Silly radiology question

[Transformers]

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If you want to view the GI tract in the PA view...what's the difference between an "upper GI series", "abdominal X-ray", and a "KUB" ?

 

[Winged Scapula]

If you want to view the GI tract in the PA view...what's the difference between an "upper GI series", "abdominal X-ray", and a "KUB" ?

A KUB and an abdominal XRay are the same thing: a single plain film image of the abdomen in the supine position. An upright or chest X-Ray is often added to assess air under the diaphragm.

An Upper GI involves the use of a contrast material (gastrograffin or Barium typically) and fluoroscopy. It may be referred to as a "swallow" and allows one to assess the lining of the upper GI Tract as well motion with the use of cine.

 

[colbgw02]

Warning - radiologist hair splitting forthcoming:

KUB is a commonly used euphemism for an abdominal radiograph. It is frequently obtained in the supine position, but can also be obtained in the prone, particularly in children.

Barium swallow = esophagram =/= upper GI series. Lots of overlap between the two, but the former concentrates on the - wait for it - esophagus, while the latter focuses on the stomach and proximal duodenum. These are not to be confused with a modified barium swallow, which speech pathology typically performs and focuses on agglutination.

 

[Winged Scapula]

Warning - radiologist hair splitting forthcoming:

KUB is a commonly used euphemism for an abdominal radiograph. It is frequently obtained in the supine position, but can also be obtained in the prone, particularly in children.

The "babygram" right?

Barium swallow = esophagram =/= upper GI series. Lots of overlap between the two, but the former concentrates on the - wait for it - esophagus, while the latter focuses on the stomach and proximal duodenum. These are not to be confused with a modified barium swallow, which speech pathology typically performs and focuses on agglutination.

Technically true although I'd venture you'll hear a lot of people (non Rads) using the terms Ba Swallow and Upper GI interchangeably. OTOH we always used "swallow study" for the Speech Path study.

 

[colbgw02]

The "babygram" right?

Not really. Most babygrams are in the inpatient setting, from the NICU or a stepdown unit, and those kids tend to stay supine. I'm thinking more in the outpatient setting up until about grade school age. Obviously, radiography can be very insensitive, but in this population it can be helpful to demonstrate a normally positioned and gas-filled cecum, which is useful when trying to exclude malrotation or intussusception. Sometimes this is easier to see while lying prone, so when a single abdominal view is ordered on a kid, that's how we do it. That's not to say it's wrong to do it supine.

 

[Winged Scapula]

Not really. Most babygrams are in the inpatient setting, from the NICU or a stepdown unit, and those kids tend to stay supine. I'm thinking more in the outpatient setting up until about grade school age. Obviously, radiography can be very insensitive, but in this population it can be helpful to demonstrate a normally positioned and gas-filled cecum, which is useful when trying to exclude malrotation or intussusception. Sometimes this is easier to see while lying prone, so when a single abdominal view is ordered on a kid, that's how we do it. That's not to say it's wrong to do it supine.

I see… Thanks for the explanation. Despite all of those years of studying for exams where I was asked about intussusception I don't recall ever seeing it or ordering any imaging for it during training.

Saw tons of kids with Malraux (ha ha thanks Siri that adds a touch of elegance) but typically the NICU Residents ordered the imaging prior to us being consulted for it.

 

[Transformers]

I see… Thanks for the explanation. Despite all of those years of studying for exams where I was asked about intussusception I don't recall ever seeing it or ordering any imaging for it during training.

Saw tons of kids with Malraux (ha ha thanks Siri that adds a touch of elegance) but typically the NICU Residents ordered the imaging prior to us being consulted for it.

Ok then just to follow up, not counting CT, so we've got the esophagus, stomach, and small intestine covered. Now what about the colon....
a.) In terms of nomenclature, is barium enema is basically like a "lower GI series"?
b.) How far does the barium enema go (cecum-> anus?)
c.) What the heck is an "air enema" in terms of what it helps you visualize?

 

[Winged Scapula]

Ok then just to follow up, not counting CT, so we've got the esophagus, stomach, and small intestine covered. Now what about the colon....
a.) In terms of nomenclature, is barium enema is basically like a "lower GI series"?
b.) How far does the barium enema go (cecum-> anus?)
c.) What the heck is an "air enema" in terms of what it helps you visualize?

I'm gonna let someone who knows what they are talking about help: @colbgw02

 

[tco]

If you want to view the GI tract in the PA view...what's the difference between an "upper GI series", "abdominal X-ray", and a "KUB" ?

OP, your original question is not a silly one. Radiologists would prefer you call them and ask questions like this rather than just blindly ordering "what sounds good." Everyone knows how little they want to work, so don't make them do the study twice.

-Future Radiologist

 

[colbgw02]

Ok then just to follow up, not counting CT, so we've got the esophagus, stomach, and small intestine covered. Now what about the colon....
a.) In terms of nomenclature, is barium enema is basically like a "lower GI series"?
b.) How far does the barium enema go (cecum-> anus?)
c.) What the heck is an "air enema" in terms of what it helps you visualize?

We haven't really covered small bowel beyond the proximal duodenum. In an adult, that's about as far as you'll reliably be able to evaluate on an upper GI series. In young children, an upper GI has to evaluate all the way to the duodenojejunal junction in order to exclude midgut malrotation, but that's a targeted exam with a very specific question that needs to be answered.

In the world of fluoroscopy, the only thing we've got in modern times is a small bowel follow-through (SBFT). These are commonly (and uselessly) added onto upper GI series. I suppose there are still a few places that trot out the SBFT's decrepit relative, enteroclysis, but that's has largely gone the way of the dodo. The best thing imaging-wise to evaluate the small bowel is really CT or MR enterography, and I've found even those to be lacking. Frankly, it's just not an organ that we can image well, particularly if you're looking for mucosal abnormalities as seen in a malabsorption disorder or infiltrative process (e.g. eosinophilia). We're a little better for masses or strictures.

An enema should evaluate from at least the cecum to the proximal rectum. The balloon will often obscure the distal rectum, which says nothing of the osseous pelvis getting in the way. If there's reflux, then you might get a look at the terminal ileum. If you're asking a radiologist to evaluate the anus with an enema, then realize that we're laughing at you. It does happen though, as in they send a newborn with lower GI obstruction for enema and the radiologist is the one that realizes there's an imperforate anus because the pediatricians never bothered to do a thorough physical exam (seen this twice).

Ideally, an upper GI or an enema should be "double-contrast", meaning we administer positive enteric contrast (frequently barium) and then find a way to get gas into the GI tract. If we're successful, then the barium clings to the mucosal and is well outlined by the gas. In the upper tract, we do this by administering effervescent crystals. For an enema, we insufflate with room air, which is frequently not well tolerated. If there is a focused clinical question or if the patient simply can't tolerate it (e.g. post-op leak status post bariatric surgery), then we can do a single-contrast study whereby we just administer contrast and dispense with the gas.

Thanks to @Winged Scapula for the shoutout.