Bontrager Workbook: Chapter 3-Abdomen

Location: Spleen, left colic flexure, stomach, two-thirds of jejunum

LUQ

Liver, spleen, transverse colon, stomach

intraperitoneum

telescoping of a section of bowel into another loop of bowel; appearance- air-filled "coiled spring"

intussusception

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

presence of the liver on right

True/False For an adult abdomen, a collimation margin must be visible on all four side of the radiograph.

False

True/False The correct term for the radiographic study of the urinary system is intravenous pyelogram (IVP)

False (IVU)

List the projections commonly performed for an accurate abdominal series or three-way abdomen series.

1. AP supine 2. AP erect or lateral decubitus abdomen 3. PA erect chest

List the three parts of the small intestine

1. duodenum 2. jejunum 3. ileum

Rotation can be determined on a KUB radiograph be the loss of symmetric appearance of?

1. iliac wings 2. obturator foramina 3. ischial spines 4. outer rib margins

List the three accessory digestive organs

1. pancreas 2. liver 3. gallbladder

What are the two causes of voluntary motion?

1. patient breathing 2. patient movement during exposure

Which projection of the three-way acute abdominal series demonstrates free air under diaphragm?

PA chest

Location: Appendix

RLQ

True/False A radiolucent pad should be placed underneath geriatric patients for added comfort?

True

Exposure for an AP projection of the abdomen should be taken on ___.

expiration

The double-walled membrane lining the abdominopelvic cavity is called the

peritoneum

abnormal accumulation of fluid in the peritoneal cavity; appearance- general adbominal haziness

ascites

True/False Because the liver margin is visible in the right upper quadrant of the abdomen, it is not necessary to place a right or left anatomic side marker on the cassette before exposure.

False

To ensure the diaphragm is included on an erect abdomen projection, the central ray should be at the level of ___, which places the top of the 14x17in IR at the level of the ___

2in above the illiac crest; axilla

What is the recommended overlap when using two crosswise images for an AP projection of a supine abdomen of a broad hypersthenic-type patient?

3-5cm (1-2in)

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?

A KUB would be performed with the correct exposure factors to visualize the possible stone

A patient in ICU 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?

A bedside portable left lateral decubitis projection could be performed to demonstrate any fluid levels in the abdomen

Gonadal shielding for females involves placing the top of the shield at or slightly above the level of the ___, with the bottom at the ___.

ASIS; Symphysis pubis

The medical prefix for stomach is

Gastro

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

No! A KUB must include the syphysis pubis to ensure the bladder is seen. Positioning error involves the centering the CR to the iliac crest. Palpate the symphysis pubis or greater trochanter to ensure its above the bottom of the cassette

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

Psoas

Location: Liver

RUQ

A radiographic image of an AP projection of the abdomen demonstrates motion. The following exposure factors were selected: 78kV, 200 mA, 2/10 second, grid, and 40in 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?

The blurriness may be caused by involuntary motion. The technologist needs to increase the mA and decrease the exposure time (eg 400 mA at 1/10 seconds)

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

The patient was rotated into a slightly right posterior oblique (RPO) position.

A radiograph of an AP projection of an average-size adult abdomen was produced using the following exposure factors: 90kV, 400mA, 1/10 second, grid, and 40in 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 structures on the repeat exposure?

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

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 three-way acute abdominal series, including the AP supine and erect abdomen and PA chest

A patient with a possible perforated duodenal ulcer enters the ER. 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 decubitis

Gonadal shielding should not be used during abdomen radiography if: a. it obscures essential anatomy b. the patient requests that it not be used c. the technologist does not elect to use it d. the patient is 40 years or older

a. it obscures essential anatomy

Which one of the following abdominal regions contains the rectum? a. pubic b. inguinal c. umbilic d. epigastric e. hypochondriac f. lumbar

a. pubic

The preferred imaging modality for examining the gallbladder quickly is: a. ultrasound b. nuclear medicine c. barium enema study d. MRI

a. ultrasound

____ is being used to evaluate patients with acute appendicitis a. ultrasound b. nuclear medicine c. CT d. MRI

a. ultrasound

A patient with a history of ascites comes to the radiology department. Which one of the following positions best demonstrates this condition? a.) Erect AP abdomen b.) Erect PA chest c.) Supine KUB d.) prone KUB

