CH 12

1. store bile 2. concentrate bile 3. contract when stimulated.

3 primary functions pf the gallbladder

Salivary glands, pancreas, liver, and gallbladder

Accessory organs of the digestion system?

deglutition

Act of swallowing is termed

Emesis

Act of vomiting

trichobezoar

Bezoar made up of hair

phytobezoar

Bezoar made up of vegetable fiber or seeds

Cholesterol

Bile contains ____, which is made soluble in the bile by the bile salts.

Liver

Bile is manufactured where?

Gallbladder

Bile is stored in the

Hematemesis

Blood in vomit

Mastification

Chewing movement is termed? initiates the mechanical part of digestion.

closes off the nasopharynx to prevent swallowed substances from going to the nose.

During swallowing the soft palate?

makes sure substances don't reenter the mouth.

During swallowing the tongue

thin and thick barium

Esophagography generally use both

lesser curvature

Found along the medial border of the stomach, forms a concave border

1 No ionizing radiation 2 detection of small calculi (stones) 3 no contrast medium 4 Less pt prep. NPO for 8 hours

Four advantages of sonography of the gallbladder

bilirubin, calcium, or cholesterol

Gall stones can be caused by increased levels of?

family history, excessive weight, over 40, female.

Gallstones Risk factors

4-8 seconds

How long does the passage of solid food take to get to the stomach.

1 quart, or 800 to 1000ml

How much bile does the liver secrete every day?

intestinal infarct or peritonitis

If a large amounts of barium escape into the peritoneal cavity this can lead to

Right Lobe

Largest Lobe

two major lobes and two minor lobes

Lobes of the liver?

Bezoar

Mass of undigested material that becomes trapped in stomach.

Hypertrophic Pyloric stenosis HPS

Most common type of gastric obstruction in infants. caused by hypertrophy of the antral muscle at the orifice of the plyorus.

Major: Right Lobe and left Lobe Minor: Caudate and Quadrate

Name the lobes of the liver

NPO 8 hours

Patient prep for Upper GI series

infant younger than 1 = NPO for 4 children older than 1 = NPO for 6

Pediatric patient prep for upper GI

Esophagography

Rad exam of specifically of the pharynx and esophagus is termed esophagography. studies function of swallowing

Upper Gastrointestinal Series . Barium sulfate is the preferred contrast medium.

Rad exam to study the distal esophagus, stomach, and duodenum in one examination is termed?

T10

The esophagus pierces the diaphragm at level?

Romance of the abdomen

The head of the pancreas nestled in the C-loop of the duodenum is called?

Caudate Lobe

The vena cava contours over the surface of which lobe?

3 or 4 parts BaSO4 to 1 part water

Thick barium mixture

1 part water 1 part BaSO4. on avg consist of average if 60% weight to volume of barium sulfate to water

Thin barium mixture

1 intake and digestion 2 Absorb 3 eliminate

Three primary functions of the digestive system

Gastric Ulcer

Ulcer of gastric mucosa

99.5 water and 0.5% solutes or salts and certain digestive enzymes.

What does saliva consist of?

T11- T12

What is the level of the duodenal bulb in a hypersthenic patient

C6

What level is the epiglottis at?

CT

What modality is best for neoplasms of the gallbladder

Falciform Ligament

What separates the left and right Lobe

when foods, such as fats or fatty acids, are in the duodenum. these foods stimulate the duodenal mucosa to secrete the hormone cholecystokinin (CCK). gallbladder contracts and the terminal opening of the common bile duct to relax. CCK causes increased exocrine activity by the pancreas.

When does the gallbladder normally contract?

result of hydrolysis ( removal of water) When too much water is absorbed or the cholesterol too concentrated, gallstones develop. Cholesterol forms the most common gallstones.

When is bile concentrated within the gallbladder?

fundus with collection of gas in body and pylorus

Where does the barium sulfate mixture settle in the supine position

begins posterior to the lvl of the lower border of the cricoid cartilage of the larynx (C6) and ends at it's connection to the stomach (T11).

Where does the esophagus begin and end

L3 to L5

Where is the duodenal bulb on a hyposthenic/asthenic patient

a colloidal suspension, not a solution.

a mixture of barium and water form

Peristalsis

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

Gastric Carcinomas

account for more than 70% of all stomach neoplasms, and 95% of them are adenocarcinomas. radiographic signs include large, irregular filling defect in the stomach. Marked or nodular edges of stomach lining, rigidity of the stomach and associated ulceration of mucosa. CT

lipid

also known as fat, digestion occurs only in the small bowel, although small amounts of the enzyme necessary for this kind of digestion are found in the stomach. end product is fatty acid and glycerol

Achalasia

also termed cardiospasm, is a motor disorder of the esophagus in which peristalsis is reduced along the distal 2/3rds of the esophagus. evident at the esophagus sphincter bc it can't relax during swallowing. common between ages 20 - 40. stricture or narrowing of esophagus

