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SPRING 2024: Advanced Procedures > UNIT 3: Lower Digestive Tract (Barium Enema) Large Intestine > Flashcards

UNIT 3: Lower Digestive Tract (Barium Enema) Large Intestine Flashcards

1
Q

Large intestine is also known as the

A

Colon

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2
Q

Large intestines extends from the

A

ileo-cecal junction to anal canal

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3
Q

Large intestine structures

A

-Cecum
-Ascending Colon
-Transverse Colon
-Descending Colon
-Sigmoid Colon
-Rectum

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4
Q

Cecum

A

-Most proximal portion of colon
-RLQ
-Veriform Appendix attaches to cecum and is 2-6 inches long

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5
Q

Ascending Colon

A

Extends up the right side of the abdomen from cecum to right colic (hepatic) flexure

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6
Q

Hepatic or Right Colic Flexure

A

-Bends to the left joining ascending colon to transverse colon
-Attaches to underside of liver
-Lies posterior

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7
Q

Transverse Colon

A

-Extends across abdomen
-Most anterior portion of colon
-From hepatic flexure to splenic (left colic) flexure

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8
Q

Splenic or Left Colic Flexure

A

-Downward bend between transverse and descending colon
-Attaches to inferior surface of spleen

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9
Q

Hepatic vs Splenic Flexure

A

Hepatic flexure sits lower then splenic flexure because of the liver

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10
Q

Descending Colon

A

-Extends down left side of abdomen
-Splenic flexure to sigmoid colon
-Lies posterior

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11
Q

Sigmoid Colon

A

-S-Shape
-Extends from Iliac Crest to rectum
-Lies anterior

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12
Q

Rectum

A

-Most distal portion of large intestine
-Extends from level of S-3 to Anal Canal

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13
Q

Anal canal

A

-Distal 1-2 inches of rectum
-Regulated by 2 sphincters

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14
Q

Haustra

A

-Pouches produced from circular muscle fibers

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15
Q

Taenia Coli

A

longitudinal band of muscle fibers extending from apex to rectum

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16
Q

Large intestine radiograph labeled

A
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17
Q

Room Preparation

A

-Fluoroscopy room setup (make sure fluoro works)
-IV Pole
-Clamps
-Gel (Lubrication), Contrast Media Prepared
-Towels, Linens, Washcloths, and Chucks available
-Grid holder, Grid, IR available near by
-Check site protocol

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18
Q

Barium enema: single vs double contrast

A

-Single: Using RADIOPAQUE contrast media only
-Ex: Barium, Gastrografin
-Double: Using RADIOPAQUE and RADIOLUCENT contrast media

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19
Q

Radiopaque vs Radiolucent

A

-Radiopaque media uses barium or a type of water based iodinated CM
-Demonstrates anatomy & tonus
-Gastrografin may be used in cases of suspected bowel perforation or leaks

-Radiolucent uses gas to distend the bowel lumen
-Enables better bowel demonstration

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20
Q

Place enema bag on IV pole prior to start of exam:
-No higher than ___ inches above anus/Tabletop
-Remove the _______ from the tube prior to tipping

A

-24
-air

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21
Q

Patient Prep

A

-Low residue diet day prior to exam
-Laxative evening prior to exam
-NPO after midnight
-Cleansing enemas morning of exam

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22
Q

Prep Contraindications

A

-Colostomy Patients
-Prolonged diarrhea
-Hirschsprung’s Disease/ Megacolon
-Absence of neurons in the bowel wall; prevents relaxation of colon
-Abdomen distention, severe constipation, and recurrent fecal impactions
-Results in defective evacuation of rectum
-Treated surgically by removal of ganglion segment
-Severe rectal bleeding

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23
Q

Enema tips

A
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24
Q

Best position for enemas

A

Sims position

-Turn patient on left side
-Lean body forward
-Slightly bend top knee forward
-Position relaxes abdominal muscles

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25
Q

Barium enema: tube insertion

A

-Use lots of lubrication
-Direct tip anterior (towards umbilicus) and slightly superior
-Follow rectal curve
-DO NOT FORCE
-Once in place, balloon is inflated to hold tip in place

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26
Q

Barium enema: contrast administration

A

-Radiologist requests enema clip be released, barium flows into colon
-Patients may begin to feel uncomfortable and “full”
-Patient may be instructed to roll around table while tip is still in place
-You need to keep bag/ line clear of patient’s feet so it does not get tangled