a.) Erect AP abdomen

The transverse colon is classified as a(n) ___ structure a.) Intraperitoneal b.) Retroperitoneal c.) Infraperitoneal d.) Extraperitoneal

a.) Intraperitoneal

Which of the following is NOT one of the accessory organs for digestion? a.) Spleen b.) Pancreas c.) Liver d.) Gallbladder

a.) Spleen

Bowel obstruction caused by a lack of intestinal peristalsis

adynamic ileus

Gonadal shielding for ___ may be impossible for studies of the lower abdominopelic region. a. males b. females c. both males and females d. small children

b. females

What scale of contrast is recommended for visualization of the abdominal structures on an abdominal x-ray? a. short scale b. long scale

b. long scale

Which one of the following organs is considered to be part of the lymphatic system? a. liver b. spleen c. pancreas d. gallbladder

b. spleen

Which one of the following organs is not directly associated with the digestive system? a. gallbladder b. spleen c. jejunum d. pancreas

b. spleen

What is the name of the double-fold of peritoneum that extends from the lesser curvature of the stomach to portions of the liver? a.) Greater omentum b.) Lesser omentum c.) Mesentery d.) Mesocolon

b.) Lesser omentum

A KUB radiograph reveals that the gonadal shielding is superior to the upper margin of the sympysis pubis. The female patient has a history of kidney stones. What is the next step the technologist should take? a.) Accept the radiograph because the kidneys were not obscured by the shielding b.) Repeat the exposure without using gonadal shielding c.) Repeat the exposure only if the patient complains of pain in the lower abdomen d.) Repeat the exposure with gonadal shielding, but position it below the symphysis pubis

b.) Repeat the exposure without using gonadal shielding

The pancreas is classified as a(n) ___ structure. a.) Intraperitoneal b.) Retroperitoneal c.) Infraperitoneal d.) Extraperitonea

b.) Retroperitoneal

A pathologic condition in which twisting of a loop of intestine creates an obstruction in termed. a.) Intussusception b.) Volvulus c.) Ascites d.) Adynamic ileus

b.) Volvulus

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 analog technique for a KUB on an adult is 76kV, 30 mAs. Should the technologist change any of these exposure factors for this patient? (AEC is not being used.) a.) No. Use the standard exposure settings. b.) Yes. Decrease the mAs c.) Yes. Increase the mAs d.) Yes. Incease the kV

b.) Yes. Decrease the mAs

Which one of the following exposure considerations would be most ideal for an AP abdomen of an average-size. a. 110-120 kV, grid, 40-in SID b. 85-95 kV, grid, 40-in SID c. 70-80 kV, grid, 40-in SID d.60-70 kV, grid, 40-in SID

c. 70-80 kV, grid, 40-in SID

With the use of iodinated contrast media, ___ is able to distinguish between a simple cyst or tumor of the liver. a. ultrasound b. nuclear medicine c. CT d. MRI

c. CT

Which one of the following projections requires a kV setting of 110-125? a. erect abdomen for acites b. supine abdomen for intraabdominal mass c. PA, erect chest for free air under diaphragm d. dorsal ducubitus abdomen for calcified aorta

c. PA, erect chest for free air under diaphragm

Which one of the following structures is a double fold of peritoneum that connects the transverse colon to the greater curvature of the stomach? a. mesocolon b. lesser omentum c. greater omentum d. mesentery

c. greater omentum

Which one of the following abdominal structures is not visible on a properly exposed KUB? a. kidneys b. margin of liver process c. pancreas d. lumbar transverse processes

c. pancreas

What is the correct for the abdominal region found directly in the middle of the abdomen? a. epigastric b. inguinal c. umbilic d. pubic

c. umbilic

Where is the CR centered for an AP erect abdomen projection as part of an acute abdomen series? a.) At iliac crest b.) ASIS c.) 1-2 in (5cm) above iliac crest d.) At xiphoid process

c.) 1-2 in (5cm) above iliac crest

What is the preferred length of time a patient should lie on his or her side prior to a lateral decubitis projection? a.) 5 mins b.) 5-8 mins c.) 10-20 mins d.) 25-30 mins

