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A static view of upper gastrointestinal tract with contrast media is called barium swallow .Barium swallow is a radiographic (x-ray) examination of the upper gastrointestinal tract spefically the pharynx (back of the mouth and throat) which includes the esophagus (hollow tube of muscle extending from below the tongue to the stomach), and small intestine. It is also a test to determine the cause of difficulty in swallowing, dysphagia, abdominal pain and unexplainable weight loss. Barium swallow image must be exposed in AP (anterior posterior) and lateral view for better view and evaluation.Radiographic examination of gastrointestinal tract for visualization and differentiation of soft tissue structure.
The contrast media that is used in this procedure is barium sulfate. Barium sulfate is a dry,white,chalky, metallic compound which will show up on the x-ray image to help see the abnormalities or pathology in the upper gastrointestinal tract and gives contrast between the soft tissue and enables the hollow structure to be seen in the image.
Barium sulfate cannot be absorbed in the body because it is water in-soluble compound. It is also irritable and dangerous outside the gastrointestinal tract. In case there is a perforated in the upper gastrointestinal tract is suspected, contrast media iodine will be used instead of barium sulfate.It is metallic powder that is mixed with water to make a thick,milkshake-like drink.When swallowed,a barium drink coats the inside walls of the pharynx and oesophagus so that the swallowing motion,inside wall lining, and size and shape of these organs is visible on x-ray.this process shows difeferences that might not be seen on standard x-rays and is used only for diagnostic studies of the GI tract.
Barium swallow can be divided into single contrast medium study which consist only barium solution and the other is double contrast medium. In single contrast medium, the barium sulfate is used as radio opaque material that appears white in colour in the radiograph. While in double contrast medium, barium solution and air is used to give better view and small lesion can easily be seen in the radiograph.
There are two ways of obtaining image for the barium swallow procedure which is cineradiography and fluoroscopy. Cineradiography records the dynamic views of the upper GI tract with contrast media, it helps to study the condition of esophagus and the gastro-esophagus sphincter. In this procedure, continuous dynamic x-ray image is exposed during the swallowing and the transition of the barium solution in the stomach. Fluoroscopy is taken where the patient drink the contrast media, the video camera is focus on the patientâ€™s oral and pharyngeal region during the swallow and the image of the reflex of swallowing is recorded on the video.
1. Dysphagia is a condition where the patient has the difficulty is swallowing
2. Oesophageal stricture is a condition where the oesophagus become narrow and cause difficulties in swallowing
3. Gastro oesophageal reflux is a chronic symptom where abnormal reflux of the stomach acid caused mucosal damage to the oesophagus.
4. Muscle disorder (pharyngeal or oesophageal),such as dysphagia (difficulty in swallowing) or spasms (pharyngeal or oesophageal).
5. Foreign body such as large bolus, glass that is appear in the oesophagus.
6. Oesophageal varices (enlarged veins)
7. Achalasia cardia is the disorder of oesophagus that cause difficulty in swallowing
8. Hiatus hernia is where the stomach protrude through the diaphragm into the thorax
9. Tumours of oesophagus is the abnormal growth of cell in the oesophagus
10. Oesophageal atresia is the incomplete development of oesophagus
11. Oesophageal Webs are thin membranes located in the upper or middle esophagus
12. chest and abdominal pain or reflux
13.Structural problems,such as diverticula,strictures,or polyps (growths)
Before the procedure:
Radiographer has to make sure that the correct amount and concentration of contrast media is administered to the patient.
Always inform consent to the patient and make sure that the patient understands
Make sure patient is not allergy to seafood (patient who is allergy to seafood may also allergy to the contrast media that being used)
Make sure all the equipment use for the procedure is sterilized.
Use mask and hand gloves.
Remove all artifacts to avoid repeat examinations
Make sure patient is well prepared (fasting) as the procedure required
Make sure the machine that will use is functioning
During the procedure:
The radiographers also have to make sure the vein or artery that is administered is correct.
Always assist patient when is needed
Observe comdition of patient
Give proper instruction and make sure the patient is understanding
Make sure there is no leakage of electrical tube or x-ray tube
Give radiation protection to the patient
Give comfort to the patient
After the procedure:
instruction patient where to collect the report
for outpatient arrange for the next appointment
for in patient ask the nurse or staff to assist the patient to ward.
Barium swallow procedure
Preparation of the procedure:
patients are advise to eat low-fiber diet for 2 or 3 days before the test, avoid taking milk, rice or bread if possible, take more water as possible
fast for 10 hours, do not eat or drink anything including water before the examination
do not smoke before the examanition
for diabetes mellitus patient requires special instruction and care
ask the patient to change into hospital gown
remove all the artifacts such as bra, jewelry, belts, dentures
inform consent to the patient and make sure the patient can understands, and sign the consent form
apply 28 days rule foe female patient and ask them whether they are pregnant or not.
