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SPRING 2024: Advanced Procedures > UNIT 3: Upper Gastro-Intestinal Tract (UGI) Stomach, Duodenum and Esophagus > Flashcards

UNIT 3: Upper Gastro-Intestinal Tract (UGI) Stomach, Duodenum and Esophagus Flashcards

1
Q

Divisions of the Abdomen

A
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2
Q

Purpose of an Upper GI exam

A

•UPPER GI:
Radiologic examination of the distal esophagus, stomach & duodenum

•PURPOSE:
To radiographically study the form & function of the distal esophagus, stomach & duodenum in order to detect abnormalities.

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3
Q

Stomach

A

-Collapsible reservoir
-LUQ
-J-shaped
-Rugae line the stomach
-Folds of gastric mucosa
-Digest & transport food via gravity and peristalsis

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4
Q

Stomach labeling

A
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5
Q

STOMACH: Cardiac Orifice

A

the superior opening of the stomach Joins the distal esophagus to the proximal stomach (inlet)

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6
Q

STOMACH: Cardiac Sphincter

A

-Regulates cardiac orifice
-This region is known as the Gastro-Esophageal Junction
-This is often an area for pathology

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7
Q

STOMACH: Pyloric Orifice

A

-Distal opening of the stomach
-Joins the distal stomach to the proximal duodenum (outlet)

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8
Q

STOMACH: Pyloric Sphincter

A

-Regulates the pyloric orifice
-This area is known as the Gastro-Duodenal Junction

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9
Q

STOMACH: Fundus

A

• Upper most portion of the stomach
• Extends above the cardiac orifice
• Lies POSTERIOR to the body of the stomach
• Contains gastric air when patient is erect or prone

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10
Q

STOMACH: Body

A

Extends from cardiac orifice to level of incisura angularis

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11
Q

STOMACH: Pylorus

A

-Also known as pyloric antrum
-Most distal part of stomach
-Extends from incisura angularis to pyloric orifice

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12
Q

STOMACH: Greater Curvature

A

Left, lateral, convex border

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13
Q

STOMACH: Lesser Curvature

A

Right, medial concave border

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14
Q

STOMACH: Incisura Angularis

A

Sharp bend below the midpoint of the lesser curvature dividing body from the pylorus

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15
Q

Stomach according to body habitus

A
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16
Q

PATIENT SYMPTOMS (reasons for UGI exam)

A

• Dysphagia
• Pain in stomach alleviated by eating; pain returns 2 – 3 hours later
• Awakened @ the same time every night by stomach pain
• Sour taste in throat shortly after eating
• Severe abdominal cramps, possible perforated ulcer

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17
Q

UPPER GI INDICATIONS

A

• Peptic Ulcers
• Hiatal hernia
• Acute/chronic gastritis
• Diverticulae

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18
Q

CONTRAINDICATIONS TO BARIUM USE (when not to use barium)

A

-MUST USE WATER BASED Contrast Media
• Bowel perforations
• Lacerations
• Visceral ruptures

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19
Q

CONTRAST MEDIA Types

A

• Barium Sulfate (BaSO4)

• Aqueous Iodinated contrast media (if suspected perforation)
-Ex: Gastrovist (liquid), Gastrografin (liquid), Oral Hypaque (powder)

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20
Q

Single Contrast Exam

A

Utilizes thick and/or thin barium depending on part being evaluated

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21
Q

Double Contrast Exam:

A

Barium and gas crystals

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22
Q

Air and Barium distribution: Supine, Prone, Erect

A
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23
Q

PATIENT PREP

A

• NPO after midnight or 8 hours before the exam
• NO smoking
– Causes excess acid to accumulate.
– Smoking over stimulates peristalsis
– Makes stomach empty faster
• NO gum chewing
– Causes excessive fluids to accumulate in stomach
– May cause barium dilution
– Also causes increased peristalsis

24
Q

POST UGI

A

• It is recommended that patients drink lots of fluid after the examination
• Stool may be white until all the barium is out of the system

