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Radiographic Procedures 2 > Barium Swallow and Upper GI > Flashcards

Barium Swallow and Upper GI Flashcards

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1
Q

concentration of esophagus study

A

30-50%

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2
Q

concentration of upper GI series study

A

30-50%

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3
Q

concentration of small intestine: small bowel series study

A

40-60%

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4
Q

concentration of large intestine: barium enema study

A

12-25%

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5
Q

concentration of GI for CT study

A

12-25%

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6
Q

which studies are administered orally

A

esophagus, stomach, small intestine and GI for CT

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7
Q

which procedures have naso-duodenal administration

A

small intestine

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8
Q

which procedures are rectally administered?

A

large intestine

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9
Q

patient prep for esophagus?

A

none

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10
Q

patient prep fr stomach

A

NPO after midnight before exam

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11
Q

patient prep for small intestine

A

Low residue diet eaten for 2 days prior to exam

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12
Q

patient prep for large intestine

A

Large amount of fluids day before exam. NPO after midnight before exam. Cleansing enema prior to exam

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13
Q

patient prep for GI for CT

A

NPO after midnight before exam

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14
Q

what is barium sulphate?

A
  • positive or radiopaque
  • chalklike substance
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15
Q

indications for water soluble iodinated contrast media

A
  • perforated viscus
  • presurgical procedure
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16
Q

contraindications for water soluble iodinated contrast media

A
  • hypersensitivity to iodine
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17
Q

what is double contrast?

A
  • barium sulfate (positive contrast)
  • carbon dioxide gas or room air (negative contrast)
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18
Q

pathological indications for esophagram

A
  • Anatomic anomalies
  • Esophageal reflux
  • Esophageal varices
  • Foreign body obstruction
  • Impaired swallowing mechanism
  • Stroke patients
  • Congenital anomalies
  • Small lesions and ulcerations
  • Gastroesophageal Reflux Disease (GERD)
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18
Q

slide 10

A

know luminal indentations of the esophagus

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19
Q

technologist responsibilities

A
  • Prepare fluoro room - Equipment set up - Contrast, supplies
  • Ensure aprons for all staff are available
  • Obtain clinical history
  • Explain procedure
  • Observe and support patient throughout
  • Introduce and assist the fluoroscopist
  • Assist the patient
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20
Q

deglutition

A

the act of swallowing

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21
Q

peristalsis

A

Greatest motility in stomach and proximal portion of small intestine
- Peristaltic activity decreases along the intestinal tract

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22
Q

techniques

A
  • Shorter exposure times for upright and hypermotile pts
  • Slightly longer for recumbent and normally motile pts
  • Make exposures of the stomach and esophagus at the end of expiration
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23
Q

