Module 9 - GI System Flashcards
1
Q
What is the main function of the esophagus?
A
To transport food from the mouth to the stomach.
2
Q
What vertebral level does the esophagus begin at?
A
C6.
3
Q
At what vertebral level does the esophagus terminate?
A
T11.
4
Q
What is the typical length of the esophagus?
A
25 cm.
5
Q
What structure is located anterior to the esophagus?
A
The trachea.
6
Q
What structure is located posterior to the esophagus?
A
The thoracic spine.
7
Q
What structure is located anterior and slightly left of the esophagus in the chest?
A
The heart.
8
Q
What anatomical landmark marks the beginning of the esophagus?
A
The inferior margin of the cricoid cartilage.
9
Q
What part of the stomach does the esophagus connect to?
A
The cardia.
10
Q
Which imaging view gives an unobscured view of the esophagus for pathology detection?
A
Oblique chest x-ray.
11
Q
In a properly positioned lateral chest x-ray, where should the esophagus be visualized?
A
Between the heart and the spine.
12
Q
Does the esophagus travel in a straight line from the pharynx to the stomach?
A
No, it deviates due to surrounding structures.
13
Q
What structure lies anterior to the esophagus in the neck?
A
The trachea.
14
Q
What structure lies posterior to the esophagus in the neck?
A
The cervical spine.
15
Q
Why is the esophagus difficult to see on x-ray without contrast?
A
It blends in with surrounding soft tissues.
16
Q
What imaging technique improves visualization of the esophagus?
A
Use of contrast media.
17
Q
At what anatomical point does the esophagus deviate slightly to the left?
A
Superior thoracic aperture.
18
Q
Which structure causes the esophagus to deviate back to the midline?
A
The aortic arch.
19
Q
What causes a rightward deviation of the esophagus just below the aortic arch?
A
The left main bronchus.
20
Q
Where does the esophagus curve left again near the heart?
A
Near the inferior border of the heart.
21
Q
Through what opening does the esophagus pass into the abdomen?
A
Esophageal hiatus.
22
Q
What is the name of the stomach region the esophagus connects to?
A
The cardia.
23
Q
How many typical anatomical constrictions does the esophagus have?
A
Four.
24
Q
What vertebral level is the pharynx-esophagus junction constriction?
A
C6.
25
What vertebral level is the aortic arch constriction?
T4.
26
What vertebral levels correspond to the left main bronchus constriction?
T5–T6.
27
What vertebral level is the esophageal hiatus constriction?
T10.
28
Why are esophageal constrictions clinically important?
Foreign objects and instruments may get stuck at these narrowings.
29
What structure lies on the right side of the esophagus superiorly?
Mediastinal portion of the parietal pleura.
30
What structure lies on the left side of the esophagus superiorly?
Thoracic aorta.
31
What structure lies posterior to the esophagus?
The spine.
32
What structure lies anterior to the esophagus superiorly?
The trachea.
33
At what vertebral level do the right pulmonary artery and left main bronchus lie anterior to the esophagus?
T4/5.
34
What two structures lie anterior to the esophagus at the T4/5 level?
Right pulmonary artery and left main bronchus.
35
Where does the esophagus lie in relation to the heart?
Midline, posterior to the heart.
36
As the esophagus passes below the heart, which direction does it deviate?
To the left.
37
What is the name of the opening the esophagus passes through in the diaphragm?
Esophageal hiatus.
38
At what vertebral level does the esophagus pass through the diaphragm?
T10.
39
What is the primary function of the esophagus?
To transport food and liquids from the mouth to the stomach.
40
What mechanism allows the esophagus to move food to the stomach?
Peristalsis.
41
Does digestion occur in the esophagus?
No.
42
Does absorption occur in the esophagus?
No.
43
What structure controls the emptying of the esophagus into the stomach?
The lower esophageal sphincter (gastroesophageal sphincter).
44
Where is the gastroesophageal sphincter located?
Just inferior to the diaphragm, where the esophagus meets the stomach.
45
What happens to the gastroesophageal sphincter during swallowing?
It opens to allow food and liquids to pass into the stomach, then closes.
46
What is a common pathology involving the lower esophagus and stomach?
Hiatus hernia.
47
What happens in a hiatus hernia?
Part of the stomach passes through the esophageal hiatus into the thorax.
48
What type of exams are used to image the esophagus?
Esophagrams, modified swallows, upper GIs, and barium swallows.
49
What contrast agent is commonly used for esophageal imaging?
Barium.
50
Why is barium used in esophageal imaging?
It enhances visualization of the esophagus on radiographs or CT scans.
51
What can tumors inside the esophagus cause?
Narrowing of the lumen.
52
What can tumors outside the esophagus cause?
