SMALL BOWEL SERIES

Question 1

Study of Small Intestine Radiographic examination specifically of the small intestine

Answer 1

small bowel series

Question 2

Study of Large Intestine The radiographic procedure designed to study the large intestine

Answer 2

barium enema (lower GI series, colon)

Question 3

Upper GI and small bowel series are frequently combined. This examination is termed as

Answer 3

small bowel follow through

Question 4

main purpose are to study the form and function of the three components of the small bowel and to detect any abnormal conditions.

Answer 4

small bowel series

Question 5

when is the time to start timing the small bowel procedure

Answer 5

when the patient has ingested a substantial amount (at least 8 oz) of contrast medium should be noted

Question 6

T/F: presurgical patients and patients suspected to have a perforated hollow viscus (intestine or organ) should not receive barium sulfate

Answer 6

TRUE

Question 7

what contrast media should be ingested by presurgical patients and patients suspected to have a perforated hollow viscus (intestine or organ)

Answer 7

Water-soluble, iodinated contrast media

Question 8

T/F: barium sulfate by mouth is contraindicated in patients with a possible large bowel obstruction.

Answer 8

TRUE

Question 9

inflammation of the intestine, primarily of the small intestine.

Answer 9

enteritis

Question 10

may be caused by bacterial or protozoan organisms and other environmental factors.

Answer 10

enteritis

Question 11

is a form of inflammatory bowel disease of unknown origin, involving any part of the gastrointestinal tract but commonly involving the terminal ileum.

Answer 11

(segmental enteritis or Crohn’s disease)

Question 12

This condition leads to scarring and thickening of the bowel wall. What appearance visible during a small bowel series

Answer 12

cobblestone

Question 13

is a common infection of the lumen of the small intestine that is caused by the flagellate protozoan (Giardia lamblia).

Answer 13

Giardiasis

Question 14

It is often spread by contaminated food and water. It can also be spread via person-to-person contact.

Answer 14

giardiasis

Question 15

is an obstruction of the small intestine

Answer 15

ileus

Question 16

is due to the cessation of peristalsis. Without these involuntary, wavelike contractions, the bowel is flaccid and is unable to propel its contents forward.

Answer 16

ADYNAMIC OR PARALYTI ILEUS

Question 17

is a physical blockage of the bowel that may be caused by tumors, adhesions, or hernia.

Answer 17

MECHANICAL OBSTRUCTION

Question 18

is evident on an erect or decubitus abdomen projection. This dilation produces the radiographic sign commonly called ______

Answer 18

staircase” or “herringbone” pattern

Question 19

is a common birth defect caused by the persistence of the yolk sac (umbilical vesicle) resulting in a saclike outpouching of the intestinal wall.

Answer 19

Meckel’s diverticulum

Question 20

outpouching in the ileum measures ____

Answer 20

10 to 12 cm in diameter and is usually 50 to 100 cm proximal to the ileocecal valve.

Question 21

is a term that means “new growth.”

Answer 21

neoplasm

Question 22

what are the common benign tumors of the small intestine

Answer 22

adenomas and leiomyomas

Question 23

the most common tumors of the small bowel, have a benign appearance, although they have the potential to become malignant. These small lesions tend to grow submucosally and frequently are missed radiographically.

Answer 23

Carcinoid tumors

Question 24

are malignant tumors of the small intestine

Answer 24

Lymphoma and adenocarcinoma

Question 25

Lymphomas are demonstrated during a small bowel series as the ______

Answer 25

“stacked coin” sign

Question 26

This sign is caused by thickening, coarsening, and possible hemorrhage of the mucosal wall

Answer 26

“stacked coin” sign

Question 27

are conditions in which the gastrointestinal tract is unable to process and absorb certain nutrients.

Answer 27

sprue and malabsorption syndromes

Question 28

is a form of sprue or malabsorption disease that affects the proximal small bowel, especially the proximal duodenum. It commonly involves the insoluble protein (gluten) found in cereal grains.

Answer 28

Celiac disease

Question 29

is a rare disorder of the proximal small bowel whose cause is unknown. Symptoms include dilation of the intestine, edema, malabsorption, deposits of fat in the bowel wall, and mesenteric nodules.

Answer 29

Whipple’s disease

Question 30

is best diagnosed with a small bowel series, which shows distorted loops of small intestine.

Answer 30

Whipple’s disease

Question 31

four methods in small bowel procedure

Answer 31

1. Upper GI–small bowel combination 2. Small bowel–only series 3. Enteroclysis 4. Intubation method

Question 32

are performed only when methods 1 and 2 are unsatisfactory or contraindicated

Answer 32

method 3 and 4

Question 33

UPPER GI—SMALL BOWEL COMBINATION Routine

Answer 33

- Routine upper GI first * Notation of time patient ingested first cup (8 oz) of barium * Ingestion of second cup of barium * 30-minute PA radiograph (centering high for proximal small bowel) * Half-hour interval radiographs, centered to iliac crest, until barium reaches large bowel (usually 2 hours) * 1-hour interval radiographs, if more time is needed after 2 hours Optional * Fluoroscopy and spot imaging of ileocecal valve and terminal ileum (compression cone may be used)

Question 33

UPPER GI—SMALL BOWEL COMBINATION Routine

Answer 33

- Routine upper GI first * Notation of time patient ingested first cup (8 oz) of barium * Ingestion of second cup of barium * 30-minute PA radiograph (centering high for proximal small bowel) * Half-hour interval radiographs, centered to iliac crest, until barium reaches large bowel (usually 2 hours) * 1-hour interval radiographs, if more time is needed after 2 hours Optional * Fluoroscopy and spot imaging of ileocecal valve and terminal ileum (compression cone may be used)

