 Alimentary Canal

› Mouth
› Pharynx
› Esophagus
› Stomach
› Small / Large
Intestine
 Accessory
glands
› Liver
› Gallbladder
› Salivary
glands
› Pancreas
 Originates around
C-6
 In thorax, it is
anterior to spine,
posterior to
trachea and heart
 Passes through
diaphragm through
esophageal hiatus
 Inferior to diaphragm
curves sharply left
 Increases in diameter
 Joins stomach at
esophagogastric
junction
 At level of xyphoid tip
 4 layers of the
esophagus
› Outermost - fibrous
› Muscular
› Submucosal
› Innermost - Mucosal
 Dilated saclike
portion of
digestive tract
 Composed of
same 4 layers as
esophagus
› Outermost - fibrous
› Muscular
› Submucosal
› Innermost - Mucosal
 Divided into 4 parts
› Cardia
› Fundus
› Body
› Pyloric portion
 Entrance to stomach
is cardiac orifice
› Controlled by cardiac
sphincter
 Exit is the pyloric
orifice
› Controlled by pyloric
sphincter
 Contains same four
layers as stomach
and esophagus
 Mucosa contains
projections called villi
to facilitate digestion
and absorption
 Divided into 3 parts:
› Duodenum
› Jejunum
› Ileum
 8 - 10 inches in length

 Widest portion of small intestine

 Follows a C-shaped course

 Contains 4 regions
› Superior, descending,
horizontal, ascending
› 1st region is known
as the duodenal bulb
› 4th portion joins
jejunum and is
supported by
ligament of Trietz
› Head of pancreas is
contained in duodenal
loop - second portion
 Jejunum
› Upper remaining 2/5 of
small bowel
 Ileum
› Terminates at ileocecal
valve
 Both are gathered into
freely movable loops (gyri)
 Attached to posterior
abdominal wall by
mesentary
 Generally found in central
and lower part of abd.
cavity within arch of large
intestine
 DEFENISI :
Pemeriksaan radiologis dengan
menggunakan kontras media untuk
memvisualisasikan saluran pencernaan
bagian atas secara dinamik dengan
fluoroskopi dan radiografi.
 Menggunakan kontras media positif
( kontras ) dan negatif (udara) untuk
menilai abnormalitas pergerakan,
lumen dan mukosa .
 Kontras : Barium Sulfat dan
menggunakan evervescent untuk
menghasilkan udara.
 Penilaian : esofagus –gaster-
duodenum.
 Kelainan mobilitias
 Kelainan mukosa (ulkus, divertikel,
inflamasi)
 Keganasan
 Degeneratif
 Kelainan kongenital
 Kelainana obstruktif
 Perforasi
 Alergi kontras
 Obstruksi total upper GI
 Anamnese pasien adanya obstruksi
 Puasa selama 6 jam sebelum
pemeriksaan
 Persiapan kontras barium , esofagus 1:
1 dan saluran cerna yang lain 1: 3
 Bila curiga perforasi atau fistel
menggunakan kontras water soluble
 Kontras diminumkan mll oral ( 1; 1) ,
untuk mengisi esofagus sambil
dilakukan fluoroskopi
 Lalu kontras Barium sulfat (1 : 3 )
diminumkan mll oral , namun untuk
mengisi udara di lambung, pasien
menggunakan evervescent .
 Posisi pasien supine
 Pasien diminta untuk berputar,
terlentang , miring , telungkup , miring
kontralateral dilakukan 2 kali. Lakukan
fluoroskopi untukmelihat kelainan.
 Setelah full filling , dapat dinilai mulai
gaster, duodenum saat bulbus terbuka
dan terisi pars descendens dan
ascendens duodenum
 Varises esofagus
 Achalasia esofagus
 Striktur esofagus
 Atresia esofagus
 Esofagitis
 Tumor esofagus
 Fistula esofagus
 Divertikulum dan spasme esofagus
 Congnital : hernia diafragmatika,
sliding hernia, etc
 Gastritis
 Gastric Ulcer plg sering terjadi pada :
minor curvature , anthrum pyloricum,
corpus, fundus, cardia
 Tumor , mis : adeno ca, leiomiosarkoma
 Congenital : atresia duodeni, spasme
duodeni
 Duodenitis
 Tumor : polip, divertikulum benign

maligna : filling defek irreguler ,

umbrella sign
 Tumor Caput Pancreas : enlarge C
loop
Barium Swallow, Single Contrast

Cricopharyngeu
s Muscle
At level of C5-C6,
Part of upper
esophageal
sphincter (UES)

