Systems-GI procedures of esophagus and stomach Flashcards
1
Q
What is the concentration of barium for the esophagus?
A
30-50%
2
Q
What is the concentration of barium for the Stomach: Upper GI series?
A
30-50%
3
Q
What is the concentration of barium for the Small Intestine: Small bowel series?
A
40-60%
4
Q
What is the concentration of barium for the Large intestine: Barium enema?
A
12-25%
5
Q
What is the concentration of barium of the GI for CT?
A
12-25%
6
Q
What are the proceedures where barium can be administered orally?
A
- Esophagus
- Stomach: Upper GI series
- Small Intestine: Small bowel series
- GI for CT
7
Q
What is the method of administration for the Small Intestine: Small bowel series
A
Oral or Naso-duodenal
8
Q
What proceedure is this for?
Large amount of fluids day before exam. NPO after midnight before exam. Cleansing enema prior to exam
A
Large intestine: Barium enema
9
Q
What proceedure is this for?
NPO after midnight before exam
A
GI for CT and Stomach: Upper GI series
10
Q
What proceedure is this describing?
Low residue diet eaten for 2 days prior to exam
A
Small Intestine: Small bowel series
11
Q
What patient prep needs to be done for esophagus imaging?
A
None
12
Q
T/F
Higher concentrations are needed for double contrast enemas
A
True
13
Q
Is barium sulfate positive or negative contrast?
A
Positive
14
Q
What is this substance?
BaSO4
A
Baruim
15
Q
What is one contraindication to Water-Soluble Iodinated Contrast Media?
A
Hypersensitivity to iodine
15
Q
What are indications for imaging with Water-Soluble Iodinated Contrast Media?
A
- Perforated viscus
- Presurgical procedure
16
Q
What type of contrast is used here?
A
Single-Contrast UGI (barium only)
17
Q
What type of contrast has been used here?
A
Double-Contrast UGI
18
Q
What is double contrast?
A
Barium sulfate (positive contrast) and
Carbon dioxide gas or room air (negative contrast)
19
Q
T/F
CO2 or air can be administered with tablets/crystals or a pump
A
True
20
Q
Where is the esophagus located in relation to the trachea?
A
Posterior to the trachea
21
Q
What are the indentations in the esophagus caused by?
A
-2 indentations for the arch of aorta
-1 indentation left primary bronchus
-1 partial indentation from the heart
22
Q
What is reflux into the esophagus?
A
Reflux involves the cardiac sphincter relaxing or not fully closing, allowing stomach contents to regurgitate back into the esophagus.
23
Q
What are varices in the esophagus?
A
Blood vessels around the esophagus becoming enlarged
24
What are the Technologist Responsibilities for imaging of the stomach and the esophagus?
1. Prepare fluoro room (Equipment set up, Contrast, supplies)
2. Obtain clinical history
3. Explain procedure
4. Observe and support patient throughout
5. Introduce and assist the fluoroscopist
6. Assist the patient
25
What is “Deglutition”
The act of swallowing
26
What is Peristalsis most prevelent?
The greatest motility in stomach and proximal portion of small intestine
27
# T/F
Peristaltic activity decreases along the intestinal tract
True
28
Why are shorter exposure times for upright and hypermotile pts?
Shorter exposure times are required for upright imaging because gravity helps the contrast agents move quicker through the esophagus
29
What is motility?
The speed at which the GI tract moves material through it
30
Why are exposures of the stomach and esophagus done at the end of expiration?
Imaging at the end of expiration delays the barium at the distal end of the esophagus for a few seconds, making it easier to catch in imaging.
31
What are some contraindications to esophageal imaging?
1. Allergy to contrast
2. Perforation (possibly)
3. High risk of aspiration
4. Uncooperative patient
32
What are the two body positions for imaging of the esophagus?
Erect and recumbent
33
What modality is used for imaging of the esophagus?
Floro
34
What are the different studies done during imaging of the esophagus for a patient step by step?
1. Fluoro with patient erect
2. Administer Barium thick and thin
3. Place patient horizontal (drink with straw)
4. Possible Trendelenburg
5. Phonation or breathing maneuvers
6. Recumbent studies
7. Coughing
35
What is the purpose of doing trandelenberg imaging for the esophagus?
To image for hiatus hernia, reflux
36
What is the purpose of doing recumbent imaging for the esophagus?
Demonstration of esophageal varices
37
What is the purpose of doing a coughing study for imaging of the esophagus?
Demonstrates reflux through cardiac sphincter
38
# T/F
Esophageal imaging is only done with double contrast.
False; done with either single or double contrast
39
What are the projections done for the esophagus imaging?
AP, PA, OBL’s, Lateral projections
40
What is the centering point for the esophagus projections?
CP is C4-C5 examining high in respiratory tract or CP is T5–T6 if digestive tract
41
For the oblique images of the esophagus, how much should the patient be obliquied?
35º-40º
42
What projection is this?
AP or PA esophagus
43
What position and projection is this?
RAO esophogram
44
What are the 4 tests that are used for diagnosis of esophageal reflux?
1. Valsalva maneuver
2. The water test
3. Compression paddle technique
4. The toe-touch test
45
Why is the Valsalva Maneuver done when looking for pathologies in the esophagus?
Valsalva increases venous pressure; can demonstrate esophageal varices
46
What is the valsalva maneuver?
Patient takes in deep breath and holds breath in while bearing down as if trying to move the bowels.
47
What is the Müller Maneuver?
Patient exhales then tries to inhale against closed glottis
48
What does the Müller Maneuver demonstrate?
R/O (rule out) aspiration or incompetent valves
49
When is the waters test positive?
