GI Studies
37 Upper GI Series
Anatomy
- Esophagus
- Esophagogastric Junction (Cardiac Orifice)
- Cardiac Sphincter
- Cardiac Notch
- Stomach
- Fundus
- Body
- Pylorus (including pyloric orifice & pyloric sphincter)
- Angular notch
- Greater curvature
- Lesser curvature
- Rugae (gastric folds)
- Duodenum
- Duodenal bulb
- C-loop
Indications, Contraindications, and Patient Preparation
Indications
- Peptic ulcers
- Hiatal hernia
- Gastritis
- Tumors
- Diverticula
- Bezoars
- Evaluation of form and function of distal esophagus, stomach, and duodenum
Contraindications
- No absolute contraindications
- Relative: Do not use barium sulfate if bowel perforation, laceration, or rupture is suspected
Patient Preparation
- NPO (nothing by mouth) for at least 8 hours prior to exam (typically after midnight)
- No smoking or chewing gum during fasting period (these increase gastric secretions, reducing mucosal coating)
- Explain exam and positioning changes to reduce anxiety and ensure cooperation
Projections
PA Stomach & Duodenum
CR Location & Positioning
- SID: 40 inches
- Patient position: Prone, MSP centered to IR
- Adjustments: Arms up near head, legs extended
- CR: Perpendicular to IR, centered at level of L1–L2 (1–2″ above lower rib margin) and 1″ left of MSP
- Pt. Instructions: Suspend respiration after expiration
- Exposure: On expiration
Evaluation Criteria
- Entire stomach and duodenum visualized
- Pylorus near center of image
- Body and pylorus filled with barium; fundus filled with air
RAO Stomach & Duodenum
CR Location & Positioning
- SID: 40 inches
- Patient position: Prone, rotated 40–70° RAO (more for hypersthenic, less for asthenic)
- Adjustments: Right arm down, left arm flexed at elbow
- CR: Perpendicular at level of L1–L2 (1–2″ above lower rib margin) midway between spine and left lateral border of abdomen
- Pt. Instructions: Suspend respiration after expiration
- Exposure: On expiration
Evaluation Criteria
- Entire stomach and duodenum visualized
- Duodenal bulb and C-loop in profile
- Body and pylorus filled with barium; fundus filled with air
Right Lateral Stomach
CR Location & Positioning
- SID: 40 inches
- Patient position: Right lateral recumbent, MCP perpendicular to IR
- Adjustments: Knees slightly flexed for stability
- CR: Perpendicular at level of L1–L2 (1–2″ above lower rib margin), midway between MCP and anterior abdomen
- Pt. Instructions: Suspend respiration after expiration
- Exposure: On expiration
Evaluation Criteria
- Entire stomach and duodenum visualized
- Pylorus and C-loop clearly demonstrated
- Spine in true lateral (no rotation)
- Body and pylorus filled with barium; fundus filled with air
LPO Stomach
CR Location & Positioning
- SID: 40 inches
- Patient position: Supine, rotated 30–60° LPO (more for hypersthenic, less for asthenic)
- Adjustments: Right arm across chest, left arm extended from body
- CR: Perpendicular at level of L1–L2 (1–2″ above lower rib margin), midway between xiphoid tip and lower rib margin, midway between spine and left lateral border
- Pt. Instructions: Suspend respiration after expiration
- Exposure: On expiration
Evaluation Criteria
- Entire stomach and duodenum visualized
- Pylorus and duodenal bulb free of superimposition
- Fundus filled with barium
- On double contrast, duodenal bulb filled with air
AP Stomach
CR Location & Positioning
- SID: 40 inches
- Patient position: Supine, MSP aligned to IR
- Adjustments: Arms at sides, legs extended
- CR: Perpendicular, centered at level of L1–L2 (bottom of IR at iliac crest); center to MSP
- Pt. Instructions: Suspend respiration after expiration
- Exposure: On expiration
Evaluation Criteria
- Entire stomach and duodenum visualized
- Diaphragm included (for hiatal hernia demonstration)
- Fundus filled with barium
Procedure Adaptation
- Body habitus:
- Hypersthenic → stomach higher and transverse; more rotation for obliques.
