Ch 4 Bontrager

The urinary system is composed of

Two kidneys, two ureters, one urinary bladder, one urethra

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

Two way abdomen, AP supine abdomen, and left lateral decubitus

Deep air filled mucosal protrusions of colon wall

Ulcerative colitis

Inflammatory condition of the colon

Ulcerative colitis

Thin crest shaped radiolucency underneath diaphragm

Pneumoperitoneum

The pancreas is located (anteriorly/ posteriorly) to the stomach

Posteriorly

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

Presence of liver on right side

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

Psoas muscles

What abdominal region contains the rectum

Pubic

Radiation protection 4 examples are

Repeat exposures, collimation, gonadal shielding, pregnancy protrction

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

Repeat the exposure using two 14x17 inch cassette placed crosswise, the hypersthenic patient often requires this type of IR placement for abdomen studies

The three digestive organs within the abdominal cavity are

Stomach, small intestine, large intestine

Acute abdomen routines for pediatrics generally include only a ( ) and one ( ) beam projection to show air fluid levels for patients younger than 2 or 3 years of age, the lateral decubitus may be difficult to obtain, and an AP erect abdomen with an immobilization device such as ( ) is preferred.

Supine, horizontal, pigg-o-stat

The two ( ) (adrenal) ( ) of the endocrine system are located at the superomedial portion of each kidney. The bean shaped kidneys are located on either side of the lumbar vertebral column, the ( ) kidney usually is situated a little lower than the ( ) one because of the presence of the large liver on the ( )

Suprarenal glands, right, left, right

Which endocrine glands are superomedial to each kidney

Suprarenals (adrenal)

( ) ( ) is the anterior junction (joint) of the two pelvic bones. The most superior anterior portion of the can be palpated when the patient is in a supine position. This landmark corresponds to the inferior margin of the abdomen. Palpation of this area, however may be embarrassing to some patients. With practice the level of the or the lower margin of he abdomen can be identified by palpating the greater trochanter with reference to the iliac crest as being at the level of the center of the cassette or IR. this the. Places the lower margin of the IR at it.

Symphysis pubis

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

Seven topographic landmarks of the abdomen

Xiphiod process, inferior costal (rib) margin, iliac crest, ASIS, greater trochanter, symphysis pubis, ischial tuberosity

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

Dorsal decubitus

The central ray is centered to the level of the ( ) for a supine AP projection of the abdomen

Iliac crest

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

Lateral position

The superior margin of the greater trochanter is about ( ) inches, ( ) cm, ( ) (superior/inferior) to the level of the symphysis purvis, and the ischial tuberosity is about ( ) inches, ( ) cm, ( ) (superior/inferior) to the superior aspect of the symphysis pubis

1.5, 3 to 4, superior, 1.5, 3 to 4, inferior

To ensure that the diaphragm is included on an erect abdomen projection, the central ray should be at the level of ( ), which places the top of the 14x17 inch (35x43 cm) cassette at the level of the ( )

2 inches (5 cm) above iliac crest, axilla

Ensuring that all of the upper abdomen, including the diaphragm, is included on the image receptor requires centering about ( ) inches or ( ) cm above the level of the crest for most patients, which usually will cut off some of the important lower abdomen, this then would require a second IR centered lower to include this lower region

2, 5

What is the gonadal dose range for an average size female patient with an AP projection of the abdomen

35 to 75 mrad

What exposure factors would be most ideal for an AP abdomen of a small to average size adult Kv, ma, second, grid/no grid, inch sid

75 kv, 600 ma, 1/30 second, grid, 40 inch sid

Certain acute or emergency conditions of the abdomen may develop from conditions such as bowel obstruction, perforations involving free intraperitoneal air (air outside the digestive tract), excessive fluid in the abdomen, or a possible intraabdominal mass.

