Chapter 3 - Exam Study Guide
ileum
third part of the small intestine ; distal three-fifths
What are the 3 parts of the small intestine?
1. Duodenum 2. Jejunum 3. Ileum
Exposure factors for abdominal radiography:
1. Medium kVp 70 - 80 (analog) 80 (+ or -) 5 kV (digital) 2. short exposure time 3. adequate mAs based on part thickness
Which positioning routine should be used for an acute abdominal series if the patient is too ill to stand?
2 way abdomen- AP supine abdomen, left lateral decubitus
What exposure considerations would be most ideal for an AP abdomen of an average sized adult using a digital radiographic system?
80-85 kVp, grid, 40 inch SID
View that best demonstrates: ulcerative colitis
AP abdomen acute abdominal series
Best imaging modality: liver
CT & MRI
Best imaging modality: pancreas
CT & MRI
Situation: The ER 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?
KUB
Situation: A child goes to radiology for an abdomen study. It is possible that he swallowed a coin. The ER physicians 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
Major quadrants of the abdomen?
LUQ, RUQ, LLQ, RLQ
A KUB radiograph reveals that the symphysis pubis was cut off along the bottom of the image. Is this an acceptable radiograph? If it is not, how can this problem be prevented during the repeat exposure?
No ; reposition to lower the image to include the symphysis pubis
A radiograph of an AP abdomen reveals the left iliac wing is more narrowed than the right. What specific positioning error caused this?
Patient was rotated into a slight right posterior oblique (RPO) position.
Situation: 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 kidney, is cut off. What is the next step the technologist should take?
Repeat the exposure using two 14 x 17 in cassette placed crosswise. The hypersthenic patient often requires this type of IR placement for abdomen studies
Situation: 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 stone. What is the next step the technologist should take?
Repeat the exposure without using gonadal shielding
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 ( 102 cm) 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 structure on the repeat exposure?
The selected kV ( 90kV) was too high. The technologist needs to lower the kV to between 70 to 80 kV. The milliamperage and exposure time can be altered to maintain the density.
Situation: 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 anteroposterior (AP) supine and erect abdomen and posteroanterior (PA) erect chest projections
Situation: 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
Kidney placement in the abdomen:
They are located on either side of the lumbar vertebral column.
Organs in the RLQ:
ascending colon, appendix (vermiform), cecum, 2/3 of ileum, ileocecal valve
Situation: A patient comes from the ER 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 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)
Yes. Decrease the milliamperage seconds (mAs)
volvulus (clinical indication)
a twisting of a loop of bowel creating an obstruction
ascites (clinical indication)
abnormal accumulation of fluid in the peritoneal cavity
View that best demonstrates: Crohn disease
acute abdominal series
View that best demonstrates: Fibrous adhesions
acute abdominal series
View that best demonstrates: Ileus
acute abdominal series
View that best demonstrates: Intussusception
acute abdominal series
View that best demonstrates: Volvulus
acute abdominal series
Most common radiographic exam for fibrous adhesions? Possible radiographic appearance?
acute abdominal series ; distended loops of air-filled small intestine ;
intussusception (pathologic condition)
air filled "coiled spring" appearance
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?
bedside portable left lateral decubitus projection
adynamic (paralytic) ileus (clinical indication)
bowel obstruction caused by a lack of intestinal peristalsis
Ileus (nonmechanical bowel obstruction)
categorized as adynamic ileus and most frequently is caused by peritonitis, or paralytic ileus which is caused by a lack of intestestinal motility
Crohn's disease (clinical indication)
chronic inflammation of the intestinal wall that may result in bowel obstruction
dynamic bowel obstruction
complete or nearly complete blockage of the flow of intestinal contents
ulcerative colitis (pathologic condition)
deep air filled mucosal protrusions of colon wall
Organs in the LLQ:
descending colon, sigmoid colon, 2/3 of jejunum
Crohn's disease (pathologic condition)
distended loops of air filled small intestine
Which decubitus position best demonstrates a possible aneurysms, calcifications of the aorta or umbilical hernias?