Deviation from the normal course of the esophagus.
53
What pathologies outside the esophagus may be indicated by its indentation pattern?
Cardiac or aortic pathologies.
54
What causes a normal indent on the esophagus seen in imaging?
The aortic arch.
55
What condition occurs when part of the stomach moves through the gastroesophageal sphincter into the thorax?
Hiatus hernia.
56
What condition appears as 'pebble-like' filling defects in the lower esophagus?
Esophageal varices.
57
What causes esophageal varices?
Dilated veins due to hypertension in the portal venous system.
58
What can esophageal imaging also help assess besides the esophagus itself?
Size and contours of the heart.
59
Is the stomach intraperitoneal or retroperitoneal?
Intraperitoneal.
60
In which abdominal quadrant is the majority of the stomach located?
Left upper quadrant.
61
What factor causes variability in stomach position?
Body habitus.
62
What is the most superior part of the stomach called?
Fundus.
63
Where is the fundus located in relation to the diaphragm?
Directly beneath the left hemi-diaphragm.
64
At what vertebral level is the inferior margin of the stomach typically located?
L3–L4.
65
What determines the shape of an individual's stomach?
Body habitus.
66
What is the common stomach shape in hyposthenic and asthenic individuals?
Fish hook or elongated 'J' shape.
67
What is the most common stomach shape, found in sthenic individuals?
'C' shape.
68
What is the typical stomach shape in hypersthenic individuals?
'Steer horn' shape.
69
In which body habitus does the stomach lie more horizontally and closer to midline?
Hypersthenic.
70
What are the three main regions of the stomach?
Fundus, body, and pylorus.
71
What is the most superior and posterior portion of the stomach?
Fundus.
72
Where is the fundus located?
Under the left hemidiaphragm, lateral to the heart.
73
What collects in the fundus when standing upright?
Swallowed air (magenblase).
74
How does swallowed air in the fundus appear on an x-ray?
As a dark patch.
75
Which region of the stomach curves inferiorly and anteriorly?
The body.
76
What does the body of the stomach rest against?
The anterior abdominal wall.
77
How many muscle layers are in the body of the stomach?
Three.
78
What are the muscle layers in the body of the stomach?
Circular, oblique, and longitudinal.
79
What is the most distal part of the stomach?
Pylorus.
80
Where is the pylorus located in relation to the body of the stomach?
Inferior to the body, near the mid-coronal plane.
81
What are the two sub-divisions of the pylorus?
Pyloric antrum and pyloric canal.
82
What is the cardia of the stomach?
The region where the esophagus meets the stomach, just below the esophageal sphincter.
83
What is the first area that receives food and liquids in the stomach?
Cardia.
84
What region lies just distal to the body of the stomach and is part of the pylorus?
Pyloric antrum.
85
What is the most narrowed part of the stomach leading into the duodenum?
Pyloric canal.
86
What muscle controls stomach emptying into the duodenum?
Pyloric sphincter.
87
What is the first portion of the duodenum called?
Duodenal bulb (or duodenal cap).
88
Why is the duodenal bulb clinically important?
It is a common site for ulcers.
89
Which stomach region lies most posterior in a lateral position?
Fundus.
90
Which stomach region lies most anterior in a lateral position?
Body.
91
Where does the pylorus lie in relation to the coronal plane in a lateral image?
Near the mid-coronal plane.
92
What is the lesser curvature of the stomach?
The concave medial border connecting the esophagus to the pylorus.
93
What structure connects the lesser curvature of the stomach to the liver?
Lesser omentum.
94
What is the greater curvature of the stomach?
The convex lateral border running from the esophagus to the pylorus.
95
What structure hangs from the greater curvature over abdominal organs?
Greater omentum.
96
What is the incisura angularis (angular notch)?
A sharp notch on the lesser curvature marking the junction of the body and pyloric region.
97
What are the internal folds of the stomach mucosa called?
Rugae.
98
How do rugae appear on imaging?
As longitudinal lines along the stomach’s long axis.
99
What does loss of rugae suggest on a radiograph?
Mucosal ulceration or chronic inflammation.
100
What are common sites of gastric ulcers?
Lesser curvature and duodenum.
101
What contrast agents are commonly used in stomach fluoroscopy exams?
Air and barium.
102
How does air appear on a radiograph?
Black (low density).
103
How does barium appear on a radiograph?
White (high density).
104
In the prone position, where does barium mostly collect in the stomach?
In the body.
105
In the prone position, where does air mostly rise to in the stomach?
The fundus.
106
In the supine position, where does barium mostly collect in the stomach?
In the fundus and pylorus.
107
In the supine position, where does air mostly rise to in the stomach?
The body.
108
What should be assessed to ensure proper centering for stomach imaging?