Acute abdominal series

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

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

A patient in intensive care may have developed intraabdominal 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 decubitus projection could be performed to demonstrate any fluid levels in the abdomen

What female projection generated the largest gonadal dose

AP abdomen

Abdomen (KUB) basic projection

AP supine

A plain ( ) ( ) radiograph of the abdomen (acronyms) generally is taken before contrast medium is introduced into the various abdominal organ systems for evaluating and diagnosis of diseases and conditions involving these systems

AP supine (KUB)

List the projections commonly preformed for an acute abdominal series or three way abdomen series

AP supine, AP erect or lateral decubitus abdomen, PA erect chest

Acute abdomen (three way with PA chest) basic projection

AP supine, AP erect, PA chest erect

Gonadal shielding for females involves placing the top of the shield at or slightly above the level of the ( ) with the bottom at the ( )

ASISs, symphysis pubis

Three muscles that are most important in abdominal radiographs are

Diaphragm, right and left psoas major

Is performed most commonly to evaluate and diagnose conditions or diseases related to bowel obstruction and/or perforation. This required visualization of air fluid levels and possible intraperitoneal free air with the use of horizontal beam erect decubitus body positions.

Acute abdominal series

Acute or emergency conditions require what is commonly called an "( ) ( ) ( )" or a "( ) ( )" or "( ) ( ) ( )" series, wherein several abdominal radiographs are taken in different positions to demonstrate air fluid levels and/or free air within the abdominal cavity

Acute abdominal series, two way, three way abdomen

Bowel obstruction caused by lack of intestinal peristalsis

Adynamic ileus

Which of the following technical factors is essential when performing abdomen studies on a young pediatric patient: short exposure time, high speed image receptor, high milliamperage, or all the above

All of the above

( ) ( ) ( ) ( ) (include acronym) it can be found by locating he iliac crest, then palpating anteriorly and inferiorly until a prominent projection or "bump" is felt (more prominent on females) this landmark is commonly used for positioning of pelvic and vertebral structures but can also serve as a secondary landmark for general abdominal positioning

Anterior superior iliac spine (ASIS)

4 forms of mesocolon exist, each named according to that portion of the colon to which it is attached

Ascending, transverse, descending, and sigmoid (pelvic)

The vertical portion of the large bowel above the cecum, the ( ) colon, joins the ( ) colon at the ( ) ( ) ( ).

Ascending, transverse, right colic flexure

Abnormal accumulation of fluid in the peritoneal cavity

Ascites

General abdominal Haziness

Ascites

Is an abnormal accumulation of fluid in the peritoneal cavity of the abdomen. It generally is caused by long standing (chronic) conditions such as cirrhosis of the liver or by metastatic disease to the peritoneal cavity

Ascites

One key factor is good abdominal radiography is the prevention of motion, voluntary motion is.... Involuntary motion is... To prevent motion use the

Breathing, peristaltic action of the bowel, shortest exposure time possible

Useful in evaluating and early diagnosis of small neoplasms involving abdominal organs such as the liver and pancreas. With use of IV contrast media, can be used to discriminate between simple cyst and solid neoplasm

CT and MRI

Voluntary motion can best be prevented by ( ) to the patient

Careful breathing instructions

When using automatic exposure control (AEC) systems, which ionization chamber(s) should be activated for an average to large size patient when performing an AP projection of the abdomen

Center and upper left chambers

KUB are commonly taken before abdominal examinations are performed with the use of contrast media to rule out

Certain pathologies

Guidelines that should be followed with digital imaging (CR and DR) of abdomen are ( ) ( )- body part being imaged and accurate centering. ( ) ( ) -use ALARA principle (as low as reasonable achievable) be followed and the lowest required to obtain a diagnostic image be used. This includes highest kv and lowest mas that will result in desirable image quality. ( ) ( ) evaluation of exposure index-the exposure index on the final processed image must be checked to verify that the exposure factors were used when in the correct range to ensure optimum quality with the least radiation to patient

Close collimation, exposure factors, post processing

One significant difference exists between male and female peritoneal enclosures. The lower aspect of the peritoneum is a ( ) sac in the male and ( ) in the female. In the male, the lower peritoneal sac lies above the urinary bladder, totally ( ) the reproductive organs from those within the peritoneal cavity. In the female, however, the uterus, uterine (Fallopian) tubes, and ovaries pass ( ) into the peritoneal cavity

Closed, not, separating, directly

Patient preparation for abdominal radiography includes removal of all....patient should wear a ( ) ( ) with the openings and ties in the back