Positive if barium regurgitates into esophagus
50
What pathology is being shown here?
GERD (contrast regurgitating)
51
Where is the compression paddle placed in esophageal imaging?
Paddle inflated under stomach with patient in prone position
52
What is the purpose of the compression paddle in esophageal imaging?
To create pressure applied to stomach region to create reflux
53
What does the toe-touch maneuver demonstrate?
Effective to demonstrate reflux and hiatal hernia
54
What is a Modified Barium Swallow done for?
Done for dysphagia or rehabbing patients (strokes)
55
# T/F
Modified barium swallows can be done wtih the patient sitting or standing, but mostly sitting
True
56
# T/F
When evaluating dysphagia you typically start with thinner materials, to see what kinds of food the patient can tolerate
True
57
# T/F
UGI's are typically done with liquids, even though it can be referred to as a Barium Meal
True
58
What does the UGI proceedure evaluate?
1. Mouth and upper esophagus
2. Distal esophagus
3. Stomach
4. Some of the small intestine
59
Label 1-4
1. Cardiac notch
2. Fundus
3. Body
4. Pyloric portion
60
Label 1-7
1. Descending duodenum
2. Pyloric sphincter
3. Pyloric antrum
4. Greater curvature
5. Fundus
6. Duodenal bulb
7. Lesser curvature
61
What is the Shortest and widest portion of the duodenum?
The C loop
62
What part of the duodenum is retroperitaneal?
The descending and ascending
63
Label 1-5
1. Superior duodenum
2. Descending duodenum
3. Horizontal duodenum
4. Ascending duodenum
5. Ligament of Tritez
64
Label 1-5
65
**What is the most posterior part of the stomach?**
The fundus
66
**Where is the body of the stomach located in relation to the fundus?**
Anterior/inferior to fundus
67
**Where is the pylorus located in relation to the body of the stomach?**
Posterior/distal to body
68
What is the difference in stomach position in hypersthenic patients vs. asthenic patients?
Hypersthenic tends to be wider and flatter, while asthenic tends to be narrow stretched downwards.
69
What body habitus is this patient?
Hypersthenic
70
What body habitus is this patient?
Asthenic or hyposthenic
71
What is the body habitus of this patient?
Sthenic
72
Where is the stomach located at in hypersthenic patients?
T11-T12
73
Where is the stomach located in asthenic/hyposthenic patients?
L3-L4
74
Where is the stomach located in sthenic patients?
f L1-L2
75
What are the 4 methods for imaging the stomach?
1. Single Contrast (SC)
2. Double Contrast (DC)
3. Biphasic
4. Hypotonic Duodenography
76
What is
Biphasic imaging for the stomach?
Combination of single and double contrast methods
77
Give 3 examples of indications for imaging the stomach:
1. Gastric cancer
2. Polyps
3. Diverticula
78
What are the contraindications to imaging of the stomach (UGI)?
1. Complete large bowel obstruction
2. Perforations (possibly)
3. Patients aspirating contrast instead of swallowing it
4. Contrast allergy
79
What patient prep needs to be done prior to imaging the stomach?
1. NPO 8-9 Hrs.
2. No smoking or chewing of gum after midnight
3. Remove all clothing, hospital gown
4. Sometimes laxative or enema to cleanse the large bowel
80
# T/F
Single contrast has low density
True
81
What is the single contrast used in UGI imaging?
Ba Suspension 30%-50%
82
Why is the trandelenberg position used in UGI imaging?
To detect any abnormal alteration in the function, position, shape or contour of the esophagus, stomach or duodenum
83
What is the advantage of using double contrast is UGI imaging?
Advantage – small lesions less obscured, mucosal lining clearly visualized
84
# T/F
Double contrast has high density.
True
85
What is the double contrast used in UGI imaging?
Ba Suspension 250% wt./vol range, and CO2 producing crystals
86
What type of medications can be used for reducing peristalsis and relaxing the smooth muscles for UGI imaging?
Hyoscine Buscopan, Glucagon
87
When in the PA -recumbent position, what parts of the stomach will contain the barium?
Body, pylorus, and duodenal bulb are barium filled
88
When in the AP -recumbent position, what parts of the stomach will contain the barium?
Fundus
89
What post care instructions should be given to patients after UGI imaging?
1. White bowel movements
2. To avoid impaction – plenty of fluids
90
Is this taken prone or supine?
prone
91
Is this taken prone or supine?
Supine
92
Picture for understanding
Keep going :)
93
What is shown in a right lateral UGI?
Retrogastric space, duodenal loop, and duodenojejunal junction
94
What is shown in a left lateral UGI?
Left retrogastric space
95
What part of the stomach will be filled with barium in an LPO UGI?
Fundus filled with barium
96
How was this image acquired?
AP supine
97
How was this image acquired?
RAO prone
98
Which position will show Dynamic emptying of the stomach?
40°-70° oblique RAO UGI
99
Should the Duodenal bulb and C-loop be in profile for the RAO position of the stomach?
Yes
100
What projection can be done to\ open up hypersthenic patients’ stomachs to show the greater and lesser curvatures, the antral portion of the stomach, the pyloric canal, and the duodenal bulb?
PA Axial projection with a 35-45° cephalad angle
101
What projections are done in UGI imaging?
1. PA -recumbent
2. AP -recumbent
3. RAO - 45°
4. LPO - 45 °
5. Right Lateral
102
What parts of the stomach are visualized in an RAO 45 degree oblique?
Entire duodenal C - loop –image of pyloric canal & duodenal bulb
103
What parts of the stomach are filled with barium in an LPO - 45 ° O?
Fundus
104
What parts of the stomach are being examined in a right lateral?
Pyloric canal and the duodenal bulb
