Test 4 Biliary, UGI, Lower GI Systems

Question 1

Where is the barium in the stomach when prone?

Answer 1

Body

Question 2

Where is the barium located in the stomach when errect?

Answer 2

Pylorus region

Question 3

What is peristalsis?

Answer 3

Movement of gastric contents towards the pylorus

Question 4

What is mastication?

Answer 4

The mechanical part of digestion. Chewing, reduces size of food particles and mixes with saliva.

Question 5

What is deglutition?

Answer 5

Swallowing

Question 6

What are the 3 functions of the digestive system?

Answer 6

Intake and digestion of food, water, vitamins and minerals, absorption of digested nutrients into the blood or lymphatic capillaries, and elimination of unused intake from the body

Question 7

When is barium contraindicated? What can be substituted?

Answer 7

If perforation is suspected or if the patient is going to surgery. May substitute with a water soluble iodinated contrast such as gastrografin.

Question 8

Where is the barium located in the stomach when supine?

Answer 8

Fundus

Question 9

What is a positive contrast medium used?

Answer 9

Barium sulfate (BaSO4) radiopaque

Question 10

What is a Negative contrast medium used?

Answer 10

Swallowed air, CO2 gas crystals and naturally present gas bubble in the stomach

Question 11

What does thick barium do that thin doesn’t?

Answer 11

Descends slowly down the esophagus and coats the mucosal lining.

Question 12

What is the reason to do a double contrast study versus a single contrast?

Answer 12

Double will demonstrate potential polyps, diverticulae, and ulcers

Question 13

What is Barrets esophagus?

Answer 13

Ulcerative tissue, lower esophagus may cause stricture

Question 14

What are esophageal varices and what causes them?

Answer 14

Displayed veins causing worm like or cobblestone appearance. Caused by acute liver disease such as cirrhosis.

Question 15

What is achalasia?

Answer 15

Cardiospasm motor disorder with reduced peristalsis, dilation

Question 16

What is zenkers diverticulum?

Answer 16

Large out pouching just above upper esophageal sphincter. Symptoms include dysphagia, aspiration and regurgitation.

Question 17

Hypersthenic organ locations:

Answer 17

Lungs: short
Stomach: high and transverse, center 1” below zyphoid process
Transverse colon: high
Large bowel: extends to the periphery of abdominal cavity

Question 18

Sthenic organ locations:

Answer 18

Stomach: J shaped and lower.

Left colic flexure is high resting under left diaphragm

Question 19

Hyposthenic and Asthenic organ locations:

Answer 19

Stomach: J shaped and low, very near the midline.
Lungs: long and narrow
Diaphragm: low
Large intestine is low in the abdomen

Question 20

What things might the patient have to swallow during an esophagram?

Answer 20

Liquid barium, cotton balls soaked in barium, barium tablets, marshmallows followed by thin barium.

Question 21

Routine patient prep for an UGI?

Answer 21

NPO from midnight or at least 8 hours before exam. No smoking or gum chewing bc it increases gastric secretions. 0-1years: NPO 4hrs
+1year: NPO 6 hours
LMP

Question 22

What is the Valsalva maneuver?

Answer 22

Demonstrates reflux. Patient takes in deep breath while beating down as if making a bowel movement. Forces air against the closed glottis.

Question 23

What is the modified Valsalva maneuver?

Answer 23

Demonstrates reflux. Patient pinches nose, closes mouth, and tries to blow nose. Cheeks expanded

Question 24

What is the Mueller Maneuver?

Answer 24

Demonstrates reflux. Patient exhales and then tries to inhale against closed glottis.

Question 25

What is the water test?

Answer 25

Demonstrates reflux. Patient swallows water and the radiologist observes the esophagogastric junction for regurgitation under fluoro.

Question 26

What is the compression technique?

Answer 26

Demonstrates reflux. Paddle is placed under prone patient and inflated to provide pressure to the stomach to demonstrate the esophagogastric junction.

Question 27

What is the toe touch maneuver?

Answer 27

Demonstrates reflux. The esophagogastric junction is observed as the patient bends over and touches their toes. Also may demonstrate hiatal hernias.

Question 28

Explain the enteroclysis procedure:

Answer 28

- double contrast study of the small bowel. - Pt intubated under fluoro w/ an enteroclysis catheter that is passed thru the stomach into the duodenum. A bilbao or sellnik catheter is advanced to the duodenojejunal flexure. high density barium is injected 100mL/min, followed by either air or methyl cellulose to distend the bowel.

Question 29

what does adding the two types of contrast in the enteroclysis procedure do?

Answer 29

- dilate the loops of SB | - increase visibility in the mucosa

Question 30

what are the indications of enteroclysis?

Answer 30

SB ileus regional enteritis (crohns) malabsorbtion syndrome

Question 31

what is the kvp for single contrast barium studies?

Answer 31

100-125 kvp

Question 32

what is the kvp for double contrast barium studies?

Answer 32

90 kvp

Question 33

how can small and large intestine be differentiated radiographically?

Answer 33

- the large intestine has a greater diameter. | - the presence of haustra indicates large intestine.

Question 34

what is the large intestine made up of?

Answer 34

3 external bands of muscle fibers from the taeniae coli, which pull the large intestine into sacculations called haustra.

Question 35

what are the contraindications of a BE?

Answer 35

- suspected perforated hollow viscus - possible LB obstruction - if a biopsy had been performed recently - pregnancy

Question 36

what is the CR for BE RAO and LPO?

Answer 36

IC and 1" lateral to the upside of MSP

Question 37

what is the CR for BE LAO and RPO?

Answer 37

1-2" above IC and 1" lateral to the upside of MSP

Question 38

what is the CR of the right and left lateral decubitus?

Answer 38

asis and MSP

Question 39

what is a colostomy?

Answer 39

surgical formation of an anastomosis between two portions of the large bowel. Part of the bowel may be removed and an artificial opening is created brining the intestine to the surface of the abdomen at a stoma.

Question 40

How is a BR performed on a colostomy patient?

Answer 40

contrast is administered into the stoma and the rectum. the stoma has no sphincter so must use a colostomy BE kit that includes adhesive to hold the barium in the stoma.

Question 41

Patient prep for a BE:

Answer 41

- light evening meal - cleansing cathartics - NPO 8 hours

Question 42

BE procedure:

Answer 42

- drain air from tip - insert tip towards umbilicus and then slightly anterior, then superior - BE bag 24" above table

Question 43

BE film sequence:

Answer 43

``` PA or AP RAO and LAO LPO and/or RPO lateral rectum R and L lateral decubitus (for double contrast) ```

Question 44

what are the special projections of the BE?

Answer 44

AP axial AP axial oblique PA axial PA axial oblique

Question 45

why is a PA projection preferred over an AP in a BE?

Answer 45

compression of the abdomen in the PA results in a more uniform density of entire abdomen.

Question 46

what are indications of a BE?

Answer 46

ulcerative collitis, diverticulosis, diverticulitis, neaplasms, volvulus, intussusception, appendicitis.

Question 47

what are the indications of SBS?

Answer 47

enteritis or gastroenteritis, meckels diverticulum, neoplasm, malabsortion syndrome, ileus obstruction, whipples disease, lymphoma adencarcinoma

Question 48

what are the pathological indications of the upper GI system?

Answer 48

``` peptic ulcer hiatal hernia diverticula gastritis tumor bezoar ```

Question 49

what is the CR for RAO esophogram?

Answer 49

T5-T6 and 1" inferior to sternal angle

Question 50

where is the CR for the upper GI series?

Answer 50

L1