Clothing, and any radiopaque objects in the area to be radiographed, hospital gown

With the use of iodinated contrast media, ( ) is able to distinguish between a simple cyst or tumor of the liver

Computed tomography (CT)

A chronic inflammation of the intestinal wall that results in bowel obstruction in at least half of those afflicted. The cause is unknown, most common in young adults and is characterized by loops of small bowel joined by fistulas or connected opening with adjacent loops of intestine

Crohn's disease

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

Crohn's disease

Distended loops of air filled small intestine

Crohn's disease

A patient comes from the ER with a large distended abdomen caused by an ileus. The physician suspects that the distinction 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)

Decrease the mas, because trapped air is easier to penetrate than soft tissue with xrays, reducing the mas will prevent overexposing the radiograph

The sigmoid colon is located between the ( ) and ( ) of the large intestine

Descending colon, rectum

The transverse colon joins the ( ) colon at the ( ) ( ) ( )

Descending, left colic flexure

Is an umbrella shaped muscle that separates the abdominal cavity from the thoracic cavity. Must be perfectly motionless during radiography of either the abdomen or the chest. Motion of the patients ( ) can be stopped when appropriate breathing instructions are given to the patient

Diaphragm

The first portion of the small intestine, the ( ), is the shortest but widest in diameter of the three segments. It is about 25 cm ( 10 inches) in length. When filled with contrast medium, the ( ) is called the duodenal bulb, or cap. It has a certain characteristic shape that usually is well seen on barium studies of the upper GI tract. Ducts from the liver, gallbladder, and pancreas drain into it.

Duodenum

List the 3 parts of the small intestine

Duodenum, jejunum, ileum

The small intestine continues from the stomach as a long, tubelike convoluted structure about 4.5 to 5.5 meters (15 to 18 feet) in length. The three parts of the small intestine are

Duodenum, jejunum, ileum

( ) (with power or force) or ( ) ( ) ( ) is the complete or nearly complete blockage of the flow of intestinal contents. It's causes include the fibrous adhesions, Crohn's disease, intussusception, and volvulus

Dynamic (with power or force) or mechanical bowel obstruction

A patient with a history of ascites comes to the radiology department. Which position best demonstrates this condition

Erect AP abdomen position, best demonstrates air/fluid levels, ascites produces free fluid in the intraperitoneal cavity

The ( ) is located in the mediastinum of the thoracic cavity

Esophagus

( ) or ( ) ( ) (include acronym), which is a radiographic examination of the urinary system, wherein the contrast medium is injected intravenously. During this examination, the hollow organs of this system are visualized with the use of the contrast medium that has been filtered from the blood flow by the kidneys

Excretory or intravenous urogram (IVU)

Exposure for an AP projection of the abdomen should be taken on ( )

Expiration

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

True/false: for an adult abdomen, a collimation margin must be visible on all four sides of the radiograph

False

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

False intravenous urogram (IVU)

Gonadal shielding for ( ) may be impossible for studies of the lower abdominopelvic region

Females

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

Fibrous adhesions

The ( ) is a pear shaped sac located below the liver. The primary functions of it are to store and concentrate bile and to contract and release bile when stimulated by an appropriate hormone. In most cases it cannot be visualized with conventional radiographic techniques without contrast media. The reason for this is because it and the biliary ducts blend in with the other abdominal soft tissues and in most cases cannot be visualized. Only about 10% to 15% of all gallstones contain enough calcium to allow visualization on a plain abdominal radiographic image

Gallbladder

What is the common term for stomach, it describes the entire digestive system, starting with the stomach and continuing through the small and large intestines

Gastro

The medical prefix for stomach is

Gastro-

These patients often require extra care and patience in explaining what is expected of them, careful breathing instructions are essential, as is assistance in helping patients move into the required position. Extra radiolucent padding under the back and buttocks for thin patients and blankets to keep patients warm add greatly to their comfort on supine abdomen radiographic procedures

Geriatric patients

The ( ) omentum connects the transverse colon to the greater curvature of the stomach inferiorly, it drapes down over the small bowel then folds back on itself to form an apron along the anterior abdominal wall

