Barium meal contrast radiography is better than endoscopy for diagnosing which of the following?
Ans. d (All of the above) (Ref. Bailey and Love 25th/1024; 1050)Bailey and Love 25th/p. 1024; 1050...Upper gastrointestinal radiology is not used as much as in previous years as endoscopy is a more sensitive investigation for most gastric problems. There is, however, a number of circumstances where the barium meal is of great value and augments the value of endoscopy. These include large hiatus hernias of the rolling type and chronic gastric volvulus where it may be difficult for the endoscopists to determine exactly the anatomy or, indeed, negotiate the deformity to see the distal stomach. Linitus plastica may be missed by even relatively experienced endoscopists as the mucosal aspect of the stomach may not look particularly abnormal. This condition may be diagnosed more easily by using contrast radiology, although this is of limited value to the patient as the outlook is so poor.Paraoesophageal ('rolling') hiatus hernias are dangerous and always require surgical repair. They may be visible on a plain X-ray of the chest as a gas bubble, often with a fluid level behind the heart. Fluid levels are not seen in sliding hernias. A barium meal is the best method of diagnosis.0 The endoscopic appearances may be confusing, especially in large hernias when the endoscopist feels as if they have lost their sense of direction.Radiology studyClinical utilityKey commentsAbdominal radiograph(X-ray abdomen)# Pneumoperitoneum# Bowel obstruction# Calcification and calculi# Chest X-ray is the most sensitive X-ray for detecting minimum pneumoperitoneum.# CT is the most sensitive method to detect air as well as calcification.Barium studies# Indirectly assess GI pathologies.# Initial test of choice to evaluate case of dysphagia is Barium swallow. Barium swallow and meal examinations give the best appreciation of gastro esophageal anatomy. This may be important to the surgeon planning an operation that may be complicated by esophageal shortening or a rolling hiatus hernia, but it is not important for the diagnosis of GORD.# Barium meal study may even be better than endoscopy for diagnosing:- Chronic gastric volvulus- Large hiatus hernia- Linitus plastica# Enteroclysis (a special study better than BMFT for small bowel) is excellent study for many non-neoplastic lesions small bowel (e.g. malabsorption, intestinal strictures, CD, TB, etc). Jejunum has typical 'feathery' pattern, while ileus is 'featureless'.# Barium enema is one of the best studies for diagnosing and evaluating colorectal pathologies like UC, CD, Diverticulosis, Hirschprung's disease, colonic polyps, volvulus, etcBarium sulphate is contrast media used. CT and MR Enteroclysis now possible.Water-soluble contrast study# Bowel perforation# TO fistulaBarium is relatively contraindicated if we suspect bowel perforation.Chest X-ray with coiled Rubber catheter is highly suggestive of TO fistula with esophageal atresia.Ultrasonography# Initial test of choice for any case of obstructive jaundice.# Initial tests of choice for acute abdomen.# Initial test of choice for abdominal trauma (Protocol = FAST)# Excellent for detecting gallstones and other conditions like adeno- myomatosis of gall bladder, CHPS, Intussusception, minimal ascites, etcAir and bone obscure imaging with USG as they produce "post-acoustic" shadow.Probe of frequency 3.5-7 MHz is used. EUS/ endoluminal sonography due to its high sensitivity is mainly used for Ca esophagus & stomach staging, insulinoma, periampullary tumours and terminal bile duct calculi detection.CT# Blunt abdominal trauma# Subdiaphragmatic abscess# Mesenteric ischemia# Complicated appendicitis# Diverticulitis and diverticular abscessMultislice spiral CT is best machine.No "tissue overlap" and rapid diagnosis are key advantages.Air and bone do not create hindrance in CT imaging. It is the "triple-phase" CECT usuallyRadiology studyClinical utilityKey comments# Small bowel tumors# Staging of Ca colon# Mesenteric cysts/tumors# Pancreatic diseases# Focal liver lesions# Adrenal lesions (e.g., adenoma)# Epiploic appendicitis# Bezoars# Extraintesinal abdominal TB (Ba study is better for intestinal IC TB)# Parietal wall lesionsdone for hepatic and pancreatic lesions. Virtual endoviewing is now possible.MRI# Liver hemangiomas of size < 2.5 cm, especially when triple phase CECT is equivocal.# MRCP is screening tool of choice for primary sclerosing cholangitis, bile duct anomalies, cholangiocarcinomas and dital intrahepatic bile duct lesions.# MRI with ER coil is supposed to be better than CT or TRUS for assessing the locoregional spread of carcinoma rectum.# It is tool of choice for preoperative staging of cervical, endometrial and prostatic cancer.# It is excellent tool for anorectal region pathologies.Due to abdominal wall motion and bowel peristalsis, overall for abdominal pathologiesMRI has not achieved the popularity compared to CT. However, due to high field strength MRI machines, Intraoperative MRI, newer and faster MRI pulse sequences (e.g., HASTE) MRI is gaining its own importance.MRI can be supposed to be better than CT for many vessels in abdomen, for some liver lesions, rectal cancer staging, pelvic pathologies (especially the female pelvis) and screening of the biliary tract with MRCP.
Large hiatus hernia (rolling type)
Linitus plastica
Chronic gastric volvulus
All of the above
G.I.T.