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Introduction ⬇

Gastric radiography visualizes the form, position, mucosal folds, peristaltic activity, and motility of the stomach and UGI tract. A UGI series, also known as a barium swallow or esophagram, visualizes the upper digestive system, including the esophagus, stomach, duodenum, and upper portion of the jejunum.

Preliminary images without the use of a contrast medium are useful in detecting perforation, presence of radiopaque foreign substances, gastric wall thickening, and displacement of the gastric air bubble, which may indicate a mass external to the stomach.

Oral contrast substances, such as barium sulfate or diatrizoate meglumine, highlight conditions such as hiatal hernia, pyloric stenosis, gastric diverticulitis, presence of undigested food, gastritis, congenital anomalies (e.g., dextroposition, duplication), or diseases of the stomach (e.g., gastric ulcer, cancer, stomach polyps).

Procedure ⬆ ⬇

  1. Have patient change from street clothing into a hospital gown. Neck and torso jewelry and other ornamentation must be removed.

  2. Instruct the patient to swallow the barium after the patient is properly positioned in front of the fluoroscopy machine. Some changes in position may be necessary during the procedure. A motorized tabletop shifts the patient from an upright to a supine position when appropriate. Fluoroscopy allows visualization and imaging of actual activity taking place in real time.

  3. Take several conventional x-ray images following fluoroscopic examination. The patient will need to hold their breath during each exposure.

  4. Inform the patient that the test may take 20–45 minutes.

  5. Follow guidelines in Chapter 1 for safe, effective, informed intratest care.

Procedural Alert

  1. If the patient has diabetes, alert the radiology department and schedule examination for early morning. If a patient with diabetes is taking metformin, special considerations may be necessary. Consult with radiology department to determine whether this medication regimen must be suspended for the day of and several days after the study.

  2. Determine whether the patient is allergic to barium. Although rare, presence of this allergy must be communicated to the radiology department so that alternate contrast can be used.

  3. All female patients of reproductive age must be screened for pregnancy before performing this study.

Clinical Implications ⬆ ⬇

Abnormal UGI series results may reveal the following conditions:

  1. Congenital anomalies

  2. Gastric ulcer

  3. Carcinoma of stomach

  4. Gastric polyps

  5. Gastritis

  6. Foreign bodies

  7. Gastric diverticula

  8. Pyloric stenosis

  9. Reflux and hiatal hernia

  10. Volvulus of the stomach

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain purpose and procedure (consult barium contrast test precautions). Written instructions on pretest preparation are helpful for the patient. Screen female patients for pregnancy status. If positive, inform the radiology department.

  2. Inform patient that complete fasting from food and fluids is required for a minimum of 8 hours before the procedure. Necessary oral medications (other than metformin) may be taken with a small sip of water. Inform radiology department because pills may be visualized during the study.

  3. Instruct the patient to hold still and follow breathing instructions during the procedure.

  4. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed.

  2. Tell the patient that normal diet and activity may be resumed. Advise drinking ample fluids.

  3. Observe and record stools for color and consistency. Monitor evacuation of barium. Counsel that follow-up procedures may be necessary.

  4. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Interfering Factors ⬆ ⬇

  1. If the patient is debilitated, proper examination may be difficult; it may be impossible to visualize the stomach adequately.

  2. Retained food and fluids interfere with optimal image clarity.

Reference Values ⬆

Normal

Normal stomach size, contour, motility, and peristaltic activity

Normal esophagus