Greater

If one entered the abdomen through the midantrior wall, the first structure encounters beneath the parietal peritoneum would be the ( ) ( ), varying amounts of fat are deposited in the (same as) (above), which serves as a layer of insulation between the abdominal cavity and the exterior. This is sometimes called the "fatty apron" because of its location and the amount of fat contained therein

Greater omentum

Which one of the following structures is a double fold of peritoneum that connects the transverse colon to the greater curvature of the stomach: mesocolon, lesser omentum, greater omentum, mesentery

Greater omentum

The major portion of the peritoneal cavity is the ( ) ( ) and is commonly referred to as simply the ( ) ( )

Greater sac, peritoneal cavity

( ) ( ) this landmark is more easily palpated on thin patients. Gentle but vey firmly palpating generally is required to feel the movement of the trochanter with one hand while rotating the leg internally and externally at the knee area with the other hand. This is not as precise a landmark as the other bony landmarks of the pelvis, but the uppermost margin of the trochanter generally is at about the same level as the upper border of the symphysis pubis. With practice, this can be used as a secondary landmark for abdominal positioning

Greater trochanter

Alternate secondary names for the two colic flexures are ( ) and ( ) flexures. Based on their proximity to the liver and spleen, respectively.

Hepatic, splenic

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

Hypersthenic body type

As will be seen in body habitus drawings, the shape and location of the large intestine vary greatly, with the transverse colon located high on wide ( ) types and low in the abdomen on slender ( ) and ( ) types.

Hypersthenic, hyposthenic, asthenic

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

Ileum

Is categorized as adynamic (without power or force) ileus and most frequently is caused by peritonitis, or paralytic (paralysis) ileus, which is caused by a lack of intestinal motility. It occurs frequently in postoperative patients, usually. 24 to 72 hours after abdominal surgery. In contrast to mechanical obstruction, it rarely leads to perforation, and the radiographic appearance is characterized by a a large amount of air and fluid, with air fluid levels visible in a greatly dilated small and large bowel and no visible distinct point of obstruction (unlike mechanical obstruction)

Ileus nonmechanical bowel obstruction

( ) ( ) level of ( )-( ) also vertebral interspace the crest of the ilium is the uppermost portion of the curved border of the ilium. The can be palpated easily by pressing inward and downward along the midlateral margin of the abdomen. The upper most or most superior portion of this crest is the most commonly used abdominal landmark and corresponds approximately to the level of the mid abdomen, which is also at or just slightly below the level of the umbilicus on most persons. If the center of the cassette or image receptor is centered to this level, the lower abdominal area generally will be included on the lower margin of the IR.

Iliac crest, L4-L5

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

Iliac wings, obturator foramina (if visible), ischial spines, outer rib margins

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

Increased object image receptor distance (OID) of kidneys on PA

( ) ( ) ( ) ( ) level of ( )-( ) this landmark is used to locate upper abdominal organs, such as the gallbladder and/or stomach

Inferior costal (rib) margin, L2-L3

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

Inferior costal margin

Located under or beneath the peritoneum in the true pelvis are the lower rectum, urinary bladder, and reproductive organs

Infraperitoneal

Lower rectum, urinary bladder, reproductive organs, male-closed sac, female-open sac (the female uterus, tubes, and ovaries, extending into the peritoneal cavity) are in what category of the peritoneal cavity

Infraperitoneal

Ovaries to the location of the peritoneum

Infraperitoneum

Testes to the location of the peritoneum

Infraperitoneum

Urinary bladder to the location of the peritoneum

Infraperitoneum

The iliac crest is at the level of the ( ) vertebra

Interspace between L4-5

Liver, gallbladder, spleen, stomach, jejunum, ileum, cecum, transverse colon, sigmoid colon are in what category of the peritoneal cavity

Intraperitoneal

Organs within the abdominal cavity that are partially or completely covered by some type of visceral peritoneum but are not retroperitoneal or infraperitoneal may be called ( ) (meaning within). These organs, which include the liver, gallbladder, spleen, stomach, jejunum, ileum, cecum, and transverse and sigmoid colon.