- Asthenic → stomach lower, J-shaped; less rotation.
- Pediatric patients: Smaller volumes of contrast, shorter exposure time.
- Pathology-specific: Double-contrast studies for ulcers, tumors, polyps, diverticula.
- Limited mobility: Modify table angles or use decubitus positioning if patient cannot rotate adequately.
Exposure Factors & Technical Considerations
- kVp: 100–125 for single-contrast; 90–100 for double-contrast
- mAs: Moderate, short exposure to minimize motion
- SID: 40 inches
- Collimation: To stomach and proximal duodenum region
- Shielding: Gonadal shielding when possible
- Contrast media:
- Barium sulfate (thin for motility studies, thick for mucosal coating)
- Water-soluble iodinated contrast (Gastrografin) if perforation suspected
Hows & Whys of UGI Radiography
Anatomy & Physiology
- Where is the stomach located?
Between the esophagus and the small intestine. - How does the shape and position of the stomach vary?
By body habitus. Hyposthenic or asthenic (tall, slender) → stomach long, low, and J-shaped. Hypersthenic (broad) → stomach higher and more transverse. - What is the esophagogastric junction, and what controls it?
The cardiac orifice, controlled by the cardiac sphincter. - What is the V-shaped structure between the esophagus and stomach?
The cardiac notch. - What is the greater curvature of the stomach?
The lateral border, extending from the cardiac notch to the duodenum. - What is the lesser curvature of the stomach?
The medial border, extending from the esophagus to the pylorus. - What is the pyloric orifice, and what does it contain?
The opening between the stomach and duodenum, containing the pyloric sphincter. - What are the three subdivisions of the stomach?
Fundus (superior), Body (middle), Pylorus (distal). - What is the angular notch?
The narrowing near the pylorus. - What are the gastric folds inside the stomach called?
Rugae. - What is the duodenal bulb?
The widened first portion of the duodenum just beyond the pylorus.
Contrast & Technique
- What does an upper GI study evaluate?
The form and function of the distal esophagus, stomach, and duodenum. - What is the usual contrast medium for an upper GI study?
Barium sulfate (thin for motility studies, thick for mucosal coating). - When are double-contrast studies preferred?
For diagnosing ulcers, tumors, or diverticula. - Are there any major contraindications for an upper GI study?
No absolute contraindications, but barium sulfate should not be used if perforation, laceration, or rupture is suspected. - Why is barium contraindicated in cases of bowel perforation?
It is not absorbed and must be surgically removed if it leaks into the peritoneum. - What contrast is used if barium is contraindicated?
Water-soluble iodinated contrast (e.g., Gastrografin). - What allergies should be checked before iodinated contrast is used?
Iodine, seafood, “x-ray dye.” - What projections fill the fundus with barium?
AP and LPO. - What projections fill the body and pylorus with barium?
PA, RAO, and Right Lateral.
Pathology & Indications
- What are the common indications for a UGI?
Peptic ulcers, hiatal hernia, gastritis, tumors, diverticula, bezoars. - What are peptic ulcers, and what can happen if they are untreated?
Erosions of the stomach mucosa that may perforate the wall. - What is a hiatal hernia?
Protrusion of part of the stomach through the esophageal hiatus into the thoracic cavity. - What is gastritis?
Inflammation of the stomach lining. - What are stomach polyps, and can they be cancerous?
Small mucosal masses that may be benign or malignant. - What are diverticula?
Outpouchings or weak areas in the stomach wall. - What are bezoars?
Masses of undigested material (hair, fibers, wood products) in the stomach.
Patient Preparation & Safety
- What dietary restrictions are required before an upper GI study?
NPO (nothing by mouth) for at least 8 hours, typically after midnight. - What other activities should patients avoid before the exam?
Smoking and chewing gum. - Why are fasting and activity restrictions necessary?
They increase gastric secretions and interfere with proper barium coating.