Ch.3 Abdomen Bontrager
what are the 7 landmarks of the abdomen
xiphoid process at level t9 to t10, nferior costal rib margin at level l2 to l3, iliac crest at level l4 to l5, anterior superior iliac spine or ASIS at level s2, greater trochanter at same level as the superior border of the symphysis pubis,
thin crest shaped radiolucency underneath diaphragm
Pneumoperitoneum
true or false. a radiolucent pad should be placed underneath geriatric patients for added comfort.
true
distended loops of air filled small intestine
Crohn's disease
Intussusception
telescoping of a section of bowel into another loop of bowel
what is the recommended overlap when using two crosswise images for an anterior posterior projection of a supine abdomen of a broad hypersthenic type patient
3 to 5 cm or 1 to 2 inches
example of an ideal exposure for an anterior posterior abdomen of an average size adult
70 to 80 kilovolts, grid, 40 inches or 102 cm source image receptor distance
list the projections commonly performed for an acute abdominal series or three way abdomen series
Anterior posterior supine, anterior superior erect or lateral decubitus abdomen. also the posterior anterior erect chest
general abdominal haziness
Ascities
with the use of iodinated contrast media
CT is able to distinguish between a simple cyst or tumor of the liver
air filled coiled spring appearance
Intussusception
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?
a bedside portable left lateral decubitus projection could be performed to demonstrate any fluid levels in the abdomen
Volvulus
a twisting of a loop of bowel creating an obstruction
gonadal shielding for a female may be impossible for studies of the lower
abdominopelvic region
Ascites
abnormal accumulation of fluid in the peritoneal cavity
retroperitoneum
adrenal glands, kidney, duodenum, pancreas, ascending and descending colon
Situation: A patient with a history of ascites comes to the radiology department. which position best demonstrates this condition?
an erect anterior posterior abdomen position best demonstrates air fluid levels. Ascites produces free fluid in the intraperitoneal cavity.
why may the posterior anterior projection of a kidney ureter bladder generally be less desirable than an anterior posterior projection
because it increases object receptor distance of kidney on posterior anterior radiograph
why is the right kidney found in a more inferior position that the left kidney?
because of location of liver on the right
Adynamic ileus
bowel obstruction caused by a lack of intestinal peristalsis
voluntary motion can best be prevented by
careful breathing instructions
Crohn's disease
chronic inflammation of the intestinal wall that may result in bowel obstruction
Situation: a patient comes for the E R 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 K U B on and adult is 76 kV, 30 mAs. Should the tech change any of these exposure factors for this patient? (A E C is not being used)
decrease the mAs. because trapped air is easier to penetrate than soft tissue with x rays, reducing the mAs will prevent overexposing the radiograph
the sigmoid colon is located between the
descending colon and rectum of the large intestine
which decubitus position best demonstrates possible aneurysms, calcifications of the aorta, or umbilical hernias
dorsal decubitus
exposure for an anterior posterior projection of the abdomen should be taken on expiration or inspiration
expiration
true or 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 or false. for an adult abdomen, a collimation margin must be visible on all four sides of the radiograph
false
true or false. it is always acceptable during kidney ureter bladder imaging practice to indicate the side of the body with a digital marker
false
true or false the correct term for the radiographic study of the urinary system is intravenous pyelogram
false , it is the intravenous urogram
Pneumoperitoneaum
free air or gas in the peritoneal cavity
list the 3 accessory digestive organs
gallbladder, pancreas, liver
The medical prefix for stomach is
gastro
continuation of the 7 landmarks of the abdomen
ischial tuberosity located 1 and a half inches below or distal to the symphysis pubis, and the symphysis pubis
gonadal shielding should not be used during abdomen radiography if
it obscures essential anatomy
Situation: A child goes to radiology for an abdomen study. It is possible that he swallowed a coin. the E R physician believes it may be in the upper G I tract. Which of the following routings would best identify the location of the coin?
k u b and lateral abdomen . with any foreign body study, two projections 90 degrees opposite is recommended to pinpoint the location of the foreign body
which projection best demonstrates a possible aortic aneurysm in the prevertebral region of the abdomen
lateral position
what quadrant is the sigmoid colon in
left lower quadrant
Intraperitoneum
liver, spleen, transverse colon, stomach
what scale of contrast is recommended for visualization of the abdominal structures on an abdominal x ray
long scale
which of the following structures helps stabilize and support the small intestine? omentum, mesentery,peritoneum, viscera
mesentery
a k u b radiograph reveals that the symphysis pubis was cut off along the bottom of the image. is this an acceptable radiograph
no. a k u b must include the symphysis pubis on the x ray to ensure that the bladder is seen. the position error involves centering of the central ray to the iliac crest
which abdominal structure is not visible on a properly exposed kidney ureter bladder radiograph
pancreas
what are the two causes of voluntary motion
patient breathing and patient movement during exposure
what is the primary cause for involuntary motion in the abdomen
peristaltic action of the bowel
example of which projection requires a kilovolt setting of 110 to 125
posterior anterior , erect chest for free air under diaphragm
which projection of the three way acute abdominal series best demonstrates free air under the diaphragm
posterior anterior chest
is the pancreas located anteriorly or posteriorly to the stomach
posteriorly
the two large muscles found in the posterior abdomen adjacent to the lumbar vertebra and usually visible on an anteroposterior radiograph are called
psoas muscles
what quadrant is the appendix in
right lower quadrant
the prominence of the greater trochanter is about the same level of the
superior border of the symphysis pubis and the lower margins of the ischial tuberosities is about 1 and a half inches or 1 to 4 centimeters distal to the symphysis pubis
which endocrine glands are superomedial to each kidney
suprarenal adrenal glands
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
situation: A patient with a possible perforated duodenal ulcer enters the emergency room. the emergency room 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 2 way acute abdomen series, anterior posterior supine abdomen and left lateral decubitus
rotating can be determined on a kidney ureter bladder radiograph by the loss of symmetric appearance of
the iliac wings, the ischial spine, the obturator foramina if visible, and the outer rib margins
which decubitus position of the abdomen best demonstrates intraperitoneal air in the abdomen
the left lateral decubitus because the free air is best visualized in upper right abdomen in area of the liver
which of the following abdominal regions contains the rectum? is it the pubic, the inguinal, the umbilical, the epigastric, the hypochondriac, or the lumbar
the rectum is in the pubic region
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 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 kilovoltage 90 kv was too high. the tech needs to lower the kilovoltage to between 70 and 80 kv . the miliamper and exposure time can be altered to maintain the density
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 abdominal fluids to accumulate
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.