Intraperitoneal

Liver to the location of the peritoneum

Intraperitoneum

Spleen to the location of the peritoneum

Intraperitoneum

Stomach to the location of the peritoneum

Intraperitoneum

Transverse colon to the location of the peritoneum

Intraperitoneum

Air filled "coiled spring" appearance

Intussusception

Telescoping of a section of bowel into another loop of bowel

Intussusception

The telescoping of a section of bowel into another loop, which creates an obstruction, it is most common in the distal small bowel region (ileus), and it is more common in children than in adults. This condition requires treatment within 48 hours to prevent necrosis (tissue death)

Intussusception

( ) ( ) this can be used to determine the lower margin on a PA abdomen with the patient in prone position. These two bony prominences, which can be palpated most easily on thin patients, bear most of the weight of the trunk when one is seated. The lower margins of the it are about 1 to 4 cm (1 1/2 inches) below or distal to the symphysis pubis. This landmark may be used for positioning a PA projection of the colon when the rectal area is to be included in the IR. this, however, may be uncomfortable and embarrassing for the patient, and other landmarks can and should be used when possible

Ischial tuberosity

Gonadal shielding should not be used during abdomen radiograph if

It obscures essential anatomy

The remainder of the small bowel lies in the central and lower abdomen. The first two fifths following the duodenum is called the ( ) it looks feathery on a radiograph, and the distal three fifths is called the ( ). The orifice (valve) between the distal ileum and the cecum portion of the large intestine is the ( ) ( )

Jejunum, ileum, ileocecal valve

The most common abdomen radiograph is an anteroposterior (AP) supine abdomen, also sometimes called a

KUB (kidneys, ureters, and bladder)

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?

KUB and lateral abdomen, with any foreign body study, two projections 90 degrees opposite is recommended to pinpoint the location of the foreign body

Each ( ) drains by way of its own ( ) to the single ( ) ( ), the bladder, which is situated above and behind the symphysis pubis, serves to store urine. Under voluntary control, the stored urine passes to the exterior via the ( )

Kidney, ureter, urinary bladder, urethra

The transpyloric plane is at the level of the lower border of ( ), and the transtubercular plane is at the level of ( ). The right and left lateral planes are parallel to the ( ) plane and are located midway between it and each ( ) ( ) ( ) ( ) (include acronym)

L1, L5, midsagittal, anterior superior iliac spine (ASIS)

If 2 perpendicular planes (at right angles) were passed through the abdomen at the umbilicus (or navel) they would divide the abdomen into four quadrants. One plane would be transverse through the abdomen at the level of the umbilicus, which on most people is at the level of the intervertebral disk between ( )-( ) which is about at the level of the iliac crest on female. The vertical plane would coincide with the midsagittal plane or midline of the abdomen and would pass through both the umbilicus and the symphysis pubis. These two planes would divide the abdominopelvic cavity into four quadrants include acronyms

L4-L5, right upper quadrant (RUQ), left upper quadrant (LUQ), right lower quadrant (RLQ), left lower quadrant (LLQ)

The sixth and last organ of digestion is the ( ) ( ), which begins in he right lower quadrant at the junction with the small intestine at he ileocecal valve. The portion of it below the ileocecal valve is a saclike area called the ( ). The ( ) (vermiform) is attached to the posteromedial aspect of the ( )

Large intestine, cecum, appendix

Acute abdomen (three way with PA chest) special projection

Left lateral decubitus (AP)

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)

Descending colon, sigmoid colon, 2/3 of jejunum what quadrant is this

Left lower quadrant (LLQ)

What quadrant is the sigmoid colon found in

Left lower quadrant (LLQ)

What quadrant is the two thirds of jejunum found in

Left lower quadrant (LLQ)

Spleen, stomach, left colic (splenic) flexure, tail of pancreas, left kidney, left suprarenal gland what quadrant is this

Left upper quadrant (LUQ)

What quadrant is the left colic flexture found in

Left upper quadrant (LUQ)

What quadrant is the spleen found in

Left upper quadrant (LUQ)

What quadrant is the stomach found in

Left upper quadrant (LUQ)

The ( ) omentum extends superiorly from the lesser curvature of the stomach to portions of the liver.