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27
Q

Barium enema: Double Contrast Media Study

A

-Radiologist will ask you to place bag on floor to drain out barium. Be sure you have enough slack on line, you don’t want to pull on the inflated tip
-Rad will “puff” air into colon. Patient’s abdomen will become distended
-This is very uncomfortable for patients! Remind them to take slow, easy breaths
-Rad will instruct patient to roll around on table

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28
Q

Single and Double Contrast views

A

-Single:
-AP
-AP Axial
-RPO
-LPO
-Left Lateral Rectum

-Double:
-AP
-AP Axial
-RPO
-LPO
-PA
-Right & Left Lateral Decubitus
-Ventral Decubitus
-Cross- Table Lateral Rectum

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29
Q

Large Intestine: Supine, Prone, Upright/Erect

A
30
Q

AP vs PA image, which is which?

A

-Image A: PA
-Image B: AP

31
Q

AP/ PA Positioning

A

-PROJECTION: AP or PA
-IR SIZE: 14 X 17 (LW)
-S.I.D: 40”
-CR: Perpendicular to midpoint of IR & iliac crests
-PATIENT POSITION: Supine or Prone
-PART POSITION: MSP centered to midline of IR. Iliac crest to midpoint of IR
-Must include pubic symphysis
-RESPIRATION: Suspend on exhalation

32
Q

AP/ PA Evaluation Criteria

A

-STRUCTURES DEMONSTRATED:
-PA or AP projection of entire colon
-EVALUATION CRITERIA:
-Entire colon including right and left colic flexures and rectum
-May need to use two IRs for hypersthenic patients
-Vertebral column centered to IR
-Descending and ascending colons visualized

33
Q

PA Obliqe RAO Positioning

A

-PROJECTION: PA Oblique
-IR SIZE: 14 X 17 (LW)
-S.I.D: 40”
-CR: Perpendicular, entering 1-2 inches lateral to midline on elevated side at level of crest. Center of IR at level of crests.
-PATIENT POSITION: Prone
-PART POSITION:
• Right arm down by side, left hand by head, left knee flexed for stability
• Roll patient onto right hip, 35-45, RAO
• Patient’s body centered to midline of IR. Iliac crest centered to midpoint of IR

34
Q

PA Oblique RAO Evaluation Criteria

A

STRUCTURES DEMONSTRATED:
-Best shows RIGHT COLIC (HEPATIC) FLEXURE
-Ascending colon
-Sigmoid portion of colon

EVALUATION CRITERIA:
-Entire colon
-Right colic flexure less superimposed or “open” as compared with PA
-Ascending colon, cecum & sigmoid colon

35
Q

PA Oblique LAO Positioning

A

-PROJECTION: PA Oblique
-IR SIZE: 14 X 17 (LW)
-S.I.D: 40”
-CR: Perpendicular, entering 1-2 inches lateral to midline on elevated side at level of crest. Center of IR at level of crests.
-PATIENT POSITION: Prone
-PART POSITION:
-Left arm down by side, right hand by head, right knee flexed for stability
-Roll patient onto left hip, 35-45 degrees, LAO
-Patient’s body centered to midline of IR. Iliac crest centered to midpoint of IR

36
Q

PA Oblique LAO Evaluation Criteria

A

-STRUCTURES DEMONSTRATED:
-Best shows LEFT COLIC (SPLENIC) FLEXURE
-Descending colon
EVALUATION CRITERIA:
-Entire colon
-Left colic flexure less superimposed or “open” as compared with PA
-Descending colon

37
Q

Left Lateral (Robbin’s method) Positioning

A

-IR SIZE: 10X12 (LW)
-S.I.D: 40”
-CR: Perpendicular, entering the MCP at level of ASIS
-Lead strip placed posterior to the patient
-PATIENT POSITION: Left Lateral Recumbent
-May be done right lateral, check facility protocol
-PART POSITION:
-Place patient in true lateral position
-Center MCP longitudinally and ASIS laterally to IR
-Flex patient’s knees for stability with support placed between knees
-BREATHING: Suspend on exhalation

38
Q

Lateral (Robbin’s method) Evaluation Criteria

A

-STRUCTURES DEMONSTRATED:
-Best shows rectum and distal sigmoid portion of colon
EVALUATION CRITERIA:
-Rectosigmoid area centered to IR
-No rotation
-Hips and femurs superimposed

39
Q

Double contrast barium location in the large intestine

A

-SUPINE:
-Air fills anterior structures: Transverse & Sigmoid Colon
-Barium fills posterior structures: Ascending and Descending colon & rectum
-PRONE:
-Reverse from supine
-ERECT:
-Air rises to highest part of each portion of colon
-Air/ Fluid lines will be demonstrated

40
Q

With the VENTRAL decubitus positions, the _____ portion of the colon is of primary importance and should not be penetrated during double contrast study

A

Air

41
Q

In double contrast studies, what gaseous medium is usually used?

