Your Radiologist Explains: Upper Gastrointestinal (GI) Examination
Summary
TLDRDr. Kristoff Walt from Ley Clinic in Boston presents an overview of upper GI tract imaging. The upper GI exam, including barium swallow for throat and esophagus, uses fluoroscopy to capture live X-ray images. Patients consume barium to coat the digestive tract, enhancing visibility. The procedure helps diagnose conditions like swallowing disorders, inflammation, ulcers, and tumors. For an upper GI exam, patients must fast, and may also ingest baking soda to produce gas, aiding in the examination of the stomach and duodenum. The presentation includes examples of conditions detected through this imaging technique.
Takeaways
- 📚 An upper GI exam is an x-ray examination of the beginning of the digestive system, including the mouth, throat, esophagus, stomach, and the first part of the small intestine (duodenum).
- 🔍 A barium swallow is a type of upper GI exam that focuses on the throat and esophagus, using barium as a contrast agent to enhance visibility on x-rays.
- 🍽 Preparation for an upper GI exam involves fasting to ensure the stomach is empty, and avoiding medications, chewing gum, and smoking after midnight before the test.
- 👨⚕️ Fluoroscopy, a special form of X-ray, is used during the exam to provide live images of the contrast material as it passes through the upper GI tract.
- 💡 Barium, when ingested, coats the inner surface of the digestive tract, making the organs visible on x-ray and highlighting any abnormalities.
- 🌬️ Some patients are also given baking soda to produce gas, which helps to distend the upper GI tract and improve the visibility of its lining.
- 🩺 An upper GI exam is recommended for symptoms such as difficulty swallowing, chest or abdominal pain, and reflux, and can diagnose conditions like swallowing disorders, inflammation, hernias, ulcers, and tumors.
- 👀 The exam can reveal specific conditions through images, such as Zenker's diverticulum, a pouch in the throat where food can get stuck, or spasms in the esophagus that impede the passage of food.
- 🔎 Radiographic images can show the normal anatomy of the stomach and duodenum, as well as abnormalities like erosive gastritis, which appears as small ulcers in the stomach lining.
- 🏥 If a blockage is found, such as a cancer in the duodenum, it may require surgical intervention to remove the obstruction and restore the passage for food and liquid.
Q & A
What is an upper GI exam and what does it evaluate?
-An upper GI exam is an X-ray examination of the beginning of the digestive system. It evaluates the mouth, throat, esophagus, stomach, and the first part of the small intestine (duodenum).
What is a barium swallow, and how is it different from an upper GI exam?
-A barium swallow is a more limited exam focusing solely on the throat and esophagus, while an upper GI exam evaluates the entire upper digestive system, including the stomach and part of the small intestine.
How should a patient prepare for an upper GI exam?
-To ensure optimal image quality, the patient’s stomach must be empty. Patients are advised to refrain from eating, drinking, taking oral medications, chewing gum, and smoking after midnight on the day of the exam.
What type of X-ray technology is used during an upper GI exam?
-Fluoroscopy, a special form of X-ray that provides live radiographic images, is used during an upper GI exam. It allows the radiologist to observe the passage of contrast through the digestive tract in real-time.
Why is barium used during the exam, and what role does it play?
-Barium is used as a contrast agent. After a patient drinks it, barium coats the inner surface of the digestive organs, making them visible on the X-ray. This allows the radiologist to assess the anatomy and function of the upper GI tract.
What are some of the symptoms that might prompt a doctor to recommend an upper GI exam?
-Doctors may recommend an upper GI exam if a patient experiences symptoms like difficulty swallowing, chest or abdominal pain, acid reflux, or other signs of digestive dysfunction.
What conditions can be diagnosed through an upper GI exam?
-An upper GI exam can diagnose a range of conditions, including swallowing disorders, inflammation of the esophagus or stomach, hiatal hernias, ulcers, tumors, and other digestive issues.
What is a Zenker diverticulum, and how does it appear on an upper GI exam?
-A Zenker diverticulum is an abnormal outpouching of the hind wall of the throat. On an upper GI exam, barium can become trapped in this pouch, which may cause symptoms like bad breath or food spilling into the airway.
What happens when the esophagus goes into spasm during the swallowing process?
