Bontrager Ch 12 Biliary tract and Upper GI system

Define Acalasia

"caridospasm" motor disorder of the esophagus in which peristalsis is reduced along distal 2/3 of the esophagus

What's the ratio of water and barium in thin barium

1 to 1

What two ducts come together to form the hepatopancreatic ampulla?

1. Common Bile Duct 2. Pancreatic Duct (Duct of Wirsung)

What 4 things can you do to help demonstrate esophageal reflux?

1. breathing exercises 2. Water test 3. Compression paddle 4. toe touch maneuver

upper gastrointestinal series is designed to study what 3 structures

1. distal esophagus 2. stomach 3. duodenum

what are the sections of the duodenum in order from proximal to distal?

1. duodenal bulb or cap 2. duodenal papilla (decending) 3. horizontal portion 4. ascending portion

digestive system has 3 primary functions

1. intake 2. absorb 3. eliminate

Salivary glands secrete how much saliva per day?

1000-1500 mL / day

The pharynx is how long?

12.5 cm long

What's a good reference point for placing the IR for an esophogram?

2" above the shoulder

How long does it take to empty the stomach?

2-6 hours

The duodenum is how long?

20-24 cm

the esophagus is about _______ cm long

25 and 2 cm in diameter

Whats the ratio of water and barium for thick barium

3-4 parts barium to 1 part water

How long does it take chyme to pass through the entire small bowel?

3-5 hours

Gall bladder holds how many mL of bile?

30-40 mL

in an upper GI series how far do you rotate for LPO position

30-60 degrees

For the esophogram RAO and LAO positions how far do you oblique the pt?

35-40 degrees

in an upper GI series how far do you rotate for RAO position

40-70 degrees

The greater curvature is ___ times larger than the lesser curvature of the stomach?

5 times

The common bile duct averages approximately ____cm in length?

7.5 cm

What percent of gallstones are cholesterol?

75%

approximately ___% of patients with carcinoma of the gallbladder have stones.

80%

What is the make up of saliva

95.5% water .5% solutes or salts and certain digestive enzymes

A mixture of barium and water creates what?

A colloidal suspension (It does NOT dissolve in water!!!!!!***)

The gallbladder is (anterior or posterior) to the midcoronal plane?

Anterior

Whats the most common radiopaque contrast medium used for GI studies?

Barium Sulfate

What is the preferred contrast medium for the entire alimentary canal?

Barium sulfate mixed with water

Define esophageal varices

Dilated submucosal veins in the lower esophagus (often seen with acute liver disease)

What is the shortest and widest part of the small intestine (small bowel)?

Duodenum

What is the opening between the esophagus and stomach called?

Esophogastric junction Cardiac sphincter cardiac orifice

True / false? The nasopharynx is part of the digestive system

FALSE

Define achalasia

Failure of cardiac sphincter to relax, no peristaltic waves in lower esophagus

LPO fills which portion of the stomach with barium?

Fundus

What's the most posterior portion of the stomach?

Fundus

What are the three subdivisions of the stomach?

Fundus body Pylorus

Define Gastroesophageal reflux disease

GERD--entry of gastric contents into the esophagus, irritating the lining of the esophagus

What part of the stomach funnels fluids directly into the pylorus

Gastric Canal

for UGI at what level does the CR come to?

Level of L1

What is the suspensory muscle of the duodenum?

Ligament of Treitz

Bile is manufactured by which organs

Liver

biliary stenosis

Narrowing of bile ducts

7-10 cm long and 3 cm wide

Normal gallbladder is how long and how wide

The pylorus is divided into 2 different parts...what are they? proximal to distal

Pyloric antrum pyloric canal

What's the opening between the stomach and the small intestine (duodenum)?

Pyloric orifice pyloric sphincter

What are the common images for UGI series?

RAO PA / AP Right Lateral LPO

What are the common images for an esophogram?

RAO / LAP Lateral PA/AP

Falciform ligament

Structure that separates large right and small left lobes of liver

Cholecystocholangiogram

Study of both the gallbladder and the biliary ducts

between which two structures should you see the esophagus between in the RAO esophogram?

T-spine and Heart

The diaphragm is at the approximate level of ____

T10

The esophagus connects to the stomach at the approximate level of _____

T11

What's the most dilated portion of the alimentary canal?

The Stomach

Posterior inferior region of the liver

The gall bladder is located where in relation to the liver

Right Upper Quadrant (RUQ)

The liver occupies most of which quadrant

800-1000 mL (1 quart)

The liver secretes ____________ of bile per day.

