Chapter 3 - Exam Study Guide

ileum

third part of the small intestine ; distal three-fifths

What are the 3 parts of the small intestine?

1. Duodenum 2. Jejunum 3. Ileum

Exposure factors for abdominal radiography:

1. Medium kVp 70 - 80 (analog) 80 (+ or -) 5 kV (digital) 2. short exposure time 3. adequate mAs based on part thickness

Which positioning routine should be used for an acute abdominal series if the patient is too ill to stand?

2 way abdomen- AP supine abdomen, left lateral decubitus

What exposure considerations would be most ideal for an AP abdomen of an average sized adult using a digital radiographic system?

80-85 kVp, grid, 40 inch SID

View that best demonstrates: ulcerative colitis

AP abdomen acute abdominal series

Best imaging modality: liver

CT & MRI

Best imaging modality: pancreas

CT & MRI

Situation: The ER physician suspects a patient has a kidney stone. The patient is sent to the radiology department to confirm the diagnosis. What specific positioning routine would be used to rule out the presence of a kidney stone?

KUB

Situation: A child goes to radiology for an abdomen study. It is possible that he swallowed a coin. The ER physicians believes it may be in the upper GI tract. Which of the following routines would best identify the location of the coin?

KUB and lateral abdomen

Major quadrants of the abdomen?

LUQ, RUQ, LLQ, RLQ

A KUB radiograph reveals that the symphysis pubis was cut off along the bottom of the image. Is this an acceptable radiograph? If it is not, how can this problem be prevented during the repeat exposure?

No ; reposition to lower the image to include the symphysis pubis

A radiograph of an AP abdomen reveals the left iliac wing is more narrowed than the right. What specific positioning error caused this?

Patient was rotated into a slight right posterior oblique (RPO) position.

Situation: A hypersthenic patient comes to the radiology department for a KUB. The radiograph reveals that the symphysis pubis is included on the image, but the upper abdomen, including the kidney, is cut off. What is the next step the technologist should take?

Repeat the exposure using two 14 x 17 in cassette placed crosswise. The hypersthenic patient often requires this type of IR placement for abdomen studies

Situation: A KUB radiograph reveals that the gonadal shielding is superior to the upper margin of the symphysis pubis. The female patient has a history of kidney stone. What is the next step the technologist should take?

Repeat the exposure without using gonadal shielding

A radiograph of an AP projection of an average-size adult abdomen was produced using the following exposure factors: 90 kV, 400 mA, 1/10 second, grid, and 40 inch ( 102 cm) SID using film/screen (analog) imaging system. The overall density of the radiograph was acceptable, but the soft tissue structures, such as the psoas muscles and kidneys, were not visible. Which adjustment to the technical considerations will enhance the visibility of these structure on the repeat exposure?

The selected kV ( 90kV) was too high. The technologist needs to lower the kV to between 70 to 80 kV. The milliamperage and exposure time can be altered to maintain the density.

Situation: A patient with a possible dynamic ileus enters the emergency room. The patient is able to stand. The physician has ordered an acute abdominal series. What specific positioning routine should be used?

The three-way acute abdominal series, including the anteroposterior (AP) supine and erect abdomen and posteroanterior (PA) erect chest projections

Situation: A patient with a possible perforated duodenal ulcer enters the emergency room. The ER physician is concerned about the presence of free air in the abdomen. The patient is in severe pain and cannot stand. What positioning routine should be used to diagnose this condition?

The two-way acute abdomen series: AP supine abdomen and left lateral decubitus

Kidney placement in the abdomen:

They are located on either side of the lumbar vertebral column.

Organs in the RLQ:

ascending colon, appendix (vermiform), cecum, 2/3 of ileum, ileocecal valve

Situation: A patient comes from the ER with a large distended abdomen caused by an ileus. The physician suspects that the distention is caused by a large amount of bowel gas that is trapped in the small intestine. The standard technique for a KUB on an adult is 76 kV, 30 mAs. Should the technologist change any of these exposure factors for this patient? (AEC is not being used)

Yes. Decrease the milliamperage seconds (mAs)

volvulus (clinical indication)

a twisting of a loop of bowel creating an obstruction

ascites (clinical indication)

abnormal accumulation of fluid in the peritoneal cavity

View that best demonstrates: Crohn disease

acute abdominal series

View that best demonstrates: Fibrous adhesions

acute abdominal series

View that best demonstrates: Ileus

acute abdominal series

View that best demonstrates: Intussusception

acute abdominal series

View that best demonstrates: Volvulus

acute abdominal series

Most common radiographic exam for fibrous adhesions? Possible radiographic appearance?