-When the esophagus goes into a spasm, it can take on a corkscrew shape, making it difficult for food or liquid (such as barium) to pass downward. This can give the patient the sensation of food being stuck.
How does erosive gastritis appear on an upper GI exam, and what can cause it?
-Erosive gastritis appears as multiple small ulcers in the stomach lining, where barium pools in the ulcer craters. It can be caused by chronic inflammation, too much stomach acid, or taking over-the-counter anti-inflammatory pills.
Outlines
🔍 Introduction to Upper GI Imaging
Dr. Kristoff Walt introduces himself as a radiologist at the Ley Clinic in Boston and explains the purpose of an upper gastrointestinal (GI) exam. This x-ray examination focuses on the initial part of the digestive system, including the mouth, throat, esophagus, stomach, and duodenum. The preparation for the test involves fasting to ensure the stomach is empty, and avoiding medications, chewing gum, and smoking. The examination uses fluoroscopy, a real-time X-ray imaging technique, to observe the movement of contrast material through the upper GI tract. Patients are given barium, which coats the inner surfaces of the organs, enhancing visibility on X-rays. The presentation also mentions the use of baking soda to produce gas, which helps in examining the GI tract lining. The exam is recommended for symptoms like difficulty swallowing, chest pain, and reflux, and can diagnose conditions such as swallowing disorders, inflammation, hernias, ulcers, and tumors.
📸 Case Studies in Upper GI Imaging
The second paragraph delves into specific case studies demonstrated through upper GI exam images. It describes an image of a patient's throat with barium, highlighting a Zener diverticulum, an abnormal pouch where food can get trapped, leading to bad breath or aspiration. Another image shows a patient's esophagus during a spasm, causing a 'corkscrew' effect and difficulty in food passage. A normal stomach image is contrasted with one showing erosive gastritis, characterized by multiple ulcers visible as white puddles of barium. The paragraph concludes with a case of duodenal cancer causing a blockage, visible as barium backup into the stomach. The speaker encourages further learning about upper GI exams through a provided website and thanks the audience for their attention.
Mindmap
Keywords
💡Radiologist
💡Upper GI Exam
💡Fluoroscopy
💡Barium
💡Baking Soda Crystals
💡Zenker Diverticulum
💡Esophageal Spasms
💡Erosive Gastritis
💡Duodenal Blockage
💡Radiologyinfo.org
Highlights
Introduction to upper GI tract imaging by Kristoff Walt and Dr. Frank Schulz.
Explanation of an upper GI exam as an x-ray examination of the digestive system's beginning.
Description of a barium swallow as a specific type of upper GI exam focused on the throat and esophagus.
Schematic drawing highlighting the parts of the upper GI tract that can be evaluated.
Enlarged view detailing the stomach and the first part of the small intestine (duodenum).
Preparation instructions for an upper GI exam, including fasting and avoiding medications, gum, and smoking.
Use of fluoroscopy in upper GI exams to provide live radiographic images.
Process of patients drinking oral contrast liquid containing barium for x-ray visibility.
Function of barium in adhering to internal organs to enhance x-ray imaging.
Administration of baking soda crystals to produce gas and distend the upper GI tract for better imaging.
Indications for an upper GI exam, including difficulty swallowing, chest pain, and reflux symptoms.
Diagnostic capabilities of upper GI exams in identifying swallowing disorders and inflammation.
Examples of conditions visible on upper GI exams, such as hiatal hernias, ulcers, and tumors.
Presentation of example images from upper GI exams, showing various pathological conditions.
Image analysis of a Zener diverticulum, an abnormal outpouching in the throat.
Demonstration of esophageal spasm causing difficulty in food passage through a radiographic movie.
Radiographic image of a normal stomach with barium coating and gas from baking soda.
Identification of erosive gastritis through the presence of ulcers in the stomach lining.
Case of a duodenal blockage caused by cancer, visible through barium backup in the stomach.
Recommendation for learning more about upper GI exams via www.radiologyinfo.org.
