Digestive System (Alimentary Canal)
Body of the stomach
descedning from the fundus and beginning at the level of the cardiac notch.
Stomach
dilated, salike portion of the digestive tract extending between the esophagus and the small intestine.
Duodenum
8-10 inches in length, and is the widest portion of the small intestine. It is retroperitoneal and relatively fixed in position.
to demonstrate a possible hital hernia
Fo the PA projection as part of the UGI exmination, why should the lower lung fields be included on a 14X17 inch IR?
Iliac Crests
For delayed AP projections demonstrating the small intestine of a sthenic patient, to which level of the patient should the IR be centered?
35-40
For images with the patient in the RAO (Esophagus) position, the patient should be rotated approximately _________ to ________ degrees.
Support patient on radiolucent sponge
For lateral decub positons, what should be accomplished to ensure that the dependent side of the patient is demonstrated?
Right
For the AP oblique projection, LPO position which sie of the patient should be elevated away from the x-ray table
35-45
For the AP oblique projection, LPO position, the patient should be rotated __________ to _________ degrees
35-45 degrees
How many degrees should the pateints be rotated from the supine position for the AP oblique projection, RPO position
40-70
How many degrees should the patient be rotated from the prone position?
peristalsis is accelerated
How might the oral method of small bowl examination be affected by giving the patient a cup of cold water after the administration of the contrast medium?
Flexures to rectum
How much of the colon should be demonstrated in the image of a lateral decub position?
Center the IR 3-6 inches lower
How should the center of the IR be adjusted if the patient is repositioned from the prone position to the upright position?
Perpendicularly
How should the central ray be directed for the PA projection?
Angled caudally (30-40)
How should the central say be directed for the PA axial Projection?
Prone
How should the patient be placed for the PA projection?
Prone
How should the patient be placed for timed images when compression of the abdominal contents is desired?
Supine
How should the patient be positioned when the small intestine is to be filled by the complete reflux method?
Center over the midline of the grid a sagittal plane passing halfway between the vertebral column and the left lateral border of the abdomen.
How should the patients positions be adjusted to center the stomach over the midline of the table?
weight supported by cushion under thorax and pelvis
How should the prone position of the patient be adjusted to prevent the full weight of the abdomen from causing the stomach and duodenum to press against the vertebral column.
LAO
What other oblique positions produces an iage receptor similar to the AP oblique projection, RPO position
Oral
What small bowel series is most common?
RAO (preferred) and LPO
What two oblique positions can be used to demonstrate the entire esophagus effectively?
A high-density barium product and carbon dioxide crystals
What two types of contrast media are used for double- contrast esophageal studies?
A barium sulfate product of 30% to 50% weight per volume concentration
What type of radiopaque contrast medium usually is used in routine UGI studies?
post evacuation image
What wording refers to the last image usually performed as part of a BE examination
to indicate the interval between the exposure of the image and the ingestion of the barium
Why is a time marker displayed on each images made during oral method small bowel series?
The LAO position may superimpose vertebral shadows with the distal esophagus.
Why is the PA oblique projection, left anterior oblique (LAO) position, not included in the typical esophageal study?
It allows more complete contrast filling of the esophagus.
Why is the recumbent right anterior oblique (RAO) position preferred over the upright position?
obtain better coating of the lumen
Why should a high-density barium product be used as the contrast medium for double contrast barium enema?
To coat the mucosal lining of the stomach
Why should patients undergoing double-contrast examinations turn from side to side or roll over a few times during a procedure?
Asthenic
With which body habitus does the greatest visceral movement occur between the prone position and the upright position?
Small intestine
extends from the pyoric sphincter of the the stomach to the ileocecal valve.
Rectum
extends from the sigmoids colon to the anal canal.
Villi
fingerlike projections, which assist the processes of digestions and absorption.
Chyme
food that has been mechanically and chemically altered in the stomach is transported to the duodenum as a material called
instruct patient to drink a glass of ice water
for a small bowel series of a patient with hypomotility of the small intestine, which procedure shoud be performed to accelerate peristalsis
2 inches below ASIS
for the AP axial projection, where on the patients anterior surface should the central ray enter when a 14X17 inch IR is used?
PA oblique porjection, RAO position
for the single contrast UGI examination with the patient recumbent, which projection produces the best image of a barium-filled pyloric canal and duodenal bulb in patients whose habitus approximates teh sthenc type?
right iliac
in which abdominal region does the large intesting originate?
