heart rate variability

To measure blood pressure changes

Which segment of the esophagus is located above the thoracic cavity?

Thoracic segment

Cervical segment (correct)

Intra-abdominal segment

Abdominal segment

What is the filling phase intended to do during an esophagography procedure?

Analyze blood flow in the esophagus

Demonstrate the mucosal pattern

Distend the lumen of the esophagus (correct)

Detect esophageal reflux

Which of the following is NOT an indication for an esophagography?

Myocardial infarction Signup and view all the answers

What condition does achalasia describe?

Abnormal constriction of the gastro-esophageal junction Signup and view all the answers

What complication must be ruled out before performing special procedures with contrast?

Suspected leakage from the esophagus Signup and view all the answers

Which of the following maneuvers is used to detect esophageal reflux?

Modified Valsalva maneuver Signup and view all the answers

What is the purpose of the mucosal phase during esophagography?

To show the mucosal pattern of the esophagus Signup and view all the answers

What condition is characterized by the inflammation of the lining or mucosa of the stomach?

Gastritis Signup and view all the answers

What type of ulcer affects the mucous membrane and is commonly caused by acid gastric juice?

Peptic Ulcer Signup and view all the answers

Which condition describes the weakening and blind outpouching of a portion of the mucosal wall?

Diverticula Signup and view all the answers

What is the definition of emesis?

Act of vomiting Signup and view all the answers

Which type of hernia is congenital and results from the weakening of muscle structure?

Hiatal Hernia Signup and view all the answers

Which of the following is NOT a type of ulcer mentioned?

Bacterial Ulcer Signup and view all the answers

What symptom is associated with dyspepsia?

Uncomfortable fullness Signup and view all the answers

What is a possible contraindication for special procedures with contrast?

Complete large bowel obstruction Signup and view all the answers

What is the volume of BaSO4 preparation for a child aged 1 year?

2 to 4 oz. Signup and view all the answers

What is the purpose of using gas producing tablets in double contrast procedures?

To coat the gastric mucosa Signup and view all the answers

Which positioning is used to demonstrate hiatal hernia in variation LPO?

Prone with body rotated Signup and view all the answers

What view is used to demonstrate the pyloric canal and the duodenal bulb?

RAO View Signup and view all the answers

What is the minimum fasting period (NPO) required before conducting a contrast procedure?

6-8 hours Signup and view all the answers

Which of the following is demonstrated using the PA view with single contrast?

Gross pathology only Signup and view all the answers

What is the main purpose of the double contrast technique?

Detect small lesions and demonstrate mucosal patterns Signup and view all the answers

What is the volume of BaSO4 preparation recommended for an adult patient?

12 to 16 oz. Signup and view all the answers

Which of the following patient conditions should contraindicate the use of a cleansing enema?

Diarrhea Signup and view all the answers

What is the typical volume of barium sulfate used in special procedures with contrast?

500-1200 ml Signup and view all the answers

Which position is commonly used to relax abdominal muscles during an enema procedure?

Sim's position Signup and view all the answers

Which imaging characteristic is associated with a neoplasm in the colon?

Apple-core or napkin ring appearance Signup and view all the answers

Which of the following is NOT an indication for special procedures with contrast?

Severe headache Signup and view all the answers

What is a common symptom associated with intussusception in infants?

Mushroom-shaped appearance in imaging Signup and view all the answers

Which of the following conditions is a contraindication for performing a contrast enema?

Toxic megacolon Signup and view all the answers

What is the usual temperature range for warm barium sulfate during procedures?

85-900°F Signup and view all the answers

What is the primary purpose of vesiculography?

To examine abnormalities in the seminal ducts Signup and view all the answers

Which condition is specifically investigated using hysterosalpingography?

Patency of the uterine tube Signup and view all the answers

What is the main focus of vagnography?

Investigating congenital abnormalities of the vagina Signup and view all the answers

What does fetography primarily determine?

The presentation and position of the fetus Signup and view all the answers

In pelvimetry, what is being compared?

Size of the fetal head and maternal bony outlet Signup and view all the answers

What is the technique used in discography?

Injection of a specific volume of fluid into lumbar intervertebral disks Signup and view all the answers

Encephalography is primarily used to examine which part of the body?