Lesser

A smaller portion of the upper posterior peritoneal cavity located posterior to the stomach is called the ( ) ( ), this sac has a special name the ( ) ( )

Lesser sac, omentum bursa

The ( ) is the largest solid organ in the body, occupying most of the right upper quadrant. One of its numerous functions is the production of bile, which assists in the digestion of fats. If bile is not needed for digestion, it is stored and concentrated for future use in the gallbladder

Liver

The accessory organs of the digestive sytem are

Liver, gallbladder, pancreas

Being used to visualize the biliary and pancreatic ducts, as is ERCP a fluoroscopic procedure in which contrast medium is injected endoscopically

MRI, endoscopic retrograde cholangiopancreatogram

The principle exposure factors for abdominal radiographs are

Medium kv (70 to 80), short exposure time, adequate mas for sufficient density

The peritoneum forms large folds that bind the abdominal organs to each other and to the walls of the abdomen. Blood and lymph vessels and the nerves that supply these abdominal organs are contained within these folds of peritoneum. One of these double folds that hold the small intestine in place is called the ( ). It is a double fold of peritoneum that extends anteriorly from the posterior abdominal wall to completely envelop a loop of small bowel. The specific term for a double fold of peritoneum that loosely connects the small intestine to the abdominal wall is (same as above)

Mesentery

Which one of the following structures helps stabilize and support the small intestine: omentum, peritoneum, viscera, mesentery

Mesentery

The peritoneum that attaches the colon to the posterior abdominal wall is the ( ).

Mesocolon

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

No, 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 palpated the symphysis pubis (if permitted by instructional policy) or greater trochanter to ensure that it is above the bottom of the cassette)

Useful as in noninvasive means of evaluating GI motility and reflux as related to possible bowel obstruction. Also useful for evaluation of lower GI bleeding, with injections of specific radionuclides, useful to examine the entire liver and the major bile ducts and gallbladder

Nuclear medicine

A specific type of double fold peritoneum that extends from the stomach to another organ is called the

Omentum

The ( ) ( ) (mouth) and the ( ) (oropharynx and laryngopharynx) are common to the respiratory system and the digestive system

Oral cavity, pharynx

The six organs of the digestive system are

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

Which position of the three way acute abdominal series best demonstrates free air under the diaphragm

PA chest

Abdomen (KUB) special projection

PA prone, lateral decubitus (AP), AP erect, dorsal decubitus (lateral), lateral

Which projection involves a kv setting of 110 to 125

PA, erect chest for free air under diaphragm

The ( ) is not seen on a plain abdominal radiograph, is an elongated gland that is located posterior to the stomach and near the posterior abdominal wall, between the duodenum and the spleen. The average length is about 12.5 cm (6 inches). It's head is nestled in the c loop of the duodenum, and the body and tail of it extend toward the upper left abdomen. This relationship of the duodenum and the head of it is sometimes referred to as "the romance of the abdomen"

Pancreas

The ( ) is part of the endocrine (internal) secretion system and is also part of the exocrine (external) secretion system. The endocrine portion of it produced certain essential hormones, such as insulin, which aids in controlling the blood sugar level of the body. As part of its exocrine functions, the pancreas produces large amounts (up to 1 1/2 quart (1500 ml) daily) of digestive juices that move to the duodenum through a main pancreatic duct as needed for digestion.

Pancreas

Which of the following abdominal structures is not visible on a properly exposed KUB: kidneys, margin of liver processes, pancreas, lumbar transverse processes

Pancreas

List the 3 accessory digestive organs

Pancreas, liver, gallbladder

The two layered peritoneum that adheres to the cavity wall is called the

Parietal peritoneum

What are the two types of peritoneum

Parietal peritoneum, visceral peritoneum

Note that a layer of visceral peritoneum only ( ) covers certain organs that are more closely attached to the posterior abdominal wall. At this level, the ascending and descending colon, the aorta, and the inferior vena cava are only partially covered; therefore, this lining would ( ) be considered mesentery, and these structures and organs are called ( ).

