Chp 12 Biliary System and Upper GI

What position is the patient usually placed in during the water test?

LPO (slight)

What is the functions of the Biliary System?

Manufacturing Bile (Liver), Transporting Bile (Various Ducts), and Storing Bile (Gall Bladder)

What position is necessary to get the gallbladder as close to the ir as possible?

Prone position

Another term for negative contrast media is:

Radiolucent contrast medium

What parts of the liver and gall bladder in the anterior view?

Two Major Lobes (Larger lobe on the right, the smaller on the left) and the Falciform Ligament that separates the two lobes.

What parts of the liver and gall bladder in the posterior view?

Two Minor lobes (Quadrate lobe and Caudate Lobe), Inferior Vena Cava is on surface of Caudate Lobe

A patient with a clinical history of hiatal hernia comes to the radiology department. Which procedure should be performed on this patient to rule out this condition?

Upper GI series

The upper GI series usually begins with the table and patient in the ____ position.

Upright (erect)

A breathing technique in which the patient takes in a deep breath and bears down is called the _____

Valsalva Maneuver

Situation: A series of radiographs taken during an Upper GI reveals that the stomach mucosa is not well visualized. The following factors were used during positioning routine: high-speed screens, bucky, 40 in SID, 80 kV, 30 mAs, and 300mL of Barium Sulfate ingested during the procedure. Which exposure factor should be changed to produce a more diagnostic study?

When using barium sulfate as a contrast medium, 100-125 kV should be used to ensure proper penetration of the contrast-filled stomach and visualize the mucosa; 90-100 kV would be adequate for a double contrast study

What does bile do?

aids in digestion of fats and absorption of fats

What are Choleliths and how are they formed?

they are gall stones; formed In abnormal situation when too much water is absorbed or cholesterol becomes too concetrated

What is the minimum amount of time that the patient should be NPO before and upper GI?

8 Hours

A patient with a clinical history of a possible bezoar comes to the radiology department. What is a bezoar, and what radiographic study should be performed to demonstrate this condition?

A mass of undigested material that gets trapped in the stomach; a rare condition that can be diagnosed with an upper GI study

What is the chemical symbol for barium sulfate?

BaSO4

Which term describes food once it is mixed with gastric secretions in the stomach

Chyme

Situation: A radiograph of an RAO position taken during an esophagram reveals that the esophagus is superimposed over the vertebral column. What positioning error led to this radiographic outcome? What must be altered to eliminate this problem during repeat exposure?

Under-rotation of the body into the RAO position led to the esophagus being superimposed

Situation: A radiograph of an RAO projection taken during an esophagram demonstrates incomplete filling of the esophagus with barium. What can the technologist do to ensure better filling of the esophagus during the repeat exposure?

When using thin barium, have the patient drink continuously during the exposure. With thick barium, have the patient hold 2-3 spoonfuls in the mouth and make the exposure immediately after swallowing

List 3 structures that pass through the diaphragm

1. Esophagus \n2. Inferior Vena Cava\n3.Aorta

The 3 most common routine projections for an esophagram are:

1. RAO\n2. Left Lateral\n3. AP

What is the average kV range for an esophagram and upper GI when using barium sulfate (single-contrast study)?

100-125 kV

How much rotation of the body should be used for the RAO projection of the esophagus?

35-40 degrees

What CR angle is required for the PA axial projection for a hypersthenic patient during an upper GI?

35-45 degrees cephlad

How much rotation of the body is required for the RAO position during an upper GI on a sthenic patient?

40-70 degrees

What is the recommended kV rang for a double contrast upper GI projection?

90-100kV range

What is the average weight of the adult human liver?

3-4 pounds

What two structures create the indentations seem along the lateral border of the esophagus?

Aortic arch; left primary bronchus

What does the spiral valve do?

prevent distention or collapse of the cystic duct

List suggested barium dosages during an Upper GI for each of the following pediatric age groups?\n1. Newborn-1yr\n2. 1-3 years\n3. 3-10yrs\n4. More than 10yrs

1. 2-4 oz\n2. 4-6oz\n3.6-12oz\n4.12-16oz

List 4 radiographic tests that may be performed to detect signs of GERD.

1. Breathing exercises\n2. Water Test\n3. Compression (paddle) technique\n4. Toe-touch maneuver

Which projection taken during an upper GI will best demonstrate the retrogastric space?

Lateral

The major parts of the stomach on an average patient are usually confined to which abdominal quadrant?