During the procedure:
patient is position either supine or erect depends on the patientâ€™s condition
strap patient securely on the x ray table, then x-ray examination is taken to check the abdominal , lungs and the heart ( preliminary ) before the barium swallow examination
patient is given 1 or 2 barium solution and the patient is advised to drink the solution in several mouth full
x-ray is taken again as the barium solution flows down the esophagus into the stomach.
The x-ray table is moved in many position and angle to obtain different view , as the patient move, the barium coats inside the upper GI tract (esophagus, stomach and small intestine)
The x-ray will continue taking until the procedure is complete
After the procedure:
Assist patient out of the room
Ask patient drink lots of water after the test to remove the barium from the body to keep patient from constipated
Ask patient to change back to their attire
Ask patien resume normal diet and activities
Ask patient to consume high fiber meal to expel the barium form the body
Risk and side effects of barium swallow
The barium swallow is actually a safe test, but there is also some complication. The complication of barium swallows are anaphylaxis and allergic reaction. Anaphylaxis which means allergic reaction which will cause deadly anaphylactic shock, while allergic reaction is a condition where the body responds to a foreign body and the immune system is triggered to protect against the foreign body.
After a barium swallow test the patient also will experience constipation if the patient do not consume much water for a few days, and need to take mild laxatives to eliminate hard fecal materials. Patient will also feel bloated after the test and discomfort for a few hours.
Besides, the barium swallow will also cause flushing or warm feeling, nausea or vomiting, headache, altered taste, coughing, dyspnea, rapid pulse, rapid respiration, if dyspnea occur, the emergency medication must be used to treat the patient immediately. Severe swallowing difficulties like aspiration may occurs too
Barium swallow also will cause seizure which means the sudden muscular contraction and will cause unconscious, muscles cramp, joint and back paint. Less common side effects are fever, prolonged cramp of the muscle or blood in the stool.
If perforated stomach or intestine is suspected, water iodine contrast media is used instead of barium sulfate because it is easily absorbed if spillage into the gastro intestinal tract occurs.
Problems that can be detected with barium swallow
Barium swallow helps to visualize certain pathology of the upper gastro intestinal tract, by differentiating the soft tissue in the body. Problems that can be detected with barium swallow are narrowing or the irritation of the esophagus (the muscular cylindrical tube located between the back of the tube and connected to the stomach) or the cardiac sphincter. This test also can detect disorder of swallowing, hiatus hernia which means an internal damage of the stomach that cause the stomach to protrude into the chest through the diaphragm. Problems like abnormally enlarged veins and cause internal bleeding in the esophagus, ulcers, cancerous cell in the pharynx and esophagus and tumor can also be seen in the test. Barium swallow test detects polyps in the upper gastro intestinal test too. Polyps is a growth which is not cancerous but it maybe precancerous cell.
Barium swallow is a radiographic examination that uses the x-ray to operate with. This test is used to check the upper gastrointestinal tract in the patientâ€™s body such as esophagus, stomach, mouth and part of the small intestine. Barium sulfate is a contrast media that is used in this procedure to made this soft tissue organ to be visible on the x-ray film, barium sulfate also differentiate the soft tissue for visualization because the soft tissue structure is more difficult to demonstrate than the bony structure.
Fluoroscopy is used during the barium swallow test. It is a dynamic radiography machine that is used to study the moving body structure or live movement in the body. Besides, the fluoroscopy machine also can record and replay again. It is a continuous x-ray beam that is penetrate into the patientâ€™s body to examined the gastrointestinal tract. In barium swallow test, the fluoroscopy capture the movement of the barium that flows from the mouth, esophagus and the stomach as the patient consume it.
There is some indication of the patient that required to undergoes this barium swallow procedure, such as, dysphagia, esophageal stricture, esophageal shortening, foreign body, achalasia, tumor of the esophagus, hiatus hernia and more. Problems that can be detected with the barium swallow test is narrowing of the esophagus, hiatus hernia, abnormally enlargement of vein, ulcer, cancerous cell in the esophagus, polyps and more.
The risk of the procedure are, flush and warm feeling of the body, headache, allergic reaction, nausea, constipation, muscular cramp may occur, if
reaction of the side effect prolonged or persist, as a radiographer must immediately inform the doctor or radiologist. Emergency trolley must be prepared all the time, incase any emergency case happen such as difficulty in breathing, cardiac arrest, seizure or allergic reaction.
All the patient that undergoes this procedure must be provided with care before, during and after the procedure. The patient also has to be well prepared to prevent repeat examination. As a radiographer, our job is to make sure the correct patient undergoes the procedure, make sure the correct barium is used during the examination, the correct amount and concentration is used and make sure the correct route is inserted during the procedure.