A

Air

42
Q

What large intestine looks like from front, side, and back

A
43
Q

AP oblique LPO positioning

A

Same as PA Oblique projection in RAO position:
-IR SIZE: 14 X 17 (LW)
-S.I.D: 40”
-CR: Perpendicular, entering 1-2 inches lateral to midline on elevated side at level of crest. Center of IR at level of crests.

EXCEPT:
-PATIENT POSITION: Supine
-PART POSITION:
-Left arm down by side, right arm across chest, right knee flexed for stability
-Roll patient onto left hip, 35-45 degrees, LPO
-May need to use a positioning sponge

44
Q

AP Oblique LPO Evaluation Criteria

A

-Structures Demonstrated:
-Right Colic Flexure and Ascending and Sigmoid portions of the colon
-Evaluation Criteria:
-Entire Colon
-Right Colic Flexure less superimposed or open compared with AP projection
-Ascending colon, cecum, and sigmoid colon
-Penetration of the contrast medium

45
Q

AP Oblique RPO Positioning

A

Same as PA Oblique projection in LAO position:
-IR SIZE: 14 X 17 (LW)
-S.I.D: 40”
-CR: Perpendicular, entering 1-2 inches lateral to midline on elevated side at level of crest. Center of IR at level of crests.

EXCEPT:
-PATIENT POSITION: Supine
-PART POSITION:
-Right arm down by side, left arm across chest, left knee flexed for stability
-Roll patient onto right hip, 35-45 degree, RPO
-May need to use a positioning sponge
-RESPIRATION: Suspend

46
Q

AP Oblique RPO Evaluation Criteria

A

-Structures Demonstrated:
-Left Colic Flexure and descending colon
-Evaluation Criteria:
-Entire colon
-Left Colic Flexure and descending colon
-Penetration of the contrast medium

47
Q

AP Axial Positioning

A

-PROJECTION: AP Axial
-IR SIZE: 14 X 17 (LW) or 10X12 (LW)
-S.I.D: 40”
-CR: 30-40 degrees cephalic entering at level of 2” below the level of the ASIS
-PATIENT POSITION: Supine
-PART POSITION: MSP centered to midline of IR. Iliac crest centered 2” above midpoint of IR
-RESPIRATION: Suspend

48
Q

AP Axial Evaluation Criteria

A

-STRUCTURES DEMONSTRATED:
-Best shows rectosigmoid area of colon
-EVALUATION CRITERIA:
-Rectosigmoid area with less superimposition than AP
-Rectosigmoid area centered to IR

49
Q

PA Axial Positioning

A

-PROJECTION: PA Axial
-IR SIZE: 14 X 17 (LW) or 10X12 (LW)
-S.I.D: 40”
-CR: 30-40 degree caudal exiting at the level of the ASIS
-PATIENT POSITION: Prone
-PART POSITION: Center MSP longitudinally to IR. Center IR at the level of the iliac crest
-RESPIRATION: Suspend

50
Q

PA Axial Evaluation Criteria

A

-Rectosigmoid area with less superimposition than in PA projection because of angulation of the central ray
-Transverse colon and both flexures not always included

51
Q

AP/PA Right Lateral Decubitus Positioning

A

-PROJECTION: AP or PA
-IR SIZE: 14X17 (LW)
-GRID: YES (BUCKY)
-S.I.D: 40”
-CR: Horizontal AND Perpendicular, entering the MSP at level of iliac crests
-PATIENT POSITION: Right Lateral Recumbent with back or abdomen in contact with IR
-Arms above head & knees bent for stability
-PART POSITION:
-Center MSP longitudinally to IR (use sponge to elevate pt or place IR below level of table)
-Center IR to level of iliac crests

52
Q

AP/PA Right Lateral Decubitus Evaluation Criteria

A

-STRUCTURES DEMONSTRATED:
-AP or PA projection showing “up” medial side of ascending colon & lateral side of descending colon
-EVALUATION CRITERIA:
-Left colic (splenic) flexure to rectum
-No rotation as exhibited by ribs and pelvis

