Anatomy of Stomach

Anatomy of Stomach

ANATOMY OF STOMACH & NORMAL BARIUM MEAL ANATOMY OF STOMACH SURFACES: Anterosuperior & Posteroinferior. BORDERS :lesser & greater curvatures.

DIVIDED INTO:Fundus, Body, Antrum & pylorus. Short obese people : Transverse & Steer horn shape. Tall thin people: Longitudinal & JShaped

Max capacity :1500ml. Completely peritoneum. covered by HISTOLOGY OF

STOMACH LYMPHATIC DRAINAGE BARIUM MEAL Radiological study of stomach , duodenum, and proximal jejunum by oral administration of contrast media(barium sulphate).

Ba fills the lumen, taking the shape of the organ and delineates any abnormal structure. Radiolucencies are produced by mass lesions displacing Ba.

Radio-opacities by ulcer, fistula, diverticulum which extends beyond normal contours of organ. INDICATIONS Symptoms epigastric pain,anorexia,wt loss,dyspepsia,etc.

Upper abdominal mass. GI Hemorrhage. Gastric or duodenal obstruction. Ca GEO junction,stomach,duodenum. Motility disorders. Systemic diseases viz-TB . CHILDREN-GE reflux, pyloric obstruction, malrotation. CONTRAINDICATIONS

Gastroduodenal perforation. H/o aspiration. Large bowel obstruction.

Fistulous communication. Recent biopsy. PREPARATION OF PATIENT NBM for 6hrs. Restrain

In In smoking. diabetes : early morning appt. Gastric outlet obstruction prolonged fasting , metaclopramide given, sometimes nasogastric intubation & aspiration needed.

SINGLE CONTRAST STUDY Low density barium suspension (80100% w/v) is used. Conventional Radiography is done at 80-90kV. 10-15 ml of Ba given with patient supine & rotated in clockwise manner to obtain good mucosal coating. 100-250ml of Ba is given & films are taken in various views.

STANDARD VIEWS FOR SINGLE CONTRAST FUNDUS BODY SUPINE ERECT OR PRONE ANTRUM & PYLORUS PRONE RT SIDE DOWN

D1 & C LOOP PRONE RT SIDE DOWN D4 SUPINE SINGLE CONTRAST HIGH KV TECHNIQUE

Barium Sulphate 30% w/v is used. Radiography Permits done at 120-130 kV. visualization through the Barium column.

ADVANTAGES OF SINGLE CONTRAST Pylorospasm, fistulae & enlarged gastric rugae are better seen. Filling defects due to large masses in pyloric & duodenal region are more easily identifiable.

Procedure of choice for suspected gastric or duodenal obstruction. DISADVANTAGES Lack of sensitivity in detecting Small erosions/ulcers. Early gastric Ca.

Subtle mucosal abnormalities. DOUBLE CONTRAST STUDY High density (200-250% w/v) low viscosity Ba Sulphate, to coat the wall. Gas producing agents are used to distend the lumen, acts as negative

contrast. Smooth muscle relaxant - Buscopan STANDARD VIEWS FUNDUS BODY ANTRUM & PYLORUS D1 & C

LOOP D4 PRONE RT SIDE DOWN SUPINE WITH HEAD END ELEVATION SUPINE RT SIDE UP SUPINE RT SIDE UP

PRONE RT SIDE DOWN ADVANTAGES Highly accurate in detecting abnormalities following:Gastric surgery Bile reflux gastritis Marginal ulcerations Recurrent Ca DISADVANTAGES

Probably misses some polyps, ulcers, erosions, especially in non dependent walls of stomach. BIPHASIC STUDY 60-100% Mucosal 200-250

low viscosity Ba Sulphate. relief film. ml of Ba given in supine position with Eno in last few mouthfuls. Prone Rt side down Duodenal cap & C loop in SC.

Supine with Rt side up oblique Duodenum in DC. Erect film with compression Duodenal Bulb. Compression

film & Fluoroscopy of stomach For contour defects, peristalsis & emptying. Erect DC films of fundus in 2 views. Supine o

, 60 head up & DC film Upper body stomach. Supine , table horizontal & DC film lower body & pyloric antrum. Erect Rt Anterior Oblique for stomach,

Duo & proximal Jejunum on 1 film. ` AREAE GASTRICAE Micromucosal pattern consists of mosaic of tiny raised nodules(24mm) with intervening grooves. Obvious in distal two

third. COMPLICATIONS 1. 2. 3. 4. 5. Leakage of Ba from an unsuspected perforation. Aspiration pneumonia.

Barium impaction. Acute gastric dilatation. Barium embolisation if a bleeding ulcer is present. THANK YOU

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