Radiography: gastrography

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Introduction

  • Use of positive, negative or a combination of contrast agents to highlight the gastric lumen.

Uses

  • Identification of the position of the stomach, eg in ascites or if suspect gastric displacement, eg diaphragmatic hernia    .
  • Investigation of vomiting    or hematemesis.
  • Investigation of melena.
  • Identification of suspected radiolucent foreign bodies    .
  • Investigation of abdominal pain or distension.
  • Investigation of inappetance.
  • Assessment of lumen size and gastric axis if stomach not visible on plain films.

Advantages

  • Relatively simple procedure in most patients.
  • Non invasive.

Disadvantages

  • Often difficult to assess subtle mucosal lesions.
  • Not very accurate for assessment of motility disorders.

Requirements

Materials required

Minimum equipment

  • X-ray machine.
  • Cassette.
  • Processing facilities.
  • Protective clothing (lead apron) for radiographer.
  • Positioning aids (sandbags, cradle and ties).
  • Method of labeling film.
  • Large syringe.
  • Means of keeping mouth open for stomach tubing, eg inner part of bandage roll.
  • Stomach tube.

Ideal equipment

  • Ability to process films during procedure so that repeat radiographs can be taken during course of study if required.
  • High output x-ray machine.
  • High definition screen.
  • Mouth gag.

Minimum consumables

  • Radiographic film.
  • Contrast agent.
  • Water-soluble lubricant for stomach tubing.

Preparation

  • Dependant upon method of restraint.
  • Food witheld for 12-24 hours (may not be required if animal inappetant).
  • Enemas required ideally night before but not within 2-3 hours of procedure.
  • May need to withhold food for 24 hours if delayed gastric emptying.
  • If considering endoscopy this should be performed before contrast radiography.

Outcomes

Reasons for treatment failure

  • Inadequate patient preparation, ie stomach not empty.
  • May not identify mucosal lesions or motility disorders.
  • Poor gastric distension.
  • Failure to obtain sufficient radiographs - lesion must be consistent on several films for diagnosis to be made.
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