Chapter 13 Lower GI Situations

A patient is referred to the radiology department for a presurgical small bowel series. What modification to the standard study needs to be made for this patient?

Because the patient is having surgery soon after the small bowels series, a water-soluble, iodinated contrast medium should be used. Barium sulfate should not be administered to presurgical patients

A radiograph of a double-contrast BE projection shows an obscured anatomic side marker. The technologist is unsure whether it is an AP or PA recumbent projection. The transverse colon is primarily filled with barium, with the ascending and descending colon containing a lesser amount. Which position does this radiograph represent?

PA prone. Because the transverse colon is an intraperitoneal aspect of the large intestine located more anteriorly, it will fill with barium in the PA prone position

A patient with a clinical history of rectocele comes to the radiology department. Which radiographic procedure will best diagnose this condition?

Evacuative proctography

A radiograph of a lateral decubitus projection taken during an air-contrast BE show the upside aspect of the colon is overpenetrated. The following factors were used during this exposure: 120 kVp, 30 mAs, 40-inch SID, and compensating filter for the air-filled aspect of the large intestine. Which of these factors must be modified during the repeat exposure?

Even with the use of a wedge compensating filter, a reduction in kVp is required. Because less barium sulfate is used during an air-contrast procedure, the kVp range should be 90 -100

During the fluoroscopy aspect of a BE, the fluoroscopist detects an unusual defect within the right colic flexure. She asks the technologist to provide the best images possible of this region. Which two projections will best demonstrate the right colic flexure?

LPO or RAO projections

A patient is unable to lie prone on the radiographic table during a BE. Which specific projection best demonstrates the right colic flexure?

LPO position

A student technologist is told to place the patient on the x-ray table in a Sim's position in preparation for the tip insertion for a BE. Describe how the patient should be positioned?

Lie on the left side and flex head and upper body forward, drawing the right leg up above the partially flexed left leg.

A patient comes to the radiology department with a clinical history of Meckel diverticulum. Which imaging modality is most often performed for this condition?

Nuclear Medicine

An infant with a possible intussusception is brought to the emergency room. Which radiographic procedure may serve a therapeutic role in correcting this condition?

A barium enema or air enema often leads to re-expansion of the telescoped aspect of the large intestine

A patient come to the radiology department for a small bowel series. However, because of a stroke, the patient is unable to swallow the contrast medium. What type of study should be performed?

A diagnostic intubation small bowel series is preferred. A nasogastric tube is passed into the small intestine, allowing the contrast medium to be installed. This procedure is effective for patients who cannot swallow.

A patient with a clinical history of possible enteritis comes to the radiology department. Which type of radiographic GI study would most likely be indicated for this condition? (Of course, this would have to be requested by the referring physician)

A small bowel series (Enteritis is an inflammation or infection of the small intestine)

A patient's clinical history includes possible giardiasis. What radiographic procedures would likely be indicated for this condition?

A small bowel series (Giardiasis is a parasitic infection of the small intestine)

A patient has a clinical history of regional enteritis. Which of the following procedures is most often performed for this condition?

Enteroclysis

A patient with a clinical history of regional enteritis arrives at the radiology department. What type of procedure would be most diagnostic for this condition?

Enteroclysis, which is a double-contrast small bowel procedure. A routine small bowel series may also demonstrate this condition, but the enteroclysis with double contrast is more effective in demonstrating mucosal changes. A CT enteroclysis may provide further evidence of obstruction or narrowing of the small intestine.

Before a BE, the technologist experienced difficulty inserting the enema rectal tip (without causing significant pain for the patient). What should the technologist do to complete this task?

Inform the radiologist and have him or her insert the tip under fluoroscopic guidance

A radiograph of an AP axial BE projection of the rectosigmoid region shows there is considerable superimposition of the sigmoid colon and rectum. The following factors were used during this exposure: 120 kVp, 20 mAs, 40-inch SID, 35 degree caudad CR angle, and collimation. Which of these factors must be modified or corrected for the repeat exposure?

The CR was angled in the wrong direction. The AP axial projection requires a 30-40 degree cephalad angle.

A patient is scheduled for a CTC. What is the recommended patient preparation for this procedure?

The patient should undergo a cleansing bowel preparation. The morning of the procedure, food intake should be limited to clear liquids. The patient should wear loose-fitting clothing without any metal snaps or clips.

A BE study performed on a hypersthenic patient demonstrates that in the majority of radiographs, the left colic flexure was cut off. What can be done during the repeat exposure to avoid this problem?

Use two 14 x 17 -inch landscape IRs for the AP/PA projections, one centered higher and one lower. Because hypersthenic patients have a wider distribution of the large intestine, two landscape-placed cassettes will ensure that all of the pertinent anatomy is demonstrated.

A patient comes to the radiology department with a clinical history of giardiasis. She is scheduled for a BE procedure. Which of the following precautions must be followed during the procedure?

Wear gloves

During a BE, a possible polyp is seen in the left colic flexure. Which of the following projections will best demonstrate it?

RPO

A technologist has inserted an air-contrast retention tip for a double-contrast BE study. He is not sure how much to inflate the retention balloon. Should he inflate it as much as the patient can tolerate, or is there a better alternative?

Retention catheters should be fully inflated only by the radiologist under fluoroscopic guidance

A patient is scheduled for a double contrast BE. During the fluoroscopy phase of the study, the radiologist detects a possible polyp in the lower descending colon. Which specific projection best demonstrates this region of the colon?

Right lateral decubitus will drain excess barium from the descending colon, allowing for the detection of small polyps