Partially, not, retroperitoneal

What are the two causes of voluntary motion

Patient breathing, patient movement during exposure

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

Patient was rotated into a slight right posterior oblique (RPO) position, the downside ilium will appear wider

What is the primary cause for involuntary motion in the abdomen

Peristaltic action of the bowel

The space of cavity between the parietal and visceral portions of peritoneum is called the ( ) ( ). This space is really only a potential cavity because normally it is filled with various organs. This cavity contains some serous lubricating type fluid, which allows organs to move against each other without friction. An abnormal accumulation of this serous fluid constitutes a condition called

Peritoneal cavity, ascites

Most of the abdominal structures and organs, as well as the wall of the abdominal cavity in which they are contained, are covered to varying degrees by a large serous, doubled walled, saclike membrane called the ( ). In fact, the total surface area of it is about equal to the total surface area of the skin that covers the entire body

Peritoneum

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

Peritoneum

4 important terms that describe anatomy of the abdominal cavity are

Peritoneum, mesentery, omentum, mesocolon

Ways to make patient comfortable

Pillow, sponge under knees, clean linen on the table, cover patients to keep them warm and protect their modesty

Abdomen images are sometimes called

Plain films

Free air or gas in the peritoneal cavity

Pneumoperitoneum

Refers to free air or gas in the peritoneal cavity. This is serious condition for which surgery is required when it is caused by perforation of a gas containing viscus, such as by a gastric or duodenal ulcer. It also can be caused by trauma that penetrates the abdominal wall. Small amounts of residual air may be evident radiographically up to 2 to 3 weeks following abdominal surgery. It is best demonstrated with a horizontal beam erect abdomen or chest radiograph, with which even a small amount of free air can be seen as it rises to the highest position under the diaphragm

Pneumoperitoneum

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 stones. What is the next step the technologist should take

Repeat the exposure without using gonadal shielding, because patient may have renal calculi in the distal ureters and urinary bladder, gonadal shielding cannot be used

Kidneys, ureters, adrenal glands, pancreas, duodenum, ascending and descending colon, upper rectum, major abdominal blood vessels (aorta and inferior vena cava) are in what category of the peritoneal cavity

Retroperitoneal

Structures closely attached to the posterior abdominal wall that are ( ) a the kidneys and ureters, adrenal glands, pancreas, duodenum, ascending colon, upper rectum, abdominal aorta, and inferior vena cava. These structures are less mobile and move around less within the abdomen than do other intraperitoneal organs.

Retroperitoneal

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

Retroperitoneal

Adrenal glands to the location of the peritoneum

Retroperitoneum

Ascending and descending colon to the location of the peritoneum

Retroperitoneum

Duodenum to the location of the peritoneum

Retroperitoneum

Kidneys to the location of the peritoneum

Retroperitoneum

Pancreas to the location of the peritoneum

Retroperitoneum

The two muscles are located on either side of the lumbar vertebral column. The lateral borders of these two muscles should be faintly visible on a diagnostic abdominal radiograph of a small to average sized patient when correct exposure factors are used

Right and left psoas major

Name the nine regions

Right hypochondriac, epigastric, left hypochondriac, right lateral (lumbar), umbilical, left lateral (lumbar), right inguinal (iliac), pubic (hypogastric), left inguinal (iliac)

Ascending colon, appendix (vermiform), cecum, 2/3 of ileum, ileocecal valve what quadrant is this

Right lower quadrant (RLQ)

What quadrant is the appendix found in

Right lower quadrant (RLQ)

The large intestine in the ( ) quadrant with a saclike area called the ( )

Right lower, cecum

Liver, gallbladder, right colic (hepatic) flexure, duodenum, head of pancreas, right kidney, right suprarenal gland what quadrant is this

Right upper quadrant (RUQ)

What quadrant is the liver in

Right upper quadrant (RUQ)

Motion prevention is of utmost importance in pediatrics, and ( ) ( ) ( ) and ( ) ( ) film and screens are essential. Children younger than 12 to 13 years of age require a significance reduction in ( ) and ( )

Short exposure time, high speed, kv, mas

The descending colon continues as the s shaped ( ) colon in the lower left abdomen. The ( ) is the final 15 cm (6 inches) of the large intestine, it ends at the ( ), the sphincter muscle at the terminal opening of the large intestine.

