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