Mumps

an inflammation and enlargement of the parotid glands caused by a paramyxovirus, which can result in inflammation of the testes in approximately 30% of infected males

enzymes

biologic catalysts found in various digestive juices produced by salivary glands in the mouth and by the stomach, small bowel, and pancreas. proteins, they accelerate chemical changes in other substances without appearing in the final products of the reaction

Sliding hiatal hernia

caused by weakening of small muscle (esophagus sphincter) located between the terminal esophagus and the diaphragm. frequently present at birth. may form schatzki ring

rhythmic segmentation

churning or mixing activity is called

nausea, heartburn, premature full feeling when eating, RUQ discomfort and vomiting

clinical indications for gallbladder disease

Compression paddle technique

compression paddle placed under pt in prone position and inflated as needed to provide pressure on stomach region.

cholelithiasis

condition of having gallstones

Anatomic anomalies

congenital or caused by disease, pt who has stokes often develop impaired swallowing mechanisms.

dysphagia

difficulty swallowing

proteins

digestion begins in the stomach and is completed in the small intestine. the end products of protein digestion are amino acids.

carbohydrates

digestion of starches begin in the mouth and stomach and is completed in the small intestine. the end products of digestion of these complex sugars are simple sugars

esophageal varices

dilation of veins in the wall of the distal esophagus. wormlike/ cobblestone appearance.

Adenocarcinoma symptoms

dysphagia, pain during meals, bleeding

Milk calcium bile, seen as a diffuse collection of sand like calcifications or sediments.

emulsion of biliary stones in the gallbladder.

Gastroesophageal reflux disease (GERD)

entry of gastric contents into the esophagus, irritating the lining of the esophagus, reported as heartburn by most patients

Ulcers

erosions of the stomach or duodenal mucosa that are caused by various physiologic or environmental conditions. appear surrounded by lucent halo.

4-5 times longer than the lesser curvature.

found along the lateral border of the stomach

gallbladder anterior to mcp and ducts more midline.

gallbladder placement and duct system in relation to the midcoronal plane.

right border approximately 6 to 7 inches

greatest vertical dimension of liver

stomach

greek word gaster means

1cm/min 3 to 5 hours to pass through

how fast does chyme move through the small intestine

2 to 6 hours

how long does gastric emptying take?

1 second

how long does it take for liquid to reach the stomach

1 - 1 1/2 inhes

how long is the cystic duct

7 1/2 - 9"

how long is the duodenum.

about 5"

how long is the pharynx

1 = 2-4 oz 2 = 4-6 oz 3 = 6-12 oz 4 =12-16

how much barium for newborn 1 year 1-3yr old 3-10yr old older than 10

2 to 2 1/2 tablespoons ( 30 to 40ml)

how much bile can a normal gallbladder store

1000 to 1500 ml

how much do the salivary glands secrete daily?

two separate ducts with separate openings

in about 40% of individuals, these ducts pass into the duodenum as _____ ?

common duct and pancreatic ducts join together to form one common passageway through the single papilla into the duodenum (ampulla) becomes narrower as it passes into the duodenum leading to common site for gallstones.

in about 60% of individuals, these ducts pass into the duodenum as ____?

water soluble iodinated contrast media

in the case of risk of a large amounts of barium escape into the peritoneal cavity calls for?

mechanical digestion

includes all movement of the GI tract

cholecystitis - restricts flow of bile from the gallbladder into the common duct. 95 % due to stone lodged in the neck of the gallbladder. over time the bile begins to irritate the inner lining of the gallbladder, and it becomes inflamed. bacterial infection and ischemia (obstruction of blood supply) may cause Acute cholecystitis. Chronic- may be an outcome of pancreatitis or carcinoma, thickening or calcification of the wall of the gallbladder

inflammation of the gallbladder

Gastritis

inflammation of the lining or mucosa of the stomach Acute- manifests with severe symptoms of pain and discomfort Chronic- intermittent condition that may be brought on by changes in diet or stress. absence of rugae, thin gastric wall, and "speckled" appearance of mucosa with acute cases.

bilary stenosis

is a narrowing of one of the bilary ducts. flow of bile may be restricted by this condition.

1 cotton balls soaked in thin barium 2 barium pills or gelatin capsules with barium 3 marshmellows

items useful for detection of foreign bodies

110-125

kVp for barium exams

Zenker diverticulum

large outpouching of the esophagus just above the upper esophageal sphincter, caused by weakening of the muscle wall

3-4 pounds

liver weight

aid in digestion of fats by emulsifying ( breaking down) fat globules and in the absorption of fat following its digestion.

major function of bile?