Sigmoid, rectum, anus

Used when gallbladder is used for detection of gallstones, detecting and evaluating lesions or inflammation of soft tissue organs such as liver and pancreas, used with ct to demonstrate abscesses, cyst, or tumors involving the kidneys, ureters, or bladders, acute appendicitis

Sonography (ultrasound)

The ( ) is that part of the lymphatic system that along with the heart and blood vessels is part of the circulatory system. It is an important abdominal organ that occupies a space posterior and to the left of the stomach in the left upper quadrant. May be visualized faintly on plain abdominal radiographs, particularly if the organ is enlarged. It is a fragile organ and is sometimes lacerated during trauma to the lower left posterior rib cage

Spleen

Which of the following organs is not directly associated with the digestive system: gallbladder, spleen, jejunum, pancreas

Spleen

Which one of the following organs is considered to be part of the lymphatic system: liver, spleen, pancreas, gallbladder

Spleen

( ) is the first organ of the digestive system that is located within the abdominal cavity. It is expandable reservoir for swallowing food and fluids. The size and shape of it is highly variable depending on the volume of its contents and on the body habitus.

Stomach

What are the breathing instructions...before making exposure, make sure that the patient is following instructions, and that sufficient time has been allowed for all breathing movements to cease

Take in a deep breath- let it all out and hold it- don't breathe

A radiograph 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 inch sid. The technologist is sure that the patient didn't 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. To control this motion, need to increase the milliamperage and decreases the exposure time (400 ma, at 1/10 second)

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 sid. 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 factors will enhance the visibility of these structures on the repeat exposure

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

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 AP supine and erect abdomen and PA erect chest projection

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

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

The abdominopelvic cavity can be divided into nine regions through the use of two horizontal or transverse planes and two vertical planes. The two transverse/horizontal planes are the ( ) plane and the ( ) plane. The two vertical planes are the ( ) and ( ) ( ) planes.

Transpyloric, transtubercular, right, left, lateral

The ( ) mesocolon as that visceral peritoneum that loosely connects the (same as above) colon to the posterior abdominal wall

Transverse

True/false: a larger patient receives a greater amount of skin dose and midline dose as compared with a smaller patient during an AP projection of the abdomen

True

True/false: a radiolucent pad should be placed underneath geriatric patients for added comfort

True

True/false: a tall asthenic patient may require two 14x17 inch (35x43 cm) image receptors placed lengthwise if the entire abdomen is to be included

True

Is a chronic disease involving inflammation of the colon that occurs primarily in young adults and most frequently involves the rectosigmoid region. In some cases, it becomes a very severe acute process, causing serious complications, such as a toxic megacolon (extreme dilation of a segment of colon) with potential perforation into the peritoneal cavity. Barium enema is strongly contraindicated with symptoms of toxic megacolon

Ulcerative colitis

( ) is being used to evaluate patients with acute appendicitis

Ultrasound

The preferred imaging modality for examining the gallbladder quickly is

Ultrasound

What is the correct name for the abdominal region found directly in the middle of the abdomen

Umbilical

What is the best mechanism to control involuntary motion

Use the shortest exposure time possible

Whereas the portion of peritoneum that covers the an organ is called

Visceral peritoneum

A twisting of a loop of bowel creating an obstruction

Volvulus

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

Volvulus

The twisting of a loop of intestine, which creates an obstruction, may require surgery for correction

Volvulus

( ) ( ) and excess ( ) are eliminated from the blood by the kidneys and are transported through the ureters to the urinary bladder

Waste material, water

The tip of the ( ) ( ) level of ( )-( )is the most distal or inferior process of the sternum. This can be palpated first gently pressing on the soft abdomen below the distal sternum, then moving upward carefully against the firm, distal margin of the (same as) (above). This landmark approximates the superior anterior portion of the diaphragm, which is also the superior margin of the abdomen, this, however is not a primary landmark for positioning the abdomen because of variation in body types and the importance of including all of the lower abdomen on most radiographic images of the abdomen.

Xiphoid process, T9-T10