Left Upper Quadrant

The division of the stomach labeled E in figure 12.3is divided into two parts, what are they?

Pyloric antrum and Pyloric Canal

Which aspect of the GI tract is best demonstrated with an RAO position during an upper GI?

Pylorus of Stomach and C-Loop

Where are the gall bladder and biliary ducts located? How does the bile travel?

outside the liver.

What position would best assist the drainage of the gallbladder?

supine posititon

Label A-F

A.Left Hepatic Duct\nB.Common Hepatic Duct\nC. Common Bile Duct\nD. Pancreatic Duct\nE. Hepatopancreatic Ampulla (ampulla of Vater)\nF. Duodenal papilla

Most of the duodenum is usually found to the ____ of the midline on a sthenic patient

Right

What food substance's digestion begins in the mouth?

Carbohydrates

What is the act of swallowing called?

Degluttition

Another term for mucosal folds of the stomach is _____.

Rugae

The 5 most common routine projections for an upper GI series are (not counting AP Scout projection) are:

1. RAO\n2. PA\n3. Right Lateral\n4. LPO\n5. AP

Label G-L

//fce-study.netdna-ssl.com/2/images/upload-flashcards/38/70/06/8387006_m.jpg G. Duodenum\nH. Fundus of Gallbladder\nI. Body of Gallbladder\nJ. Neck of Gallbladder\nK. Cystic Duct\nL. Right Hepatic Duct

Label A-F

//fce-study.netdna-ssl.com/2/images/upload-flashcards/38/71/65/8387165_m.jpg A. Tongue\nB. Oral Cavity (Mouth)\nC.Hard Palate\nD.Soft Palate\nE.Uvula\nF.Nasopharynx

Label G-L

//fce-study.netdna-ssl.com/2/images/upload-flashcards/38/71/71/8387171_m.jpg G. Oropharynx\nH. Epiglottis\nI. Laryngopharynx\nJ. Larynx\nK. Esophagus\nL. Trachea

Label A-F

//fce-study.netdna-ssl.com/2/images/upload-flashcards/38/72/19/8387219_m.jpg A. Fundus\nB.Greater Curvature\nC.Body \nD. Gastric Canal\nE. Pyloric Portion (pylorus)\nF. Pyloric Orifice

Label G-K

//fce-study.netdna-ssl.com/2/images/upload-flashcards/38/72/22/8387222_m.jpg G. Angular Notch\nH. Lesser Curvature\nI. Esophagogastric Junction (Cardiac Orifice)\nJ. Cardiac Antrum\nK.Cardiac Notch (incisura cardiaca)

Identify the correct body position for A, B, and C.

//fce-study.netdna-ssl.com/2/images/upload-flashcards/38/72/76/8387276_m.jpg A. Supine B. Prone C. Erect

Label A-H

//fce-study.netdna-ssl.com/2/images/upload-flashcards/38/72/91/8387291_m.jpg A. Pylorus (pyloric sphincter)\nB. Bulb (or cap) of duodenum\nC. First (superior) portion of Duodenum\nD. Second (descending) portion of duodenum\nE. Third (horizontal) portion of duodenum\nF. Fourth (ascending) portion of duodenum\nG.Head of pancreas\nH. Suspensory muscle of duodenum or ligament of Trietz

Label A-F

//fce-study.netdna-ssl.com/2/images/upload-flashcards/38/73/12/8387312_m.jpg A. Distal Esophagus\nB. Area of Esophagogastric junction\nC. Lesser curve of the stomach\nD. Angular notch\nE. Pyloric region of stomach\nF. Pyloric Valve or sphincter

Label G-L

//fce-study.netdna-ssl.com/2/images/upload-flashcards/38/73/18/8387318_m.jpg G. Duodenal bulb\nH. Second descending portion of duodenum\nI. Body of stomach\nJ. Greater curvature of stomach\nK. Rugae of stomach (mucosal folds)\nL. Fundus of stomach

What is the end product for:\n1. Carbohydrates\n2. Lipids\n3. Proteins

1. Simple sugars\n2. Fatty acids and glycerol\n3. Amino Acids

Name functions of the Gall Bladder:

1. Storage of Bile\n2. Concentration of bile \n3. Contraction When Stimulated

A radiograph taken during an upper GI (double-contrast study) reveals that the anatomic side marker is missing. The technologist is unsure whether it is a recumbant AP or PA projection. The fundus of the stomach is filled with barium. which position does this radiograph represent?

