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