Ventricular and cisternal systems of the brain Signup and view all the answers

Which condition is NOT investigated using hysterography?

Ovarian tumors Signup and view all the answers

Study Notes

Esophagography / Ba.Swallow

Demonstrates pharynx and esophagus.
Indirectly investigates suspected lesions of the heart and great vessels.
Esophagus measures 10” / 25-30 cm in length.
Posterior to the trachea and pharynx.
Anterior to the vertebral column.
Passes through the diaphragm in front of the aorta to enter the stomach.
Has 3 segments: cervical, thoracic, and intra-abdominal.
Two phases employed for examination: filling and mucosal.
Filling phase distends the lumen of the esophagus using a 2:1 or 3:1 ratio of barium to water.
Mucosal phase demonstrates the mucosal pattern of the esophagus using a 4:1 ratio of barium to water.

Indications for Esophagography

Dysphagia (difficulty swallowing).
Barret's esophagus/syndrome (stricture in the distal esophagus, developed peptic ulcer in the distal esophagus).
Thyroid gland enlargement.
Esophageal carcinoma (cancer of the esophagus).
Mediastinal mass.
Chalasia (abnormal relaxation of the gastro-esophageal junction, symptoms include heartburn, retrosternal pain, regurgitation, and eructation - belching).
Achalasia (abnormal constriction of the gastro-esophageal junction).
Hiatal hernia (protrusion of the stomach through the wall of the diaphragm).
Cardiomegally (enlarged heart).
Foreign body (FB).

Contraindications for Esophagography

Suspected leakage from the esophagus into the mediastinum, pleural, or peritoneal cavities.
Aspiration into the bronchial tree.

Esophageal Reflux Procedures

Breathing exercises: Valsalva maneuver (straining while holding breath) and Mueller maneuver (exhaling and trying to inhale against a closed glottis).
Water test (swallowing a mouthful of water through a straw).
Phytobezoar (ingested vegetables, fiber, or seeds).

Radiographic Appearance of the Esophagus

Light coating of BaSO4 is used.
Diverticula (weakening and blind out pouching of a portion of the mucosal wall).
Emesis (act of vomiting) aids in identifying the cause of vomiting.

Gastritis

Inflammation of the lining or mucosa of the stomach.
- Acute Gastritis: Severe pain or discomfort.
- Chronic Gastritis: Intermittent pain, often related to diet or stress.

Other Indications for Upper GI Series

Dyspepsia (uncomfortable feeling of fullness, nausea, and bloating).
Gastrointestinal (GI) hemorrhage.
Upper abdominal mass.
Partial obstruction.
Hiatal hernia: congenital or caused by weakening of the muscle.
Sliding hiatal hernia (degree of herniation can be observed).
Schatzke’s ring (ringlike constriction at the distal esophagus).
Ulcers (erosions of the stomach or duodenal mucosa).
Weight loss.

Types of Ulcers

Peptic ulcers (ulceration of mucous membrane, caused by the acid of gastric juice).
Duodenal ulcers (a type of peptic ulcer, frequent in the 2nd and 3rd aspect of the duodenum).
Gastric ulcers (ulcer of gastric mucosa).
Perforating ulcers (ulcer of the entire thickness of the wall of the stomach and intestines).

Parts of the Stomach

Cardia (junction of the esophagus and stomach).
Fundus (lies above the horizontal junction of the stomach and esophagus).
Body.
Pyloric portion.

Upper GI Series Contraindications

Complete large bowel obstruction.
History of bowel perforation and laceration.

Stomach Habitus

Eutonic or Normotonic: Incisura and pylorus are at the same level.
Hypotonic: Pylorus is higher than incisura angularis by 1 cm.
Steerhorn: Incisura is higher than the pylorus by 1 cm.

Upper GI Series Preparation

Patient must be NPO (nothing by mouth) for 6-8 hours.
6-hour delayed study: Used in cases of suspected pyloric stenosis to assess gastric emptying rate.
24-hour delayed study: Used if suspicion exists in the small intestine, appendix, or colon.

Barium Sulfate Preparation

1 year old: 2 to 4 oz.
1 to 3 years old: 4 to 6 oz.
3 to 10 years old: 6 to 12 oz.
Older than 10 years old: 12 to 16 oz.
30-50% weight/volume (WV) for single contrast.
50-80 ml. for esophagus and mucosal pattern of the stomach.
300 ml. for stomach and duodenum.
100 g/8 oz. in water.

