Upper GI series

Radiologic procedures rely on the differential absorption of radiation of adjacent tissues to highlight anatomy and pathology. Radiologic procedures important in evaluating the GI tract include plain radiography, upper GI series, lower GI series, and enteroclysis. ... 

FIGURE 31-1. Upper GI series with small bowel follow-through demonstrating narrowed distal terminal ileum and separation of small bowel loops (arrow). These findings are consistent with Crohn s disease. 

Other diagnostic tests should include a chest x-ray, an intravenous pyelogram, cystoscopy, proctoscopy, and a barium enema. Depending on clinical evaluation, computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound may be indicated. An upper GI series is indicated in patients with gastrointestinal symptoms or with bowel obstruction. 

The video esophagram, or modified barium swallow, is the standard technique to evaluate dysphagia. This examination is more sensitive than clinical evaluation of aspiration (DeMatteo et al. 2005), and is also more sensitive than the conventional upper GI series for the detection of aspiration (Vazquez and Buonomo 1999). A scout radiograph of the chest should be obtained to assess for evidence of aspiration. For the examination, the child must be securely... 

On upper GI series, loss of distensibility, distortion of the normal surface pattern of the stomach with thickened irregular folds and mucosal nodularity or irregular narrowing with or without ulceration (the ulcer is located intraluminally in contrast to a benign ulcer which is located beyond the expected border of the stomach) can be seen anywhere in the stomach (Fig. 3.22). 

Before stent placement an accurate diagnosis is paramount for choosing between curative and palUative treatment. CT, upper GI series and endoscopy with biopsy should be performed to evaluate length, location and nature of the stenosis (Fig. 3.5a). In addition, distal obstruction in the small bowel which could compromise passage of intestinal contents should also be excluded (De Baere et al. 1997 Soetikno et al. 1998). Insertion of stents via gastrostomy... 

Fig. 13.3a,b. A 67 year old woman admitted to the intensive care unit for peritonitis after colon resection, demonstrated gas distension on chest X-ray. a Upper GI series showed a markedly distended stomach (arrows) with no sign of outlet obstruction and the duodenum rapidly filled with contrast material, b The degree of gastric dilatation is shown on CT images. Gastric function became normal during general improvement of the patient... 

Fig. 13.22. A 62 year old man, 4 weeks after gastrectomy, presenting with fever, tachycardia and abdominal pain. Upper GI series revealed a leak of the oesophagojejunal anastomosis. The extravasation extends along the lower border of the left hepatic lobe (thin arrow) to a round structure measuring several centimeters (thick arrow). Within the structure, there is an air/fluid level and a level between the contrast material and secretions. CT and subsequent surgery confirmed a subhepatic abscess. The leak was oversewn...

Adhesion and slowing intestinal transit are two mechanisms that have been proposed to extend the absorption phase of drugs, particularly if colonic permeability is poor. Our real-time measurements of the transit of formulations along the GI tract elegantly demonstrate that during the initial phases of transit through the duodenum and jejunum, the formulation is swept forward in a series of pulsatile movements that would leave little opportunity for adhesion in the upper gut in the fasting state [28]. 

In the presence of opposite asymmetries (gi and qz of different sign), the intensities of the overlapping series may reflect those of the perturbers, as shown in fig. 8.32. This does not, however, lead to any dramatic changes in the corresponding two-dimensional graph. A good experimental example of this behaviour appears in the 3p-spectrum of Ca [447], where the presence of perturbers from the upper series can be detected through intensity modulations in the lower one. 

The preferred mode for dmg administration is undoubtedly the oral route, but the efficiency of oral administration is often limited by premature uptake or degradation. For dmgs that need to enter systemic circulation, the adsorption window is situated in the upper intestine. For treatment of inflammations in the lower part of the GI tract, uptake in the small intestine is to be avoided. A typical example is the treatment of ulcerative colitis and Crohn s disease with 5-aminosa-licylic acid (5-AS A). The parent drag is not efficient because of premature uptake in the upper intestine. One possible solution is the use of polymeric conjugates of 5-ASA linked to a polymeric carrier via an azo bond. It is well known that the colon is a reductive medium that can split azo bonds with formation of amino constituents. It is anticipated that polymer-5-ASA conjugate will pass intact through the upper part of the GI tract and reach the colon, where 5-ASA will be released. We have prepared in our laboratory a series of azo-coupled polymer-5-ASA conjugates (Fig. 34.10). 

Gastric teratoma is an extremely rare gastric tumor, comprising less than 1% of all teratomas in children (Chandrasekharam et al. 2000). They typically occur in infancy (during the first year of life), most commonly in boys. The patients will present with an upper abdominal mass with evidence of proximal GI obstruction or Gl hemorrhage. The therapy of choice should be resection. It has an excellent prognosis as described in a series of seven patients by Wakhlu and Wakhlu (2002). 

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