What is The investigations for duodenal ulcer are -a) Hypotonic duodenographyb) Barium mealc) Barium swallowd) Upper GI endoscopye) Abdominal X-ray erect view and explain in detail?
Duodenal ulcers are best diagnosed by upper GI endoscopy but double contrast barium studies also yield good results.


Barium studies done for duodenum ulcers:

-       double contrast barium meal
-       double contrast hypotonic duodenography
Hypotonic duodenography is a special procedure of barium study in which smooth muscle relaxants are used to produce a state of hypotonia in the duodenum during barium examination. In hypotonic state mucosal lesions are better appreciated.

Hypotonic duodenography is indicated if routine studies have resulted in equivocal findings or when there is suspicion of a primary lesion in the duodenum.

Radiological appearance of ulcer on double contrast barium study:

ulcer appears as a sharply defined, constant collection of barium, sometimes with a surrounding zone of edema or radiating folds.
anterior wall ulcers are normally shown best on the prone view; they may have the appearance of a ring shadow on the supine view as a result of the barium dropping out of the centre of the crater.