Question 34

SMALL BOWEL–ONLY SERIES

Answer 34

Routine * Plain abdomen radiograph (scout) * 2 cups (16 oz) of barium ingested (noting time) * 15- to 30-minute radiograph (centered high for proximal small bowel) * Half-hour interval radiographs (centered to crest) until barium reaches large bowel (usually 2 hours) * 1-hour interval radiographs, if more time is needed (some routines including continuous half-hour intervals) Optional * Fluoroscopy with compression sometimes required

Question 35

ENTEROCLYSIS (DOUBLE-CONTRAST SMALL BOWEL SERIES)

Answer 35

Procedure * Special catheter advanced to duodenojejunal junction * Thin mixture of barium sulfate instilled * Air or methylcellulose instilled * Fluoroscopic spot images and conventional radiographs taken Optional * Patient may have CT scan of gastrointestinal tract * On successful completion of examination, intubation tube removed

Question 36

PA, 15 or 30 minutes

Answer 36

centered approximately 2 inches (5 cm) above iliac crest.

Question 37

PA, hourly

Answer 37

centered to iliac crest.

Question 38

position for PA small bowel series

Answer 38

Patient is prone (or supine if patient cannot lie in prone position) with a pillow for the head.

Question 39

Recommended Collimation (small bowel series)

Answer 39

Collimate on four sides to anatomy of interest.

Question 40

Respiration (small bowel series)

Answer 40

Suspend respiration and expose on expiration.

Question 41

Anatomy Demonstrated:

Answer 41

Entire small intestine is demonstrated on each radiograph, with the stomach included on the first 15-minute or 30-minute radiograph

Question 42

purpose is to demonstrate radiographically the form and function of the large intestine to detect any abnormal conditions

Answer 42

barium enema

Question 43

is an inflammatory condition of the large intestine that may be caused by many factors, including bacterial infection, diet, stress, and other environmental conditions

Answer 43

Colitis

Question 44

Because of chronic inflammation and spasm, the intestinal wall has a________ appearance.

Answer 44

“saw-tooth” or jagged appearance.

Question 45

is a severe form of colitis that is most common among young adults. It is a chronic condition that often leads to development of coin like ulcers within the mucosal wall.

Answer 45

Ulcerative colitis

Question 46

is an outpouching of the mucosal wall that may result from herniation of the inner wall of the colon.

Answer 46

diverticulum

Question 47

The condition of having numerous diverticula

Answer 47

diverticulosis

Question 48

diverticula become infected, the condition is ____

Answer 48

diverticulitis

Question 49

is a telescoping or invagination of one part of the intestine into another. It is most common in infants younger than 2 years of age but can occur in adults.

Answer 49

Intussusception

Question 50

Radiographically, progression of the barium through the colon terminates at a ______ dilation.

Answer 50

“mushroom-shaped” dilation.

Question 51

leading cause of death among both men and women

Answer 51

carcinoma of the large intestine

Question 52

are common in the large intestine

Answer 52

Neoplasms

Question 53

(neoplasm) The radiographic appearance of these tumors, as demonstrated during a barium enema, has led to the use of descriptive terms such as _______ lesions.

Answer 53

“apple-core” or “napkin-ring” lesions.

Question 54

one of the most typical forms of colon cancer, may form an “apple-core” or “napkin-ring” appearance as the tumor grows and infiltrates the bowel walls. It frequently results in large bowel obstruction.

Answer 54

Annular carcinoma (adenocarcinoma),

Question 55

are saclike projections similar to diverticula except that they project inward into the lumen rather than outward, as do diverticula.

Answer 55

Polyps

Question 56

is a twisting of a portion of the intestine on its own mesentery, leading to a mechanical type of obstruction

Answer 56

Volvulus

Question 57

CONTRAINDICATIONS TO LAXATI VES (CATHARTICS)

Answer 57

(1) gross bleeding, (2) severe diarrhea, (3) obstruction, and (4) inflammatory conditions such as appendicitis.

Question 58

Two different classes of laxatives

Answer 58

1. irritant laxatives, such as castor oil 2. saline laxatives, such as magnesium citrate or magnesium sulfate.

Question 59

Two different classes of laxatives

Answer 59

1. irritant laxatives, such as castor oil 2. saline laxatives, such as magnesium citrate or magnesium sulfate.

Question 60

A closed-system enema container is used to administer barium sulfate or an air and barium sulfate combination during the barium enema.

Answer 60

Barium Enema Containers

Question 61

three most common enema tips

Answer 61

(A) plastic disposable, (B) rectal retention, and (C) air-contrast retention enema tips.

Question 62

is the most common type of positive-contrast medium used for the barium enema.

Answer 62

Barium sulfate

Question 63

A standard mixture used for single-contrast barium enemas

Answer 63

between 15% and 25% weight-to-volume (w/v)

Question 64

A standard mixture used for thicker barium used for double-contrast

Answer 64

75% and 95% or greater.

Question 65

TYPES OF LOWER GI EXAMINATIONS (PROCEDURES )

Answer 65

1. Single-contrast barium enema 2. Double-contrast barium enema 3. Evacuative proctography (defecogram)

Question 66

is a procedure in which only positive-contrast media are used. In most cases, the contrast material is barium sulfate in a thin mixture.

Answer 66

single-contrast barium enema procedure

Question 67

contrast media for single-contrast barium enema procedure

Answer 67

water-soluble contrast material

Question 68

are more effective in demonstrating polyps and diverticula than single-contrast studies.

Answer 68

DOUBLE-CONTRAST BARIUM ENEMA PROCEDURE

Question 69

must be introduced in DOUBLE-CONTRAST BARIUM ENEMA PROCEDURE

Answer 69

both air and barium

Question 69

must be introduced in DOUBLE-CONTRAST BARIUM ENEMA PROCEDURE

Answer 69

both air and barium