Carcinoma of esophagus

most common malignancies of the esophagus, adenocarcinoma, carcinoma and pseudo carcinoma. point of stricture, narrowing, or atrophic changes in mucosa

Production of large amounts of bile.

most radiographic applicable function of the liver?

peristalsis

moves the gastric content towards the pyloric valve. propel intestinal contents along the alimentary canal

Rugae

mucosal folds are termed

85% are adenocarcinoma 15% squamous cell carcinoma 80% that have carcinoma have stones

of the neoplasms of the gallbladder what percent are adenocarcinomas and what percent are squamous cell carcinomas

esophagogastric junction

opening between the esophagus and the stomach is termed

stomach contents, respiration, body position, previous surgeries, and age

other factors that may affect the position of the stomach

Valsalva maneuver

patient asked to hold breath while bearing down trying to move the bowels. forces air against the closed glottis.

Duodenal Ulcer

peptic ulcer situated in the duodenum. generally located in second or third aspect of duodenum.

Mueller maneuver

performed as pt is exhales and then tries to inhale against a closed glottis.

Hiatal Hernia

portion of the stomach herniates through the diaphragmatic opening. most of the stomach is found in the thoracic cavity. common in 50% of us pop over 50 years.

Diverticula

pouch like herniations. can occur in the stomach or small intestine. 70% to 90% arise in posterior aspect of fundus

Chole

prefix denoting relationship to bile

cysto

prefix denoting to sac or bladder

cholelithiasis

prefix for gallstones

symptoms of carcinosarcoma

produce large irregular polyp

Bucky slot sheild

protects gonadal region. ensure bucky is all the way to the end of the table, covers aprox 2 inches of space under table top.

modified Valsalva

pt pinches nose closes mouth and tries to blow the nose

Water test

pt supine and turned slightly to the left side slight LPO. fills fundus with barium. pt asked to swallow mouthful of water through a straw under flouro

compression paddle

reduces exposure to arm and hand of fluoroscopist

Barrett esophagus or Barrett's syndrome

replacement of normal squamous epithelium with columnar- lined epithelium ulcer tissue in the mid to lower esophagus. may produce a stricture in lower esophagus. Nuc Med modality of choice. injected with technetium 99m pertechnetate to demonstrate shift in tissue types. "streaked" appearance

chyme

semifluid mass

2 1/2 to 4 inches long and approximately 1 inch wide.

size of a normal gallbladder?

averages approximately 3 inches in length and has an internal diameter of a drinking straw.

size of the common bile duct

J shaped extends from T11 down to L2

stomach shape for sthenic pt

J shaped extending from T11 down to L5 or lower

stomach shape of hyposthenic/ asthenic

cholecystectomy

surgical removal of the gallbladder

Cardiac antrum

the abdomen segment of the esophagus

lower right rib cage

the liver is protected by?

calcium and magnesium citrate

two common forms of gas producing crystals?

perforating ulcer

ulcer that involves entire thickness of the wall of the stomach or intestine, creating an opening on both surfaces. sign include presence of free air under the diaphragm

peptic ulcer

ulceration of the mucous membrane of the esophagus, stomach, or duodenum caused by the action of acid gastric juice.

large intestine

unused or unnecessary solid material is eliminated by?

pt is sensitive to iodine or experiencing severe dehydration

water soluble iodinated contrast media should not be used if

cholesterol (radiolucent) and pigment. 75% are cholesterol.

what are the two types of stones

amylase

what enzyme in saliva breaks down starch

T9- T12

what is the level of the stomach in a hypersthenic patient?

prevent distention or collapse of the cystic duct

what is the spiral valve function in the cystic duct

20% often visualized without contrast media

what percent of gallstones are composed of crystalline calcium salts.

another 25 to 30 percent

what percent of gallstones are primarily cholesterol and crystalline slats ( also radiolucent)

supine

what position would be most appropriate to drain the gall bladder into the duct system

Prone

what position would be most appropriate to visualize the gallbladder with consideration of OID

breathing exercises Water test Compression paddle technique toe-touch maneuver

what procedures can be performed to detect reflux

small intestine and a small amount in the stomach

where are digestive end products absorbed

body and pylorus

where does the air gas settle in erect position?

fundus in highest position causing it to fill with gas, barium fills anterior body and pylorus portion.

where does the gas and barium settle in a RAO prone position?

from the diaphragm to just below the body of the tenth rib

where does the right border of the liver extend to on an average size person

L3-L4

where is the Gallbladder on a hyposthenic/asthenic patient

L1-L2

where is the duodenum bulb for sthenic pt

nestled centrally in the posterior inferior region of the liver

where is the gallbladder located in relation the liver

RUQ, almost all of the right hypochondrium , major part of epigastrium and a significant part of the left hypochondrium

where is the liver located

superior border 8 - 9 inches. is convex to conform the inferior surface of right hemidiaphragm.

widest portion of liver