BA Swallow, UGI, Small Bowel Fluoro

Question 1

Single Contrast study

Answer 1

using one type of contrast
ex: thin barium

Question 2

double contrast study

Answer 2

using two or more types of contrast
ex: thick barium and crystals (create air)

Question 3

Patient prep for barium swallow - ugi - small bowel

Answer 3

esophagus - no prep needed
esophagus with UGI - NPO 8 hrs prior (looking for polyps and surface of stomach)
UGI/Small Bowel - NPO 8 hrs prior

Question 4

fluoro room prep

Answer 4

place foot board
fluoro generator
table position starts erect (after scout image if needed), remove tray/bucky tray to bottom end of table
wearing lead and lead skirt is placed
fluoro carriage in position

Question 5

Barium swallow anatomy

Answer 5

pharynx and esophagus

Question 6

upper GI

Answer 6

distal esophagus and stomach

Question 7

small bowel study

Answer 7

small intestine

Question 8

Pre-prep

Answer 8

room set up
contrast preparation
obtain accurate history
patient care/change the patient
scout image if needed

Question 9

SCOUT image

Answer 9

pre-procedure image, to just survey the area being examined

Question 10

contrast prep

Answer 10

per dept protocol
barium is non-soluble
water soluble - absorbed to body, possible perforation or obstruction
cups, straw, napkins

Question 11

Valsalva maneuver

Answer 11

breathing/muscular technique where you bear down like doing a BM

Question 12

esophagus overhead images

Answer 12

RAO
Lateral
AP/PA

Technique: high kvp 90-125 needed to adequately penetrate and visualize barium filled structures

Question 13

What would you do to adjust your technique with a barium filled tract?

Answer 13

increase to compensate for barium

Question 14

How is the stomach situated in the body

Answer 14

fundus tilts toward the spine (posterior)
body is inferior

Question 15

in supine position - where is the air and barium

Answer 15

Barium - fundus
air - body

Question 16

in prone position - where is the air and barium

Answer 16

barium - body
air - fundus

Question 17

erect position - where is the air and barium

Answer 17

barium - body (inferior)
air - fundus

Question 18

stenic patient where do you center

Answer 18

L1 around duodenal bulb

Question 19

hypersthenic patient where is centering

Answer 19

2in higher/superior
stomach sits higher and is more transverse

Question 20

hyposthenic/asthenic where is centering

Answer 20

2 in lower/inferior
stomach sits longer in body, more J shaped stomach

Question 21

achalasia

Answer 21

“cardiospasm”
can be visualized on a swallow study
motor disorder of the esophagus where peristalsis is reduced along the distal 2/3 of esophagus
evident at the esophagogastric sphincter
common in males and females 20-40 yrs old

Question 22

barrett esophagus

Answer 22

severe reflux which erosion of squamosal lining of esophagus is seen
lining erodes and replaced by columnar epithelium
stricture in lower esophagus
peptic ulcer can develop in distal esophagus
anorexia can cause this
nuclear med can differentiate between irritation v erosion
contrast study is recommended

Question 23

dysphagia

Answer 23

difficulty swallowing
many reasons/causes
congenital or acquired condition, trapped bolus, paralysis of muscles or inflammation
narrowing or enlarged, flaccid appearance of the esophagus

Question 24

esophageal varices

Answer 24

dilated veins in distal esophagus and caused by portal hypertension associated with cirrhosis of the liver
veins dilated and engorged with blood
pt may have hememesis
double contrast study, upright and recumbent vws
wormlike or cobblestone appearance (like rosary beads) of esophagus

Question 25

Gastroesophageal reflux disease (GERD)

Answer 25

backflow of stomach acid into esophagus
result of inflammation of the esophagus
dilated esophagus w/low peristalsis
ulcerations and erosions appear as streaks
outer borders of distal esophagus hazy appearance
valsalva maneuver

Question 26

Valsalva maneuver

Answer 26

when a pt takes a deep breath and “bears down” like they are taking a BM

Question 27

hiatal hernia

Answer 27

protrusion of a portion of the stomach into the thoracic cavity through the esophageal hiatus within the diaphragm
commonly causes GERD
Swallow and UGI study combo is done
can be seen on Chest XR

Question 28

zenker diverticulum

Answer 28

“out pouch”
large pouching of the esophagus above the esophagus sphincter (upper portion)
cause: weakening of the muscle walls
symptoms: dysphagia, aspiration, regurgitation
Treatment: surgery in some cases

Question 29

bezoar

Answer 29

mass of undigested material trapped in the stomach
usually hair, vegetable fibers, or wood (pyka disorder)
obstruction in stomach
trichobezoar - hair
phytobezoar - vegetable
Study: UGI

Question 30

diverticula

Answer 30

out pouches of the mucosal wall (weakened muscles of stomach)
1/2 - 3 inches in diameter
70-80% of gastric diverticula arise in posterior aspect of fundus
asymptomatic
may cause infection, possible burst
Study: UGI, seen on Lateral vw in retrogastric space

Question 31

gastritis

Answer 31

inflammation of the mucosa of stomach lining
cause: various physiologic and environmental conditions (air)
seen on image as inflamed rugae or absence of rugae (lining is inflamed)
treatment: meds in severe cases

Question 32

ulcers

Answer 32

erosions of the stomach or duodenal mucosa
cause: excessive gastric secretions, stress, diet, smoking, etc
overactive chemical digestion
Treatment: the cause of ulcer

Question 33

peptic ulcer

Answer 33

overactive pepsin enzyme cause erosion
inflammatory processes in the esophagus, stomach, duodenum
severe cases will cause bleeding
treatment: medication, diet change, lifestyle change
preceded by gastritis

Question 34

esophagus goes through the diaphragm at the level of what?

Answer 34

T10
through the esophageal hiatus