25
Q

PA UPPER GI Positioning

A

-IR: 10 x 12 or 14 x 17 LW collimate 10 x 12 or 11 x 14
-SID: 40”
-CR: Approx. L1-L2, to the midpoint of IR (halfway between spine and lateral margin of body)
-PT. POSITION: Prone
-PART POSITION:
-Center longitudinally half-way between the vertebral column and the lateral border of the abdomen
-Prone: Center IR at level of L1-L2, approx. Level of the elbow. Halfway between inferior angle of scapula and top of iliac crest
-Upright: Center IR 3-6 inches lower than L1-L2
-BREATHING: Suspend on exhalation
-SHIELD

26
Q

AP UPPER GI

A

-PT. POSITION: Supine
-PART POSITION:
-Center longitudinally half-way between the vertebral the lateral border of the abdomen
-Center IR at approx. level of L1-L2, midway between xiphoid process and lower rib margin
-All else the same as PA

27
Q

PA/AP UPPER GI Evaluation Criteria

A

-STRUCTURES DEMONSTRATED:
-Entire stomach and duodenal loop (review textbook)
-Barium filled stomach and duodenal bulb
-EVALUATION CRITERIA:
-Entire stomach and duodenal loop/bulb
-Stomach centered at level of pylorus
-No rotation

28
Q

UPPER GI PA Projection Barium and Air

A

• Pyloric antrum/canal and bulb are filled with barium
• Fundus is air filled
• Stomach moves 11⁄2 - 4” superiorly according to body habitus.

29
Q

UPPER GI AP Projection Barium and Air

A

• Pyloric antrum & bulb are air filled
• Fundus is filled with barium
• Stomach lies transverse in hypersthenic patients

30
Q

RAO UPPER GI Positioning

A

-PROJECTION: LPO
-IR: 10X12 or 14 x 17 LW; collimate 10 x 12 or 11 x 14
-CR: perpendicular to 1 to 2 inches above the lower rib margin at the level of L1-L2 midway between the spine and the lateral border of the body (elbow flexion) OR Approximately L1-L2, to the midpoint of IR
-PT POSITON: Recumbent
-BREATHING: Suspend on Exhalation
-PART POSITION:
-RAO, approx 40-70 degrees.
-NOTE: Rotate hypersthenic (larger) patients more
-From the prone position, place right arm down by patient’s side
-Elevate patient’s left side 40-70 degrees
-Mark side up

NOTE:
-Gastric peristalsis is generally more active in this position
-Air is in the fundus & barium is located in the duodenum

31
Q

RAO UPPER GI Evaluation Criteria

A

-STRUCTURES DEMONSTRATED:
•Entire stomach and duodenal loop
•Best image for DUODENAL BULB & PYLORIC CANAL (especially in sthenic patients)

-EVALUATION CRITERIA:
•Entire stomach and duodenal loop
•Pylorus and duodenal bulb in PROFILE WITHOUT superimposition
-Air is in the fundus & barium is located in the duodenum
-Stomach centered at the level of the pylorus

32
Q

RIGHT LATERAL UPPER GI Positioning

A

-IR: 10 x 12 or 14 x 17 LW; collimate 10 x 12 or 11 x 14
-CR: Approx. L1-L2, to the midpoint of IR, At level of the elbow
-PT. POSITION:
*Right Lateral (Recumbent) with knees slightly bent
*Left Lateral (Upright)
-PART POSITION:
-Patient in true lateral
-Center longitudinally, midway between the MCP and the anterior wall of the abdomen to the center of the IR
-IR centered midway between inferior scapular angle and top of iliac crest
-Shield Patient

33
Q

RIGHT LATERAL UPPER GI Evaluation Criteria

A

-STRUCTURES DEMONSTRATED:
-Anterior & Posterior aspects of stomach
-Best projection for PYLORIC CANAL and DUODENAL BULB (especially in hypersthenic patients)

-EVALUATION CRITERIA:
-No rotation
-Stomach centered at the level of pylorus
-Air in fundus
-Duodenojejunal junction