Upper GI Series Contrast Types

Single contrast: To demonstrate gross pathology only, used for children and very ill patients.
Double contrast: To demonstrate the mucosal pattern of the stomach and to detect small lesions.
Gas-producing tablets are given with double contrast.
Patient is rotated 360° to coat the gastric mucosa.

Upper GI Series Positions

PA: Demonstrates the relationship of the stomach and retrogastric space.
RAO: Demonstrates pyloric canal and duodenal bulb, antrum, greater curve, and peristalsis of the stomach.
RLR: Demonstrates duodenal loop, duodenojejunal junction, and the right retrogastric space.
LPO: Demonstrates hiatal hernia and the greater and lesser curvatures, antral portion of the stomach.

Upper GI Series Modifications

Gordon's maneuver: Used to demonstrate the pylorus and the duodenal bulb. Patient is prone with CR 35-45° cephalad.

Barium Enema (BE)

Used to investigate the large intestine (colon).
500-1200 ml. of warm BaSO4 (85-90° F / 29-30° C) or cold BaSO4 (41° F / 5° C) is used.

BaSO4 Concentrations for BE

15%-25% WV for single contrast.
75%-95% WV for double contrast.

Preparation for BE

Patient must be cleansed with laxatives and enemas to ensure the colon is clean.

Reasons for Warm BaSO4 in BE

Produces less irritation.
Stimulates tonic contraction of the anal sphincter.
Container is typically 90 cm (36 inches) above the table top to avoid undue discomfort to the patient.

Sim's Position for BE

Recommended position (35-40°) because it relaxes the abdominal muscles, decreases intra-abdominal pressure on the rectum, and makes relaxation of the anal sphincter easier.

Indications for BE

Change in bowel habit.
Pain.
Mass.
Obstruction.
Colitis (inflammatory condition of the large intestine).
Polyps (sac-like projections that project inwards).
Volvulus (twisting of a portion of the intestine, most common in males 20-50 years old, "beak" appearance).
Intussusception (telescoping or invagination of one part of the intestine into another, common in infants under 2 years old, "mushroom-shaped" appearance).
Ulcerative colitis (severe form, "cobblestone" appearance, can develop "stovepipe colon").
Diverticulum (common in adults over 40 years old).
Neoplasm (benign tumor, "apple-core" or "napkin ring" appearance).

Contraindications for BE

Toxic megacolon.
Pseudomembranous colitis.
Rectal biopsy.
Incomplete bowel prep.
Recent barium meal.

BE Positions

AP/PA.
LAO.
RAO.
Left Lateral.

Vesiculography

Radiographic examination of the seminal ducts used to investigate abnormalities such as cysts, abscesses, tumors, inflammation, and sterility.
Demonstrates the vas deferens and seminal vesicles using contrast medium.

Hysterosalpingography

Determines the uterus and uterine tube.
Delineates lesions such as polyps, submucosal tumors, masses, and fistula tracts.
Investigates the patency of the uterine tube.
Demonstrates the uterus and the fallopian tubes.
Investigates infertility.

Vaginography

Investigates congenital abnormalities, vaginal fistulas, and other pathologic conditions of the vagina.

Fetography

Demonstrates the fetus in the uterus after 18 weeks of gestation.
Detects suspected abnormalities of development.
Confirms suspected fetal death.
Determines the presentation and position of the fetus.
Determines whether the pregnancy is single or multiple.

Pelvimetry

Demonstrates the architecture of the maternal pelvis.
Compares the size of the fetal head with the size of the maternal bony outlet.

Discography

Demonstrates lumbar intervertebral disks by injecting 0.5 ml of contrast medium via a lumbar puncture needle.

Encephalography

Demonstrates the ventricular and cisternal system of the brain by injecting gas or air into the lumbar subarachnoid space or directly into the cisterna magna.

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Description

This quiz covers the essentials of esophagography, including the anatomy of the esophagus, its segments, and the phases of examination. It also discusses indications for the procedure, such as dysphagia and esophageal carcinoma. Test your knowledge on this vital diagnostic tool!