Patient's body habitus.
109
What outlines the rugae of the stomach during barium studies?
Barium.
110
What does a normal erect stomach image show in the fundus?
An air bubble (magenblase).
111
What might an increased space between the stomach air bubble and diaphragm suggest?
A mass or pathology.
112
When does stomach emptying begin during a barium meal?
Almost immediately.
113
How long does it typically take for a barium meal to empty completely from the stomach?
Within 3 hours.
114
What patient position is used to enhance stomach emptying?
RAO (GI) position.
115
What type of food slows gastric emptying the most?
Protein.
116
What nerve is involved in controlling stomach motility?
Vagus nerve.
117
Does sitting or walking slow stomach emptying more?
Sitting.
118
Does erect or recumbent posture allow faster stomach emptying?
Erect.
119
What is the approximate length of the small bowel?
About 6 meters.
120
Where does the small bowel begin?
At the pylorus of the stomach.
121
Where does the small bowel end?
At the ileocecal valve.
122
What are the three sections of the small bowel?
Duodenum, jejunum, ileum.
123
Which section is the shortest part of the small intestine?
Duodenum.
124
Which section of the small bowel makes up about 40% of its length?
Jejunum.
125
In which abdominal quadrant is the jejunum primarily located?
Left upper quadrant.
126
Which section of the small bowel makes up about 60% of its length?
Ileum.
127
In which abdominal quadrant is the ileum primarily located?
Right lower quadrant.
128
Is the duodenum intraperitoneal or retroperitoneal?
Retroperitoneal.
129
What is the approximate length of the duodenum?
25 cm.
130
What are the three muscular layers of the duodenum?
Circular, oblique, and longitudinal.
131
How many parts does the duodenum have?
Four.
132
What are the four parts of the duodenum?
Duodenal bulb, descending duodenum, inferior duodenum, ascending duodenum.
133
What is another name for the duodenal bulb?
Superior duodenum.
134
Where is the duodenal bulb located?
About 5 cm to the right of midline at the level of L1.
135
What is a common pathology found in the duodenal bulb?
Ulcers.
136
Which part of the duodenum is C-shaped and runs inferiorly to the right?
Descending duodenum.
137
What ducts open into the medial wall of the descending duodenum?
Pancreatic and biliary ducts.
138
What structure is located at the opening of the pancreatic and biliary ducts?
Major duodenal papilla.
139
What controls the flow of secretions at the major duodenal papilla?
Sphincter of the ampulla.
140
Which procedure visualizes the major duodenal papilla?
ERCP (Endoscopic Retrograde Cholangiopancreatography).
141
What direction does the inferior duodenum run?
Superiorly and to the left.
142
What does the ascending duodenum join?
The jejunum.
143
At what vertebral level does the duodenum join the jejunum?
Approximately L2.
144
What structure does the duodenum cradle?
The head of the pancreas.
145
What is the term used to describe the close relationship between the duodenum and pancreas?
"Romance of the abdomen."
146
What percentage of the small bowel does the jejunum make up?
Approximately 40%.
147
In which abdominal quadrant is the jejunum primarily located?
Left upper quadrant (LUQ).
148
How does the jejunal mucosa appear when filled with barium?
Feathery.
149
What causes the feathery appearance of the jejunum on imaging?
Plicae circulares (circular folds in the mucosa).
150
What imaging exam commonly shows the mucosal pattern of the jejunum?
Small Bowel Follow Through (SBFT).
151
What percentage of the small bowel does the ileum make up?
Approximately 60%.
152
Where is the ileum primarily located in the abdomen?
Right lower quadrant (RLQ) and pelvis.
153
How do the walls and lumen of the ileum compare to the jejunum?
The walls are thinner and the lumen is narrower.
154
How does the mucosa of the ileum appear on barium imaging?
Less feathery than the jejunum.
155
What are the mucosal folds in the ileum called?
Plicae circulares.
156
What happens to the plicae circulares in the distal ileum?
They decrease in size and number and eventually disappear.
157
Where does the ileum terminate?
At the ileocecal valve.
158
What structure does the ileum join at its termination point?
The cecum (beginning of the large intestine).
159
What is the approximate length of the large bowel?
About 1.5 meters.
160
How does the diameter of the large bowel compare to the small bowel?
It is larger in diameter.
161
How many abdominal quadrants does the large bowel span?
All four quadrants.
162
Where is the large bowel generally located in the abdomen?
Along the periphery.
163
Where does the large bowel receive contents from?
The ileum at the ileocecal junction.
164
What landmark indicates completion of a Small Bowel Follow Through (SBFT)?
The ileocecal valve.
165
How does the large bowel appear radiographically compared to the small bowel?
