GI tract

Question 1

patient preparation

Answer 1

• 3 forms of ID
• explanation
• justification
• remove artefacts
• bowel prep
• nil by mouth 6 hours prior

Question 2

upper GIT

Answer 2

• barium swallow
• barium meal

Question 3

lower GIT

Answer 3

• small bowel meal
• barium enema
• CT colonography

Question 4

equipment

Answer 4

• fluoroscopic equipment
• tilting table
• lead rubber aprons
• trolly
• injection equip
• emergency drugs
• vomit bowl
• oxygen

Question 5

what does a contrast medium achieve

Answer 5

helps differentiate between different structures

Question 6

positive contrast medium

Answer 6

• barium sulphate solution

Question 7

negative contrast medium

Answer 7

• air, CO2
• gas granules

Question 8

intravenous buscopan

Answer 8

relaxes smooth muscles (reduce peristalsis)
- reduces motion artefact

Question 9

how long and diameter of oesophagus

Answer 9

• 25cm long
• 2cm diameter

Question 10

walls of oesophagus

Answer 10

lubricated by mucus to assist bolus movement

Question 11

clinical indications

Answer 11

• dysphagia
• dyspepsia
• goitre
• oesophageal motility
• stricture

Question 12

outline the radiological procedure of barium swallow

Answer 12

• patient stands and rapid image sequences taken while patient swallows barium sulphate solution
• full length views of oesophagus in PA and lateral and right anterior oblique (RAO)
• prone views to demonstrate oesophageal varices
• ensure patients arms and drinking equipment kept clear of image field

Question 13

patient aftercare

Answer 13

• general reassurance
• check patient knows how to get results
• escort to changing area and check general condition
• send home and advise to eat and drink normally
• warn patient of possibilities of constipation

Question 14

clinical indications of barium meal

Answer 14

• peptic ulcer
• duodenal ulcer
• dyspepsia
• weight loss
• pain after meals
• hiatus hernia

Question 15

contrast medium and drugs for barium meal

Answer 15

• barium sulphate solution
• gas granules
• intravenous buscopan

Question 16

outline radiological procedure of barium meal

Answer 16

• give buscopan
• give gas granules (straight to back of mouth with little water)
• vertical table (stand on step)
• shake barium sulphate solution well
• patient holds cup
• images taken while patient swallowing
• face table horizontally
• patient rotates to coat stomach with barium
• views of stomach taken
• image taken while drinking with straw (check for reflux)
• duodenal cap views
• patient stands for erect fundus view

Question 17

pylorus function

Answer 17

acts as a valve regulating flow of gastric contents into duodenum

Question 18

small bowel sizes

Answer 18

6m long
2.5/3cm diameter

Question 19

anatomy of small bowel

Answer 19

• duodenum curves around head of pancreas
• jejenum
• ileum
• ends at ileo-caecal valve

Question 20

clinical indications causing for small bowel meal

Answer 20

• pain
• diarrhoea
• bleeding per rectum
• malabsorption
• partial obstruction
• extent of malignant or inflammatory disease

Question 21

patient prep before small bowel meal

Answer 21

• whole GI tract should be clear
• low residue diet for 48 hours prior
• laxatives started 24 hrs prior
• nil by mouth 6 hours prior
• stop drugs that may inhibit peristalsis

Question 22

outline small barium meal procedure

Answer 22

• ask patient to drink barium mixture
• lie on right to encourage gastric emptying
• prone abdomen after 15 mins
• subsequent images at 30 min intervals
• ## prone films to open bowel loops

Question 23

size of large intestine

Answer 23

1.5 metres long
3 bands of longitudinal muscle

Question 24

clinical indications needing barium enema

Answer 24

• change in bowel habit
• pain
• meleana
• mass in abdomen
• malignant disease
• obstruction
• failed failed colonoscopy

Question 25

patient preparation for barium enema

Answer 25

- low residue diet for 48 hours prior - laxatives 24 hours prior - no food 6 hours prior - iv buscopan immediately prior procedure

Question 26

radiographer prep for barium enema

Answer 26

- prepare enema bag - gloves - lubricating gel - facilities for washing patient - prep of equipment and other requirements - radiation protection - control of fluoroscopic equipment

Question 27

outline barium enema procedure

Answer 27

- patient on left side - rectal catheter inserted and taped - barium bag raised on drip stand - barium solution allowed to flow as far as mid transverse colon - fluoroscopy used to check - enema bag lowered and drained of most barium solution - buscopan given at this point - remaining barium pushed by air/ CO2 - gives double contrast - images then taken

Question 28

patient aftercare after barium enema

Answer 28

- directed to toilet - washed - warned of white bowel motions - drink plenty water - warned of blurred vision from buscopan - check ok and reassure - tell patient where to get results

Question 29

outline radiological procedure of CT colonography

Answer 29

- same clinical indications and bowel prep as barium enema - trolley - insufflator, catheter, lubricating gel - buscopan - inflate large bowel with air prior to scan - topogram from sternal angle to symphysis pubis - supine and prone imaging - enhanced scan - post processing on specialist workstation