AP because the fundus is more posterior that the body or pylorus, it ill fill with barium when that patient is in a supine (AP) position

A patient with a possible lacerated duodenum enters the emergency room. The ER physician orders an upper GI to determine the extent of the injury. What type of contrast medium should be used for this examination?

An oral, water soluble contrast media should be used for an upper GI when ruptured viscus or bowel is suspected. Not barium because barium is not water soluble

Why should cigarette use and gum chewing be restricted before and Upper GI?

Both increase gastric secretions

List the 3 classes of substances that are ingested that must be chemically digested

Carbohydrates, Proteins, Lipids (fats)

What part of the Upper GI tract is a common site for ulcer disease?

Duodenal bulb (or cap)

Which region of the GI tract better visualized when the radiologist uses a compression paddle during an esophagram?

Esophagogastric Junction

T or F: Respiration should be suspended during inspiration for Upper GI radiographic projections

False (expiration)

T or F: the body of the stomach curves inferiorly and posteriorly from the fundus.

False; anteriorly and inferiorly

Which two anatomic structures are known as the "Romance of the Abdomen"?

Head of Pancreas and C-Loop of Duodenum

pancreatic duct and common bile duct join to form this

Hepatopancreatic Ampulla

What does and what is Cholecystikinin (CCK) do?

Increased levels of cck in the blood cause the gall bladder to contract and distal end of common bile duct to relax; a hormone secrected by duodenal mucosa when stimulated by food)

Would the fundus be more superior or more inferior when one takes in a deep breath? Why?

Inferior, because of its proximity to the diaphragm

The speed which barium sulfate travels through the GI Tract is called:

Motility

What is the barium to water ratio for thin barium?

One to one ration of barium and water

Which optional position should be performed to demonstrate the upper esophagus located btwn/ the shoulders?

Optional Swimmer's Lateral

What type of contrast medium should be used if the patient has a history of bowel perforation?

Oral, water-soluble iodinated contrast media

How many different functions of the liver and name one that deals with the biliary system?

Over 100 functions; production of bile (about 800-1000mL a day)

What is the shape of the gallbladder and what are the 3 parts?

Pear Shaped; Fundus, body, neck

Where is Peristaltic activity not found?

Pharynx

Why is the RAO preferred over the LAO for an esophagram?

Places esophagus between the vertebral column and heart

The C- Loop of the duodenum and the pancreas are ______ (intraperitoneal or retroperitoneal) structures.

Retroperitoneal (behind peritonium)

What is the entire bile route?

Right/Left Hepatic Duct -> Common hepatic duct -> common bile duct -> pancreatic duct -> Duodenum

Absorption of nutrients primarily takes place in _______, although some substances are absorbed through the lining of the _____.

Small intestine; stomach

Circular muscle fiber that relaxes when cck increases in the blood

Sphincter of Oddi

Name the two abdominal organs that most dramatically affected, in relation to location, by body habitus.

Stomach and Gallbladder

Is the mixture of barium sulfate a suspension or a solution?

Suspension (colloidal)

Situation: A patient comes to radiology with a clinical history of possible gastric diverticulum in the posterior aspect of the fundus. Which projection taken during the upper GI series best demonstrates this defect?

The lateral position best demonstrates a gastric diverticulum located in the posterior region of the stomach.

What is the purpose of the PA axial projection for the hypersthenic patient during an upper GI?

To prevent superimposition of the pylorus over the duodenal bulb and better visualize the lesser and greater curvatures of the stomach

T or F: The esophagram usually begins with fluoroscopy with the patient in the erect position

True

Where is the liver and gall bladder located?

Under right hemidiagphragm

Situation: A patient with a fish bone stuck in his esophagus enters the emergency room. What modifications to a standard esophagram may be needed to locate the foreign body?

With radiolucent foreign bodies in the esophagus. shredded cotton soaked barium may be used to help locate it. But today, most foreign body studies of the esophagus are located and removed through endoscopy

Situation: An Upper GI is being performed on a thin, asthenic-type patient. Because of room scheduling conflicts. this patient was brought into your room for the overhead follow-up images following fluoroscopy. Where would you center the CR and the 30- x 35- cm (11 x14 inch) image receptor to ensure taht you included the stomach and duodenal region

Would center lower than usual, to the mid-L3 to L4 region or 1.5-2 inches (4-5cm) above the level of the iliac crest

How is bile concentrated?

by hydrolysis, which is the removal of water

Protusion of muscle into duodenum from sphincter of oddi

duodenal papilla