1311 Ch. 3

iliac crest

at the level of the L4-L5, most common used abdominal landmark

greater trochanter

easily palpated on thin patients. same level as superior border of symphysis.

intravenus urogram (IVU)

radiographic examination of the urinary system

no. a KUB must include the symphysis pubis on the radiograph to ensure that the bladder is seen. the positioning error involves centering of the central ray to the iliac crest. the technologist should also palpate the symphysis pubis (if permitted by institutional policy) or greater trochnater to ensure that it is above the bottom of the cassette.

a KUB radiograph reveals that symphysis pubis was cut off along the bottom of the image. is this an acceptable radiograph? how can this problem be prevented during the repeat exposure?

KUB and lateral abdomen

a child goes to radiology for an abdomen study. it is possible that he swallowed a coin. the ER physician believes it may be in the upper GI tract. which of the following routines would best identify the location of the coin?

greater omentum

a double fold of peritoneum that connects the transverse colon to the greater curvature of the stomach

erect AP abdomen

a patient with a history of ascites comes to the radiology department. which one of the following positions best demonstrates this condition?

the three way acute abdominal series, including the anteroposterior supine and erect abdomen and posteroanterior erect chest projections

a patient with a possible dynamic ileus enters the ER. the patient is able to stand. the physician has ordered an acute abdominal series. what specific positioning routine should be used?

the two way acute abdomen series, including the anteroposterior supine abdomen and left lateral decubitus.

a patient with a possible perforated duodenal ulcer enters the ER. the ER physician is concerned about the prsence of free ait in the abdomen. the patient is in severe pain and cannot stand. what positioning routine should be used to diagnose this condition?

umbilical

abdominal region found directly in the middle of the abdomen

pubic

abdominal region that contains the rectum

Ascites

abnormal accumulation of fluid in peritoneal cavity of the abdomen. possible radiographic appearance: abdominal haziness

pancreas, liver, gallbladder

accessory digestive organs

right lower quadrant

ascending colon appendix cecum 2/3 of ileum ileocecal valve

Hypersthenic

body habitus that may require two 14 x 17 image receptors to be placed crosswise if the entire abdomen is to be included

Asthenic

body habitus that may require two 14x17 image receptors to be placed lengthwise if the entire abdomen is to be included

ileus nonmechanical bowel obstruction

categorized as adynamic (without force) ileus and most frequently is caused by peritonitis or paralytic ileus, which is caused by a lack of intestinal motality. possible radiographic appearance: large amounts of air in entire dilated small and large intestine with air fluid levels visualized

AP supine

center of IR is mid sagittal and level to iliac crest. make exposure at the end of expiration. Best for visualization of the kidneys because they are closer to the IR.

PA prone

center of IR is midsagittal and level to the iliac crest. make exposure and the end of expiration

ulcerative colitis

chronic disease involving inflammation of the colon that primarily occurs in young adults and most frequently involves the rectosigmoid region. DO NOT USE BARIUM ENEMA! possible radiographic appearance: deep air filled mucosal protrusion of colon wall, usually in rectosigmoid region

Crohns disease

chronic inflammation of the intestional wall that results in bowel obstruction possible radiographic appearance: distended loops of air filled small intestine

left lower quadrant

descending colon sigmoid colon 2/3 jejunum

ischial tuberosity

determine the lower margin on a PA abdomen with patient in a prone position.

expiration

exposure for an AP projection of the abdomen should be taken on

Pneumoperitoneum

free air or gas in the peritoneal cavity. possible radiographic appearance: thin crest shaped radiolucency under dome of right hemidiaphragm on erect

females

gonadal shielding for ____ may be impossible for studies of the lower abdominopelvic region

anterior superior iliac spine (ASIS)

gonadal shielding for females involves placing the top of the shield at or slightly above the level of the ____, with the bottom at the symphysis pubis

it obscures essential anatomy

gonadal shielding should not be used during abdomen radiography if:

mesentery

helps stabilize and support the small intestine

4th lumbar vertebra to 5th lumbar vertebra. the central ray is centered to the level of the ____ for a supine AP projection of the abdomen.