dorsal decubitus
Situation : A patient with a history of ascites comes to the radiology department. Which one of the following positions best demonstrates this condition?
erect AP abdomen
imaging modalities that requires the use of intravenous, iodinated contrast media for studies of the abdomen:
excretory or intravenous urogram
causes of dynamic bowel obstruction include:
fibrous adhesions, Crohn disease, intussusception, volvulus
duodenum
first portion of the small intestine ; shortest, but widest (about 25 cm (10 in.) in length
Pneumoperitoneum (clinical indication)
free air or gas in the peritoneal cavity
ascites (pathologic condition)
general abdominal haziness
What structure is a double fold of peritoneum that connects the transverse colon to the greater curvature of the stomach?
greater omentum
ulcerative colitis (clinical indication)
inflammatory condition of the colon
With the use of _______, CT imaging can discriminate between a simple cyst and a solid neoplasm.
intravenous, iodinated contrast media
Why should a patient be placed in the decubitus position for a minimum of 5 minutes before exposure?
to allow intra-abdominal air to rise and to allow abnormal fluid to accumulate
A radiographic 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 in ( 102 cm) SID. The technologist 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?
involuntary motion ; increase mA and decrease exposure time
Retroperitoneal organs:
kidneys, ureters, adrenal glands, pancreas, c-loop of duodenum, ascending & descending colon, upper rectum, major abdominal blood vessels (aorta & inferior vena cava)
volvulus (pathologic condition)
large amount of air trapped in sigmoid colon with a tapered narrowing at the site of obstruction
Which decubitus position of the abdomen best demonstrates intraperitoneal air in the abdomen?
left lateral decub- free air is best seen in the upper right area of the liver
Air needs _____ penetration while fluid needs _____.
less ; more
Organs in the RUQ:
liver, gallbladder, right colic (hepatic) flexure, duodenum (C-loop), head of pancreas, right kidney, right suprarenal gland
Intraperitoneal organs:
liver, gallbladder, stomach, spleen, jejunum, ileum, cecum, sigmoid colon
Retroperitoneal
located behind the peritoneal cavity
Infraperitoneal
located under or beneath the peritoneal cavity
Infraperitoneal organs:
lower rectum, urinary bladder, reproductive organs, male closed sac, female open sac (uterus, tubes, ovaries - extending into peritoneal cavity)
Which of the structure helps stabilize and support the small intestine?
mesentery
Location of liver:
occupies the majority of the RUQ
Organs for digestion:
oral cavity, pharynx, esophagus, stomach, small intestine, large intestine
pyelo-
pelvis
Location of gallbladder:
posterior and inferior to the liver
Location of spleen:
posterior and to the left of the stomach in the LUQ
Location of pancreas:
posterior to the stomach and near the posterior abdominal wall, between the duodenum and the spleen
umbilical hernia
protrusion of part of the intestine at the navel
The _____ kidney is situated a little more inferior than the other because of the __________.
right ; presence of the large liver on the right
jejunum
second part of the small intestine ; two-fifths
What technical considerations are essential when performing abdomen studies on a pediatric patient?
short exposure times, high speed image receptor, and reduced kV and mAs
What are the parts of the parts of the lymphatic system?
spleen, lymph nodes, lymph vessels, lymph glands
Organs in the LUQ:
spleen, stomach, left colic (splenic) flexure, tail of pancreas, left kidney, left suprarenal gland
gastro-
stomach
intussusception (clinical indication)
telescoping of a section of a bowel into another loop of bowel
Fibrous adhesions
the most common cause of mechanically based obstruction, in which a fibrous band of tissue interrelates with the intestine, creating a blockage
Pneumoperitoneum (pathologic condition)
thin crest shaped radiolucency underneath diaphragm
Best imaging modality: gallbladder
ultrasound
Best imaging modality: spleen
ultrasound
Intraperitoneal
within the peritoneal cavity