Larger diameter and smoother walls.
166
What quadrant contains the cecum and appendix?
Right Lower Quadrant (RLQ).
167
What structure separates the small bowel from the large bowel?
Ileocecal valve.
168
Where is the cecum located?
Below the ileocecal junction in the right iliac fossa.
169
What is the appendix a continuation of?
The cecum.
170
Which quadrants contain the ascending colon?
RLQ and RUQ.
171
Is the ascending colon retroperitoneal or intraperitoneal?
Retroperitoneal.
172
Where does the ascending colon extend from and to?
From the cecum to the undersurface of the liver.
173
At what anatomical landmark does the ascending colon end?
Hepatic flexure (right colic flexure).
174
Which quadrant contains the hepatic flexure?
Right Upper Quadrant (RUQ).
175
Why is the hepatic flexure lower than the splenic flexure?
Because the liver lies above it.
176
What does the hepatic flexure connect?
Ascending colon to the transverse colon.
177
Which quadrants contain the transverse colon?
RUQ and LUQ.
178
Is the transverse colon retroperitoneal or intraperitoneal?
Intraperitoneal.
179
What is the most mobile part of the large bowel?
Transverse colon.
180
Where is the splenic flexure located?
Left Upper Quadrant (LUQ).
181
What does the splenic flexure connect?
Transverse colon to descending colon.
182
Which quadrants contain the descending colon?
LUQ and LLQ.
183
Is the descending colon retroperitoneal or intraperitoneal?
Retroperitoneal.
184
Where does the descending colon end?
At the sigmoid colon near the pelvic brim.
185
Where is the sigmoid colon located?
Left Lower Quadrant (LLQ).
186
What shape is the sigmoid colon?
S-shaped.
187
Is the sigmoid colon retroperitoneal or intraperitoneal?
Intraperitoneal.
188
Where does the sigmoid colon join the rectum?
At the rectosigmoid junction.
189
What is the narrowest part of the large bowel?
Rectosigmoid junction.
190
At what vertebral level does the rectum begin?
S3.
191
How long is the rectum approximately?
About 15 cm.
192
Is the rectum retroperitoneal or intraperitoneal?
Retroperitoneal.
193
What structure follows the rectum and controls bowel emptying?
Anal canal and anal sphincter.
194
How long is the anal canal?
About 4 cm (1–1.5 inches).
195
How many muscle layers does the wall of the large bowel have?
Two.
196
What is the orientation of the external muscle layer in the large bowel?
Longitudinal.
197
What is the orientation of the internal muscle layer in the large bowel?
Circular.
198
Which muscle layer in the large bowel is difficult to see on radiographs?
The internal circular layer.
199
What are the thickened bands of the external longitudinal muscle layer called?
Teniae coli.
200
How many bands are present in the teniae coli?
Three.
201
What structures are formed by the contraction of the teniae coli?
Haustra.
202
What is the term for the sac-like pouches of the large bowel?
Haustra.
203
How do haustra appear on a radiograph?
As a segmented or sacculated pattern along the colon.
204
What does reflux into the ileum during a barium enema indicate?
The large bowel is completely filled.
205
Why is reflux into the ileum during a barium enema common?
The ileocecal valve is inefficient and allows backflow.
206
What shape is the sigmoid colon?
S-shaped.
207
Why is the central ray often angled for sigmoid colon imaging?
To reduce self-superimposition of its loops.
208
Which colon section has the highest percentage of colonic lesions?
The sigmoid colon.
209
How should the central ray be angled to view the sigmoid colon in AP?
Cephalad at 35 degrees.
210
Why is care required when inserting an enema tip?
The rectum and anus curve along the sacrum and coccyx.
211
What patient position best demonstrates the hepatic flexure?
LPO or RAO.
212
What patient position best demonstrates the splenic flexure?
RPO or LAO.
213
For flexure visualization in supine, which side should the patient rotate away from?
The side of the flexure.
214
For flexure visualization in prone, which side should the patient rotate toward?
The side of the flexure.
215
What shape does the transverse colon take in hypersthenic patients?
High and horizontal.
216
In which patients may the transverse colon dip into the pelvis?
Hyposthenic or asthenic.
217
What imaging strategy may be required for hypersthenic patients?
Two overlapped cassettes (centered at L1 and ASIS).
218
What does barium demonstrate during a single contrast enema?
The outer contours and haustral pattern of the bowel.
219
What does a double contrast (barium and air) enema demonstrate?
Barium-coated bowel walls and separated lumen for detecting small lesions.
220
Where is barium located in the AP position during large bowel imaging?
Ascending, descending colon, and rectum.
221
Where is barium located in the PA position during large bowel imaging?
Transverse and sigmoid colon.