true or false. a tall asthenic patient may require two 14 by 17 inch image receptors placed lengthwise if the entire abdomen is to be included
true, because the thorax is narrow in width and shallow from front to back but is very long in its vertical dimension
the preferred imaging modality for examining the gallbladder quickly is
ultrasound
Situation: K U B 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 tech. should take?
Because the patient may have renal calculi in the distal ureters and urinary bladder, gonadal shielding cannot be used
deep air filled mucosal protrusions of colon wall
Ulcerative colitis
large amount of air trapped in sigmoid colon with a tapered narrowing at the sit of the obstruction
Volvulus
gonadal shielding for females involves placing the top of the shield at or slightly above the level of the
anterior superior iliac spine with the bottom at the symphysis pubis
to ensure the diaphragm is included on an erect abdomen projection, the central ray should be at the level of 2 inches or 5 centimeters above the iliac crest which places the top of the 14 by 17 image receptor at the level of the
axilla
which of the following structures helps stabilize and support the small intestine? greater omentum, peritoneum, viscera, mesentery
greater omentum
what quadrant is the liver in
right upper quadrant
list the 3 parts of the small intestine
duodenum, jejunum, ileum
which type of body habitus may require two crosswise images to be taken if the entire abdomen is to be included
hypersthenic body type, because patient has a thorax that is very broad and very deep from front to back but is shall in vertical dimensions
which portion of the small intestine is considered to be the longest
ileum
the central ray is centered to what level of the abdomen for a supine anterior posterior projection?
iliac crest
which topographic landmark is found at the level of l2 to l3?
inferior costal rib margin
Ulcerative colitis
inflammatory condition of the colon
the iliac crest is at the level of the
interspace between l4 and l5
Situation: the emergency room 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?
k u b would be performed with the correct exposure factors to visualize the possible stone
what quadrant is the left colic flexure in
left upper quadrant
what quadrant is the spleen in
left upper quadrant
what quadrant is the stomach in
left upper quadrant
what quadrant is the two thirds of jejunum in
left upper quadrant
a radiograph of an AP abdomen reveals the left iliac wing is more narrowed that the right. what specific positioning error caused this?
patient was rotated into a slight right posterior oblique position. the downside ilium will appear wider
the double walled membrane lining the abdominopelvic cavity is called
peritoneum
Situation: a hypersthenic patient comes to the radiology department for a K U B. 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 tech. should take
repeat the exposure using two 14 by 17 inch cassettes placed crosswise. the hypersthenic patient often requires this type of image receptor placement for abdomen studies
the organs located posteriorly to or behind the serous membrane lining of the abdominopelvic cavity are referred to as
retroperitoneal
the large intestine begins in the
right lower quadrant and cecum of the large intestine
which of the following technical considerations is essential when performing abdomen studies on a young pediatric patient?
short exposure times, high speed image receptor, reduced kilovolts and milliamps per second
which of the following organs is not directly associated with the digestive system, gallbladder, spleen, jejunum, or pancreas
spleen
which one of the following organs is considered to be part of the lymphatic system, is it the liver, spleen, pancreas, or gallbladder
spleen
Situation: A patient with a possible 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 3 way acute abdominal series, including the anteroposterior supine and erect abdomen and posteroanterior erect chest projections
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 40 SID. The tech 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. to control this motion, the technologist needs to increase the miliamperage and decrease the exposure. example 400 mA at 1/10 second
which positioning routine should be used for an acute abdominal series if the patient is too ill to stand
two way abdomen, anterior posterior supine abdomen, and a left lateral decubitus
which modality is being used to evaluate patients with acute appendicitis?
ultrasound
what is the correct name for the abdominal region found directly in the middle of the abdomen? is it the epigastric, inguinal, umbilical or pubic
umbilical
infraperitoneum
uqurinary bladder, reproductive organs ovaries and testes
what is the best mechanism to control involuntary motion?
use the shortest exposure time possible