3-4 lbs

What is the average weight of the adult human liver?

Define Barrett's esophagus

When the normal, squamous epithelium of the distal esophagus is replaced by columnar epithelium ulcer tissue in mid- lower espohagus

Define bezoar

a mass of undigested material that becomes trapped in the stomach

define peristalsis

a wavelike series of involuntary muscular contractions that propel solid and semisolid materials through the tubular alimentary canal

Major function of bile

aid in digestion of fats and in the absorption of fat after digestion

Another word for hepatopancreatic ampulla

ampulla of Vater

In order to place the IR as close to the gallbladder as possible it should be on what surface of the body?

anterior

The trachea is ______ to the esophagus

anterior

Define submandibular

below the mandible

Define sublingual

below the tongue

Define Trichobezoars

bezoar made up of undigested hair

cystic duct

carries bile to and from the gallbladder

What hormone causes the gallbladder to contract?

cholecystokinin (CCK)

the most common Gallstones are formed when

cholesterol becomes too concentrated in the gallbladder

cholelithiasis

condition of having gallstones

choledocholithiasis

condition of stones in the biliary ducts

esophagus begins posterior to the level of what structure?

cricoid cartilage (C5/ C6)

3-4 cm long

cystic duct is how long

define dysphagia

difficulty swallowing

Another word for pancreatic duct?

duct of wirsung

The junction between the duodenum and the next part of small bowel (jejunum) is called what?

duodenojejunal flexure

What is the 5th and final part of the upper GI

duodenum

What is the membrane covered cartilage that moves down to cover the opening of the larynx during swallowing?

epiglottis

the esophogram or barium swallow study which two structures

esophagus and pharynx

What's the most superior portion of the stomach

fundus

Bile is stored in the

gallbladder

choleliths

gallstones

choleliths

gallstones - caused when cholesterol becomes too concentrated.

A common site for impaction of gallstones

hepatopancreatic ampulla or ampulla of Vater

define sliding hiatal hernia

hiatal hernia caused by leaking of the esophageal sphincter

In which body habitus type is the stomach almost horizontal and high in the abdomen?

hypersthenic (5%)

in which body habitus type is the stomach hanging low and J shaped?

hyposthenia / asthenic

Cholecystitis

inflammation of the gallbladder (acute or chronic)

right lobe

largest lobe of the liver is which lobe

Where is the CR location for an Esophogram? (all body positions)

level of T6, 2-3" inferior to the jugular notch

What is the largest solid organ in the human body

liver

What are the 3 parts of the pharynx

nasopharynx, oropharynx, laryngopharynx

Define parotid

near the ear

neoplasm

new growth

Terminal end of the common bile duct is closely associated with which other duct?

pancreatic duct (duct of Wirsung)

describe the water test

patient lays supine in an LPO position and drinks a mouth full of water, if there is significant amounts of barium regurgitate into esophagus there is an issue

What are 2 contraindications for administering barium sulfate as a contrast medium?

perforated viscous pre-surgery

Radiolucent

permitting the passage of x-rays (appears black)

describe the muller maneuver

pt exhales then tries to inhale against a closed glottis

Describe the valsalva maneuver

pt takes a deep breath and hold while trying to bear down as though trying to make a bowel movement

Cholangiogram

radiographic image of bile ducts

Another word for hepatopancreatic sphincter

sphincter of Oddi

define hiatal hernia

stomach protrudes through diaphragm

3 functions of gall

store bile, concentrate bile, contract when stimulated

Radiopaque

substances that do not permit the passage of x-rays (appears white)

In order to drain the gallbladder patient should be in what position

supine

cholecystectomy

surgical removal of the gallbladder

between which two structures should you see the esophagus between in the LAO espohogram?

the T-spine and hilar region

define deglutition

the act of swallowing

define emesis

the act of vomiting

Define Rugae

the folds in the mucosa lining the stomach

4 lobes (2 major and 2 minor)

the liver is divided into how many lobes?

define hypertrophic pyloric stenosis

the most common type of gastric obstruction in infants. hypertrophy of the astral muscle at the orifice of the pylorus

define mastication

the process of chewing

right lobe

the two minor lobes of the liver are attached posteriorly to which major lobe?

define phytobezoar

undigested veggie fibers

define hematemisis

vomiting blood

Superior Border (8-9 inches)

which border of the liver is the longest