Esophagu
s
 Barium Swallow, Single Contrast

Main
Indication:
Dyshagia
 Double
Contrast

Identation of
A.A

Indentation of
L.main
bronchus

Single Contrast
 Barium Swallow, Single Contrast

Double Contrast

L.
A
Heart .
L.
V.
Barium Swallow, Double Contrast

Indentation of
L.main
bronchus

Double Contrast

Single Contrast
 Barium Swallow, Single Contrast

Ampulla
Normal Varient

Fundus

Body
Barium Swallow, Single Contrast

Aortic
Arch
Barium Swallow, Double Contrast

Narrowing:
Could be peristalsis
So other shot is
advised
 Barium Meal, Double Contrast
(Supine Position) Supine
Position:
Note Barium
Distribution in the
Fundus due to gravity

Angular Notch
Incisura
Angularis

Antrum Bod
y
 Barium Meal + Follow-Through
(Erect Position)
DJJ: Barium
Normal Position= Left Meal
side
Angular Notch
Incisura Angularis
Duodenal
Cap
Pyloric
Canal
2nd Part of
Duodenum

3rd Part of Body Jejunum:

Duodenum Plica Circularis on the
Antru outer border
m

Ileu
m
Barium
Follow-Through
 Barium Follow-Through to Cecum
(Erect Position)

DJJ:
Normal Position= Left
2nd Part of side

Duodenum

3rd Part of
Duodenum
 Small Bowel Enema

A Modified Follow-Through which is called Small Bowel Enema note that the
bowel is more distended here
This procedure involves inserting a thin tube through the mouth, esophagus and past the stomach to inject
barium, methylcellulose and water into the small bowel. This allows for better visualization of the small bowel
than can be seen during a small bowel follow-through
Barium Swallow, Single Contrast

Esophag
us

Proximal
Dilatations

Narrowing
(Stricture)

Bird Peak
Sign
DDx:
 Barium Swallow, Single Contrast

Benign
Stricture:
The transitional Zone
looks smooth and free
of filling defects

Proximal
Dilatations

Distal
Narrowing
 Barium Swallow, Single Contrast

Malignant Stricture:
-The transitional Zone looks
Irregular & ill defined
- Presence of many filling
defects

DDx:
Adeno CA
Sq. Cell
CA

Filling
Defect

It shows an irregularity that almost looks like an apple core lesion in the esophagus. This is typical
in carcinoma of the esophagus
 Barium Swallow, Single Contrast
(Oblique)

Filling
Defect

Malignant
Stricture

Long Irregular
Narrowing

It shows an irregularity that almost looks like an apple core lesion in the esophagus. This is typical
in carcinoma of the esophagus
Barium Swallow, Single Contrast
(Oblique)

Irregular Wall & Dilatation:

Tertiary Contraction (Pathological non-propulsive
Contraction)

Funnel
Shape
(Achalasia)

Barium swallow in this patient with achalasia reveals a

smooth distal tapering caused by the hypertensive lower
esophageal sphincter that straddles the diaphragm, and
multiple non-Peristaltic contractions throughout the body of
the esophagus. This radiographic appearance sometimes has
been called "vigorous achalasia". This term has little value,
however, because recent studies suggest that patients with
so-called vigorous achalasia cannot be distinguished clinically
 Barium Swallow, Single Contrast
Well Defined
Contrast Filled
(Oblique)
left cervical level
sac

Pharyngeal Pouch
(Zenker's
Diverticulum):
occurs in an area of anatomic
weakness known as Killian's
dehiscence
 Barium Swallow, Single Contrast

Irregular
Multiple Filling
Defects

Differential Diagnosis
Multiple Esophageal Filling
Defects:
1.Fungal Infx
2.Polyps
3.Esophageal Varices
(irregular)
4.Food Particles

Varices Barium swallow examination: AP view: Numerous rounded and elongated smooth-
contoured filling defects are present in the inferior two thirds of the esophagus. The contour of the
Barium Swallow, Single Contrast

Irregular
Multiple Filling
Defects
(Esophageal
Varices)
Barium Meal, Double Contrast

Contrast Filled
Speculated
Lesion
(Gastric Ulcer)
Barium Meal, Double Contrast

Ruga
e

Contrast Filled
Outpouching at
the Greater
Curviture
(Malignant Gastric
Ulcer)
 Barium Meal + Follow-Through

Contrast Filled
Speculated
1st Part of Lesion
duodenum (Duodenal Ulcer)

2nd Part of
duodenum

4th Part of
duodenu
m
3rd Part of
duodenum
Barium Meal, Double Contrast

Speculate
d Mass

Ulcer

Pylorus

Stomac
h
 Barium Meal, Double Contrast
(Erect Position)

DDx:
Pyloric Stenosis

Mushroom’s Sign
(or apple core
Sign)
String’s
Sign

Shoulder’s
Sign

For further information refer to “Pediatric Abdomen Radiology” Slides