c.) 10-20 mins

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? a.) KUB and left lateral decubitis b.) Acute abdominal series c.) KUB and lateral abdomen d.) Supine and erect KUB

c.) KUB and lateral abdomen

The sigmoid colon is located in the ___ quadrant. a.) RUQ b.) LUQ c.) LLQ d.) RLQ

c.) LLQ

Which of the following projections will best demonstrate intraperitoneal free air? a.) KUB b.) Dorsal decubitus c.) Left lateral decubitus d.) PA chest

c.) Left lateral decubitus

Voluntary motion can best be prevented by___ to the patient

careful breathing instructions

Chronic inflammation of the intestinal wall that may result in bowel obstruction; appearance- distended loops of air-filled small intestine

crohn's disease

Which of the following technical considerations is essential when performing abdomen studies on a young pediatric patient? a. short exposure times b. high-speed image receptor c. reduce kV and mAs d. all of the above

d. all of the above

Which one of the following structures helps stabilize and support the small intestine? a. omentum b. peritoneum c. viscera d. mesentery

d. mesentery

What 2 large abdominal muscles extend next to the lumbar spine and are indicators of a well-exposed KUB? a.) Rectus abdominis b.) Quadrantus lamborum c.) Erector spinae d.) Psoas major

d.) Psoas major

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 kidneys, is cut off. What is the next step the technologist should take? a.) Accept the radiograph b.) Repeat the exposure, but expose it during inspiration to force the kidneys lower into the abdomen c.) Ask the radiologist whether the upper abdomen really needs to be seen. Repeat only if requested. d.) Repeat exposure. Use two 14inx17 IRs crosswise to include the entire abdomen.

d.) Repeat exposure. Use two 14inx17 IRs crosswise to include the entire abdomen.

The sigmoid colon is located between the ___ and ___ of the large intestine.

descending colon, rectum

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

dorsal decubitus

True/False It is always acceptable during KUB imaging practice to indicate the side of the body with a digital marker

false

Which type of body habitus may require two crosswise images to be taken if the entire abdomen is to be included?

hypersthenic body type

Which portion of the small intestine is considered to be the longest?

ileum

The central ray is centered to the level of the ___ for a supine AP projection of the abdomen.

illiac crest

Why may the PA projection of a KUB generally be less desirable than the AP projection?

increased OID of kidneys on PA

Which topographic landmark is found at the level of L2-L3?

inferior costal margin

Urinary bladder, ovaries, testes

infraperitoneum

The iliac crest is at the level of the ___ vertebra

interspace between L4-L5

Which projection best demonstrates a possible aortic aneurysm in the prevertebral region of the abdomen?

lateral position

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

left lateral decubitus (free air best visualized in upper right abdomen in area of liver)

What is the primary cause for involuntary motion in the abdomen?

peristaltic action of the bowel

Free air or gas in the peritoneal cavity; appearance- thin crest-shaped radiolucency underneath diaphragm

pneumoperitoneum

The pancreas is located ___ to the stomach

posteriorly

The organs located posteriorly to, or behind, the serous membrane lining of the abdominopelvic cavity are referred to as

retroperitoneal

Kidneys, duodenum, adrenal glands, pancreas, ascending and descending colon

retroperitoneum

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

right lower, cecum

The prominence of the greater trochanter is about the same level of the ___ of the symphysis pubis, and the lower margins of the ischial tuberosities is about ___inches ___ to the symphysis pubis.

superior border, 1.5, distal

Which endocrine glands are superomedial to each kidney?

suprarenals (adrenal)

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

symphysis pubis

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

to allow intraabdominal air to rise or abnormal fluids to accumulate

Why is it recommended to take abdominal radiographs at the end of patients expiration?

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

True/False A tall asthenic patient may require two 14x17in image receptors placed lengthwise if the entire abdomen is to be included

true

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

two-way abdomen: AP supine abdomen and left lateral decubitus

inflammatory condition of the colon; appearance- deep air-filled mucosal protrusions of colon wall

ulcerative colitis

What is the best mechanism to control involuntary motion?

use the shortest exposure time possible

A twisting of a loop of bowel creating an obstruction; appearance- large amount of air trapped in sigmoid colon with a tapered narrowing at the site of obstruction.

volvulus