Transcripts
hello my name is Kristoff Walt and I'm a
radiologist at the Ley clinic in Boston
my colleague Dr Frank Schulz and myself
have prepared the following short
presentation to explain Imaging of the
upper GI
tract an upper GI exam is an x-ray
examination of the beginning of the
digestive system when the exam is
limited to the throat and esophagus only
we call it a barium
swallow this is a schematic drawing
highlighting the various parts of the
upper ey tract we can evaluate with this
test as I said before we image the mouth
and throat esophagus and stomach here's
enlarged view of the stomach and the
first part of the small intestine which
is also known as the Dum which we can
also evaluate on an upper GI
exam you may wonder how best to prepare
for this test to ensure the best
possible image quality your stomach must
be empty of food you will likely be
asked not to eat or drink anything
including any medications taken by mouth
especially and aets also please refrain
from chewing gum and smoking after
midnight on the day of the
examination upper GI exams use a special
form of X-ray called
fluoroscopy fluoroscopy provides live
radiographic images while switched on
the radiologist shown here sitting
behind a protective screen uses the
equipment to watch the passage of
contrast through the upper G tract and
to observe internal organs in
motion before or during the exam
patients are asked to drink an oral
contrast liquid most commonly containing
a substance called
barium an X-ray camera can see barium
inside a patient from the outside after
drinking it barium sticks to the inner
surface of your internal organs like
paint to a wall and makes them invisible
to the X-ray eye the radiologist can now
View and assess anatomy and function of
the digestive tract some patients are
also given baking soda crystals which
produce some gas inside the patient
distending the upper GI tract using both
contrast and the gas helps to see the
lining of the GI tract
better your doctor may ask you to
undergo an upper GI exam if you have
symptoms such as difficulty swallow
flowing chest and abdominal pain reflux
which is a backward flow of partially
digested food and digestive juices and
other symptoms an upper GI exam helps to
evaluate digestive function and can
diagnose many diseases of the upper GI
tract here are some examples swallowing
disorders inflammation of the esophagus
stomach and duodenum hial hernias ulcers
tumors and other things the following
slides contains some example images from
upper GI exams showing some of the
conditions we can see on these
exams this is an image of a patient's
throat seen from the side for
orientation the spine is labeled barium
seen here in black is passing through
the throat shown by the Green Arrow and
some of the barium gets caught in an
abnormal outpouching of the hind wall of
the throat called a zener
diverticulum this this second image
shows that most of the Barum has passed
into the
esophagus while some got stuck in the
zener
diverticulum in patients with this
condition food can get stuck in this
little pouch and cause bad breath or
accidentally spill out into the
neighborhood such as the breathing
tube here you see a short Loop of a
movie of a patient whose esophagus is
giving trouble the image shows a view
into the patient from the side the p
patient is actually swallowing barium
contrast the black column in this image
is barium passing through the esophagus
as the camera is filming it the
esophagus which is basically a tube
mostly made up of muscle is first moving
the barium downward just fine but then
at some point goes into a spasm which
looks like a cork screw and makes it
difficult for Mor barium to pass
downward when the spasm occurs the
patient has a sensation that food or in
this case barium is getting
stuck this is a radiographic picture of
a normal stomach the stomach lining is
coated with barium the stomach is filled
with gas from baking soda crystals you
can see the body which is the main part
of the stomach marked by the letter b
and the exit of the stomach the
so-called antrum marked by the letter A
little black arroe heads point to normal
folds of the lining of the stomach the
first part of the stomach called the
fundus marked by the letter F is filled
here with dense white
barium this is an image of a patient
with erosive gastritis this condition
can be caused by taking common
over-the-counter anti-inflammatory
painkiller type pills chronic
inflammation of the stomach lining and
too much acid in the stomach can result
in the development of many little erss
shown here on images from an upper GI
exam the small image at the bottom shows
the many little ulcers in the stomach
barium which looks white on these images
pools in the little ulcer craters which
are shallow grooves in the lining of the
stomach the dark ring arout eat little
white barium puddle on this image is
caused by swelling of the inflamed
stomach lining surrounding the alcer
crater this patient has developed a
tight blockage in the duodenum the
duodenum normally looks like a tube tube
and is the first part of the human small
bowel in this patient the blockage
causes barium to back up into the
stomach the reason is a cancer of the
duodenum marked here with a red C which
wraps around the duodenum squeezing it
tightly which is illustrated by the
green arrows if the cancer has not yet
spread this patient may need an
operation to remove the cancer and
restore passage for food and liquid
if you would like to learn more about
upper GI exams please visit www.
radiologyinfo.org and I thank you for
your
attention
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