contraindications to contrast

A
  • allergy to contrast
  • perforation
  • high risk of aspiration
  • uncooperative patient
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24
equipment for contrast studies
- Straws, spoons, K- basin, cotton balls or marshmallows, cups, Kleenex, damp cloth - Contrast (follow department protocols and manufacturer’s instructions) - Glass of water
25
esophagus procedure
- Fluoro with patient erect - Administer Barium - Drink by hand (thin), fed by spoon (thick) - Place patient horizontal (drink with straw) - Phonation or breathing maneuvers
26
recumbent studies esophagus used for
demonstration of esophageal varices
27
use of coughing during esophageal studies
reflux through cardiac sphincter
28
when would you use trendelenburg for esophagus
hiatus hernia or reflux
29
AP and PA Esophagram
- AP/PA projection - CR to T5-T6 - No rotation
30
Lateral esophagram
- true lateral - CR to T5-T6 - Esophagus midway between spine and heart - arms not superimposing esophagus
31
general evaluation criteria
- Entire esophagus from lower part of neck to entrance of the stomach - Esophagus filled with barium - Penetration of the barium
31
RAO esophagram
RAO 35-40 oblique - CR to T5-T6 (1 in. inferior to sternal angle) - esophagus between the spine and the heart
32
AP or PA Evaluation Criteria
esophagus through the superimposed thoracic vertebrae with no rotation
33
lateral evaluation criteria
- patient's arms not interfering with proximal esophagus - ribs superimposed/no rotation
34
diagnosis of esophageal reflux
1. valsavla manuver 2. the water test 3. compression paddle technique 4. the toe-touch test
35
valsalva maneuver
deep breath and hold while bearing down - increases venous pressure; can demonstrate esophageal varices
36
Müller maneuver
exhale then tries to inhale against closed glottis - R/O aspiration or incompetent valves
37
Water test
positive if barium regurgitates through esophagus - LPO position, swallow water through a straw
38
compression paddle
- paddle inflated under stomach with patient in prone position - pressure applied to stomach region to create reflux
39
toe touch maneuver
- effective to demonstrate reflux and hiatal hernia
40
modified barium swallow
- Done for dysphagia or rehabbing patients (strokes) - Patient sitting or standing - Drinks/eats various mixtures of Ba with liquids/solids - Thinnest to thickest or vice versa - Lateral and AP fluoroscopy performed
41
Emptying time for stomach with Barium vs. Water soluble contrast
- Barium 2-3 hours - Water soluble contrast 1-2 hours
41
upper GI studies evaluate
- Mouth and upper esophagus - Distal esophagus - Stomach - Some of the small intestine - Emptying time for stomach
42
Be able to label slide 35-41
GI anatomy
43
duodenum
- shortest and widest portion: C loop - retroperitoneal
44
fundus
most posterior
45
body of stomach
anterior/inferior to fundus
46
pylorus
posterior/distal to body
47
hypersthenic GI anatomy
- stomach high and transverse - duodenal bulb T11-T12 right od midline - large intestine widely distributed
48
hyposthenic/asthenic GI Anatomy
- stomach J shaped and low - Duodenal bulb L3-L4 at midline - large intestine low near pelvis
49
sthenic GI Anatomy
- Stomach J-shaped and low - duodenal bulb L1-L2 right of midline - large intestine L colic flexure high
50
biphasic method
combination of single and double contrast methods
51
hypotonic duodenography
- mostly replaced by CT and biopsies
52
Indications of Stomach/Upper GI studies
- Dyspepsia - Upper abdominal mass - Bezoar - Gastric cancer - Polyps - Diverticula - Assessment perforation sites - GERD - Post duodenal bulb lesions and Pancreatic Disease - Weight loss - GI Hemorrhage - Hiatal hernia - Gastritis - Ulcers - Emesis – hematemesis
53
contraindications of contrast in upper GI
- complete large bowel obstruction - perforations - patients aspirating contrast instead of swallowing it - contrast allergy
54
patient prep for upper GI
NPO 8-9 Hrs. - Small bowel – NPO after evening meal - No smoking or chewing of gum after midnight - May stimulate gastric secretions - Remove all clothing, hospital gown - Sometimes laxative or enema to cleanse the large bowel
55
gastrics studies
- dehydration is a concern - book early in day - may require more time and assistance
56
paediatric gastrics
- parents don lead aprons to assist positioning - usually performed recumbent - infants may drink barium from bottle - increase hole in nipple - minimal prep
57
slide 54
understand air distribution based on position
58
Upper GI PA
- recumbent - body, pylorus and duodenal bulb are barium filled - CR - L1-2 (3-6 inches lower if upright) - 1/2 way between vertebrae and left lateral border of body - entire stomach and duodenum demonstrated - air in fundus
59
Upper GI AP
- recumbent - demonstrates barium filled fundus of stomach - CR to L1 - trendelenberg for hiatus hernia or asthenic body type
60
Upper GI RAO 45
- more rotation for hypersthenic patients (40-70) - CR to L1-2 - dynamic emptying of stomach - pyloric canal and duodenal bulb with no superimposition - body and pylorus barium filled - duodenal bulb and C-loop in profile
61
Upper GI LPO 45
- varies from 30-60 - barium filled fundus - DC body, pylorus and bulb are air filled - shows entire stomach and duodenal loop - CR to L1 - body and pyloric with double contrast visualization - no superimposition of the pylorus and duodenal bulb
62
Upper GI Right Lateral
- images of the pyloric canal and the duodenal bulb (hypersthenic pt.) - true lateral - CR to L1 - entire stomach and duodenum demonstrated - retrogastic space demonstrated - vertebrae in true lateral perspective
63
compression studies of Upper GI
can use compression paddle to visualize the duodenal bulb in various stages of filling
64
slide 64
which is prone versus supine
65
post care
- white bowel movements - to avoid impaction - plenty of fluids

Radiographic Procedures 2 (15 decks)

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