34
Q

LPO UPPER GI Positioning

A

-PROJECTION: RAO
-IR: 10X12 or 14 x 17 LW; collimate 10 x 12 or 11 x 14
-CR: perpendicular to 1 to 2 inches above the lower rib margin at the level of L1-L2 midway between the spine and the lateral border of the body (elbow flexion) OR approximately L1-L2, to the midpoint of IR
-PATIENT POSITION: Recumbent
-BREATHING: Suspend on Exhalation
-PART POSITION:
-LPO, approx 30-60 degrees, average is 45 degrees
-From the supine position, abduct left arm and place left hand near patient’s head
-Place right arm across chest or along side the body
-Bend right knee toward the left for support

35
Q

LPO UPPER GI Evaluation Criteria

A

-STRUCTURES DEMONSTRATED:
-Entire stomach and duodenal loop
-Barium is in the fundus & air is located in the pylorus.
-Stomach centered at the level of the pylorus

-EVALUATION CRITERIA:
-Entire stomach and duodenal loop
-PYLORUS and DUODENAL BULB visualized without superimposition in PROFILE
-Fundus portion of the stomach

36
Q

Pathology: Gastritis

A

-Inflammation of mucosa of the stomach
-Acute: thickening of the rugae
-Chronic: thinning or loss of rugal folds

37
Q

Pathology: Tumors

A

-Tumors: in stomach or duodenum
-Adenocarcinoma: cancer that begins in the mucus producing cells that line the stomach

38
Q

Pathology: Polyp

A

-Small mass of tissue growth
-Grows on tissue wall
-Can be benign or cancerous

39
Q

Pathology: Diverticula(e)

A

-Weakening & outpouching of the mucosal wall.
-Radiographic appearance: saccular outpouching from the gastric wall

40
Q

Pathology: Bezoar

A

-Mass of undigested matter trapped in stomach and/or intestinal tract
-May consist of hair, vegetable fibers, orange sections, or wood products, milk curds, medication
• Radiographic appearance:
• Intraluminal filling defect
• Upright view may show a mass at the air/ fluid level
• Obstruction

41
Q

Pathology: Pyloric Stenosis

A

-Thickening of pyloric musculature
-String or “mushroom” sign

42
Q

Pathology: Peptic Ulcers

A

-Occur in distal esophagus, stomach or duodenum
-Mucosa is eroded, leaves a round or oval sore in the mucosal lining

43
Q

Pathology: Perforated Ulcer

A

-Acid has eaten a hole through the stomach wall
-Atmospheric air is swallowed with food and escapes through the hole into the peritoneal cavity
-Free air in the peritoneal cavity is demonstrated under the diaphragm

44
Q

Pathology: Hiatal Hernia

A

-Portion of stomach herniates through diaphragmatic opening
-May be used during UGI studies to demonstrate hiatal hernia:
-Valsalva Maneuver:
-Forcing a deep breath through a closed glottis
-Straining as if having a bowel movement
-Trendelenburg: Patient supine or prone and place head lower than the feet, approx. 45 degrees

45
Q

Images

A
46
Q

In which position is gastric peristalsis more active?

A

RAO

47
Q

In the RAO POSITION, air is in the _________ and barium is in the _________

A

fundus, duodenum

48
Q

In what position(s) is the pylorus and duodenal bulb visualized without superimposition?

A

LPO and RAO

49
Q

In the Right Lateral position, where is the air?

A

In the fundus

50
Q

In what position is the duodenal bulb in profile?

A

RAO and LPO

51
Q

What position best show the right retro-gastric space?

A

Right lateral recumbent

52
Q

What position best show the left retro-gastric space?

A

Upright left lateral

53
Q

To show esophageal regurgitation and hiatal hernias, the head end of the table is lowered ___ to ___ degrees

A

10 to 15

54
Q

Are small lesions less easily obscured with the single or double contrast exam?

A

Double

55
Q

What position is best to show hiatal hernia?

A

RAO

SPRING 2024: Advanced Procedures (25 decks)

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