iliac crest

Retroperitoneal organs

kidneys ureters adrenal glands pancreas c loop of duodenum ascending and descending colon upper rectum aorta and inferior vena cava

xiphoid process

level of T9-T10

right upper quadrant

liver gallbladder right colic (hepatic) flexure duodenum head of pancreas right kidney right suprarenal gland

Intraperitoneal organs

liver gallbladder spleen stomach jejunum ileum cecum transverse colon sigmoid colon

Infraperitoneal organs

lower rectum urinary bladder reproductive organs male - closed sac female - open sac (uterus, tubes, ovaries, extending into the peritoneal cavity)

70-80 kVp with the shortest exposure time

most ideal exposure considerations for an AP abdomen of an average sized adult.

spleen

not an accessory digestive organ. considered to be part of the lymphatic system.

what abdominal structure is not visible on a properly exposed KUB?

pancreas

duodenum, jejenum, ileum

parts of the small intestine

peristalic action

primary cause for involuntary motion in the abdomen.

iliac wings, ischial spine, obturator formanion, outer rib margins

rotation can be determined on a KUB radiograph by the loss of symmetric appearance of:

left upper quadrant

spleen stomach left colic (splenic) flexure tail of pancreas left kidney left suprarenal gland

short exposure times, high speed image receptor, reduced kV and mAs.

technical considerations essential when performing abdomen studies on a young pediatric patient.

shortest exposure time possible

the best mechanism to control involuntary motion

Peritoneum

the double walled membrane lining the abdominopelvic cavity

right lower, cecum

the large intestine begins in the ____ quadrant with a saclike area called the ____

retroperitoneal

the organs located posteriorly to the serous membrane lining of the abdominopelvic cavity

Ultrasound

the preferred imaging modality for examining the gallbladder quickly. used to evaluate patients with acute appendicitis.

symphysis pubis, symphysis pubis

the prominence of the greater trochanter is about the same level of the superior border of ____ and the lower margins of the ischial tuberosities is about 1 1/2 inches (1-4 cm) distal to the____

descending colon, rectum

the sigmoid colon is located between the ____ and ____ of the large intestine.

Intussusception

the telescoping of a secion of bowel into another loop. (primarily in infants). requires treatment within 48 hours to prevent necrosis (tissue death) possible radiographic appearance: air filled coiled spring appearance

why is it recommended to take abdominal radiographs at the end of patient expiration?

to increase the room for expansion of the abdominal organs within the abdominal cavity

inferior costal (rib) margin

topographic landmark found at the level of L2-L3

symphysis pubis

topographic landmark that corresponds to the inferior margin of the abdomen and is formed by the anterior junction of the two pelvic bones.

Two Transverse/Horizontal Planes

transplyoric plane and transtubercular plance

breathing and patient movement during exposure

two causes of voluntary motion

Psoas major

two large muscles found in the posterior abdomen adjacent to the lumbar vertebra and usually visible on an anteroposterior (AP) radiograph

lateral decubitus (AP)

used for abdominal masses, air-fluid levels, and possible accumulations of intraperitoneal air are demonstrated. patient should be on his side for a minimum of 5 minutes before exposure. IR and CR approximately 2 inches above level of iliac crest to include diaphragm. exposure at end of expiration.

dorsal decubitus (right or left lateral)

used for abnormal masses, accumulations of gas, air fluid levels, aneurysms, vein or heart. cr horizontal to center of IR 2 inches above iliac crest and to midcoronal plane. use arrow markers as well.

AP projection - erect

used for abnormal masses, air-fluid levels, and accumulations of intraperioneal air under diaphragm. IR should be 2 inches above iliac crest to include diaphragm. exposure should be at the end of expiration.

lateral position

used for foreign bodies, abnormal masses, umbilical hernia, prevertebral region for possible aneurysms of aorta or calcifications. CR perpendicular to table, centered at level of iliac crest to midcoronal plane.

careful instructions

voluntary motion can be prevented by

radiolucent pad

what should be placed underneath geriatric patients for added comfort?

posteriorly

where is the pancreas located in relation to the stomach?

suprarenal (adrenal) glands

which endocrine glands are superomedial to each kidney?

ileum

which portion of the small intestine is the longest?

the liver is on the right side

why is the right kidney found in more of a inferior position than the left kidney?

Computed tomography

with the use of iodinated contrast media, ____ is able to distinguish between a simple cyst or tumor of the liver.