acute abdominal series ; distended loops of air-filled small intestine ;

intussusception (pathologic condition)

air filled "coiled spring" appearance

Situation: A patient in intensive care may have developed intra - abdominal bleeding. The patient is in critical condition and cannot go to the radiology department. The physician has ordered a portable study of the abdomen. Which specific position or projection can be used to determine the extent of the bleeding?

bedside portable left lateral decubitus projection

adynamic (paralytic) ileus (clinical indication)

bowel obstruction caused by a lack of intestinal peristalsis

Ileus (nonmechanical bowel obstruction)

categorized as adynamic ileus and most frequently is caused by peritonitis, or paralytic ileus which is caused by a lack of intestestinal motility

Crohn's disease (clinical indication)

chronic inflammation of the intestinal wall that may result in bowel obstruction

dynamic bowel obstruction

complete or nearly complete blockage of the flow of intestinal contents

ulcerative colitis (pathologic condition)

deep air filled mucosal protrusions of colon wall

Organs in the LLQ:

descending colon, sigmoid colon, 2/3 of jejunum

Crohn's disease (pathologic condition)

distended loops of air filled small intestine

Which decubitus position best demonstrates a possible aneurysms, calcifications of the aorta or umbilical hernias?

dorsal decubitus

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

erect AP abdomen

imaging modalities that requires the use of intravenous, iodinated contrast media for studies of the abdomen:

excretory or intravenous urogram

causes of dynamic bowel obstruction include:

fibrous adhesions, Crohn disease, intussusception, volvulus

duodenum

first portion of the small intestine ; shortest, but widest (about 25 cm (10 in.) in length

Pneumoperitoneum (clinical indication)

free air or gas in the peritoneal cavity

ascites (pathologic condition)

general abdominal haziness

What structure is a double fold of peritoneum that connects the transverse colon to the greater curvature of the stomach?

greater omentum

ulcerative colitis (clinical indication)

inflammatory condition of the colon

With the use of _______, CT imaging can discriminate between a simple cyst and a solid neoplasm.

intravenous, iodinated contrast media

Why should a patient be placed in the decubitus position for a minimum of 5 minutes before exposure?

to allow intra-abdominal air to rise and to allow abnormal fluid to accumulate

A radiographic image of an AP projection of the abdomen demonstrates motion. The following exposure factors were selected : 78 kV, 200 mA, 2/10 second, grid, and 40 in ( 102 cm) SID. The technologist is sure that the patient did not breathe or move during the exposure. What may have caused this blurriness? What can be done to correct this problem on the repeat exposure?

involuntary motion ; increase mA and decrease exposure time

Retroperitoneal organs:

kidneys, ureters, adrenal glands, pancreas, c-loop of duodenum, ascending & descending colon, upper rectum, major abdominal blood vessels (aorta & inferior vena cava)

volvulus (pathologic condition)

large amount of air trapped in sigmoid colon with a tapered narrowing at the site of obstruction

Which decubitus position of the abdomen best demonstrates intraperitoneal air in the abdomen?

left lateral decub- free air is best seen in the upper right area of the liver

Air needs _____ penetration while fluid needs _____.

less ; more

Organs in the RUQ:

liver, gallbladder, right colic (hepatic) flexure, duodenum (C-loop), head of pancreas, right kidney, right suprarenal gland

Intraperitoneal organs:

liver, gallbladder, stomach, spleen, jejunum, ileum, cecum, sigmoid colon

Retroperitoneal

located behind the peritoneal cavity

Infraperitoneal

located under or beneath the peritoneal cavity

Infraperitoneal organs:

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

Which of the structure helps stabilize and support the small intestine?

mesentery

Location of liver:

occupies the majority of the RUQ

Organs for digestion:

oral cavity, pharynx, esophagus, stomach, small intestine, large intestine

pyelo-

pelvis

Location of gallbladder:

posterior and inferior to the liver

Location of spleen:

posterior and to the left of the stomach in the LUQ

Location of pancreas:

posterior to the stomach and near the posterior abdominal wall, between the duodenum and the spleen

umbilical hernia

protrusion of part of the intestine at the navel

The _____ kidney is situated a little more inferior than the other because of the __________.

right ; presence of the large liver on the right

jejunum

second part of the small intestine ; two-fifths

What technical considerations are essential when performing abdomen studies on a pediatric patient?

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

What are the parts of the parts of the lymphatic system?

spleen, lymph nodes, lymph vessels, lymph glands

Organs in the LUQ:

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

gastro-

stomach

intussusception (clinical indication)

telescoping of a section of a bowel into another loop of bowel

Fibrous adhesions

the most common cause of mechanically based obstruction, in which a fibrous band of tissue interrelates with the intestine, creating a blockage

Pneumoperitoneum (pathologic condition)

thin crest shaped radiolucency underneath diaphragm

Best imaging modality: gallbladder

ultrasound

Best imaging modality: spleen

ultrasound

Intraperitoneal

within the peritoneal cavity