53
Q

AP/PA Left Lateral Decubitus Positioning

A

-PROJECTION: AP or PA
-IR SIZE: 14X17 (LW)
-GRID: YES (BUCKY)
-S.I.D: 40”
-CR: Horizontal AND Perpendicular, entering the MSP at level of iliac crests
-PATIENT POSITION: Left Lateral Recumbent with back or abdomen in contact with IR
-Arms above head & knees bent for stability
-PART POSITION:
-Center MSP longitudinally to IR (use sponge to elevate pt or place IR below level of table)
-Center IR to level of iliac crests

54
Q

AP/PA Left Lateral Decubitus Evaluation Criteria

A

-STRUCTURES DEMONSTRATED:
-AP or PA projection showing “up” lateral side of ascending colon & medial side of descending colon
-EVALUATION CRITERIA:
-Left colic (splenic) flexure to rectum
-No rotation as exhibited by ribs and pelvis

55
Q

Rectum Cross-table Lateral Ventral Decubitus Positioning

A

-PROJECTION : Lateral
-IR SIZE: 10 X 12 (LW)
-GRID: STATIONARY GRID***
-S.I.D: 40”
-CR: Perpendicular to approx level of ASIS.
-PATIENT POSITION: Prone with right or left side against grid
-PART POSITION: Center mid-coronal plane to middle of grid/ IR

56
Q

Rectum Cross-table Lateral Ventral Decubitus Evaluation Criteria

A

-STRUCTURES DEMONSTRATED:
-Rectum with air in most superior portion or “UP Side”
-EVALUATION CRITERIA:
-Recto-sigmoid area in centered on image

57
Q

Defecogram

A

-AKA: Evacuation proctography or dynamic rectal examination
-For patients with defecation dysfunction:
-Prolapse Rectum
-Rectal Intussusception
-Rectocele
-Demonstrate rectal sphincter, post CVA (stroke)
-Functional study of anus and rectum during evacuation and rest phases of defecation
-Barium product instilled directly into rectum
-Patient seated on radiolucent commode in front of fluoroscopic unit for lateral projection
-Spot images or video recording is utilized to capture defecation process
-Anorectal angle and angle between the long axes of the anal canal and rectum are
evaluated
-Aqueous iodinated contrast may be instilled into vagina and bladder to assess changes in proximity between these structures and rectum during defecation

58
Q

Pathology: Colitis

A

-Mucosal disease that effects mucosa and submucosa of rectosigmoid area
-May demonstrate loss of haustral sacculations
-“Hose Pipe” appearance

59
Q

Pathology: Diverticulosis vs Diverticulitis

A

-DIVERTICULOSIS: Pouch created by herniation of mucous membrane through muscular coat
-DIVERTICULITIS: Inflamed diverticulae

60
Q

Pathology: Obstruction

A

Mechanical pathology: Lumen of the bowel is occluded

61
Q

Pathology: Volvulus

A

-Portion of bowel twisting or knotting on itself
-Commonly occurs in sigmoid colon

62
Q

Pathology: Intussusception

A

-“Telescoping” of one part of bowel into lumen of adjacent part of bowel
-Causes obstruction

63
Q

Pathology: Apendicitis

A

Inflammation of the vermiform appendix

64
Q

Pathology: Neoplasm Polyp

A

benign adenomas and/ or carcinomas (malignancy)

65
Q

Pathology: Neoplasm Apple-Core Carcinoma

A

Malignancy

66
Q

Pathology: Chron’s disease

A

-Inflammatory bowel disease involving the intestinal wall
-Appears in small bowel and/or colon

67
Q

If a polyp is seen on the LATERAL aspect of the DESCENDING colon, what position best shows this and why?

A

Right lateral decubitus because this position best shows the “up” MEDIAL side of ascending colon and the LATERAL side of the descending colon when it is inflated with air

68
Q

Which projection does not require colic Flexure to be included in the image?

A

AP Axial and Lateral

69
Q

If a polyp is seen on the LATERAL aspect of the ASCENDING colon, what position best shows this and why?

A

Left lateral decubitus because this position best shows the “up” LATERAL side of ascending colon and the MEDIAL side of the descending colon when it is inflated with air

70
Q

Which projections best demonstrate the rectal-sigmoid area?

A

AP/PA Axial and Lateral

SPRING 2024: Advanced Procedures (25 decks)

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