Ileocecal Valve
valve projects into the lumen of the cecum and gaurds the opening between the ileum and the cecum
Fluoro and x-ray
what 2 imaging modalities are most commoly used to examne the alimentary canal after the introduction of a barium product?
storage, where food is broken down
what are the 2 main functions of the stomach?
single and double contrast
what are the two basic methods for performing a barium enema?
examined first with double contrast, then with single contrast
what is a biphasic GI examination?
no fecal matter present
what is considered the most important aspect of patient preparation for the BE?
24 inches
what is the maximum height above the level of the anus that a BE bag may be place on an IV stand?
barium sulfate
what is the most common type of contrast medium used for a barium enema?
Restrictive diet, laxatives, and cleansing enema
what should be included in the instructions generally given to a patient in preparation for a BE
85-90 degrees
what should the temp of the barium be when the administration of a warm barium solution is desirable?
Air and Carbon dioxide
what two radiolucent contrast media can be used during the double contrast BE study
RAO and LPO
what two recumbent oblique poistions can be used to demonstrate best an unobstructed image of a barium-filled esophagus between the vertebrae and the heart?
Barium Sulfate
what type of contrast is used to visualize the alimentary canal.
patient cant tolerate retrograde filling of the colon
when might an orally administered, water-soluble, iodinated contrast medium be used in place of a barium sulfate mixture for a BE?
6th cervical vertebrae, T11
where does the esophagus originates? And where does it terminate?
between the descedning colon and the rectum
where in the large intestin is the sigmoid located?
between the transverse colon and the descending colon
where in the large intestine is the left colic flexure located?
Enterolysis
which method of preforming a small bowel series does not use a cleansing enema as part of patient preparation?
Rectum and sigmoid
which portions of the large intestine are of prime interest with the left lateral portion
PA axial projection
which projection produces an image similar to the AP axial projection?
Complete Reflux
which small bowel series method often requires the administration of glucagon or diazepam to relax the intestine and reduce patient discomfort during the initial filling of the small intestine
cecum
which structure, when visualized on an image as part of a small bowel series usually indicates the completion of the examination
Hypersthenic
Which type of body habitus requires the most rotation?
ASIS
To which level of the patient should the central ray be directed for the PA axial projection?
True
True of False: A barium sulfate mixture is the preferred contrast medium for esophagrams.
True
True of False: For the average patient, the PA oblique projection, RAO position, produces the vest images of the pyloric canal and the duodenal bulb filled with barium.
True
True of False: The PA projection with the patient in the prone position demonstrates the contour of the barium filled stomach and duodenal bulb.
True
True of False: The barium sulfate suspension sue for double contrast examinations should have a higher weight per volume ration then the barium sulfate suspension sued for single contrast examinations
False
True of False: The most important requirement for the contrast medium is that the weight per volume should be rated greater than 50%
False
True of False: A compression band may be placed across the patients abdomen to immobilize the patient and reduce involuntary movement of the viscera.
True
True of False: The patient should suspend respiration for the exposure for the AP projection
True
True or False: For the PA oblique projection RAO position, the patient should be rotated 35-45 degrees from the prone position
False
True or False: For the PA oblique projections RAO position, the central ray should be directed 35-45 degrees caudally
True
True or False: Other imaging modalities such as sonography and computed tomography have largely replaced hypotonic dudenography
True
True or False: The PA oblique projections, RAO position, is performed primarily to demonstrate the right colic flexure.
True
True or False: The PA projections with the patient in the upright position shows the size, shape, and relative position of the barium- filled stomach.
True
True or False: The entire colon should be demonstrated for the AP projection
True
True or False: Both colic flexures should be seen in the RAO positon image.
False
True or False: Both colic flexures should be seen with the PA axial projection
True
True or False: Single or Double contrast studies can be sued to demonstrate the esophagus.
UGI
What acronym refers to the Upper Gastrointestinal Series?
reabsorption of fluids and eliminate waste
What are the 2 main functions of the large intestine?
Digestion and absorption
What are the 2 main functions of the small intestine?
High-density barium sulfate suspension and gas producing substance
What are the two types of contrast media used in double contrast procedures
With intubation and without intubation
What are two methods of performing hypotonic duodenography?
Suspended inspiration after expiration
What breathing instructions should be given to the patient when making the exposure? (UGI)
Haustra?
What do the cicles represent?
Jejunum
What is B
Illeum
What is C
Duodenum
What is letter A
Lesser Curvature
What is letter B
Cardia
What is letter C
Fundus of the stomach
What is letter E
Greater Curvature
What is letter H
Pyloric Sphincter
What is letter H
Pyloric Antrum
What is number 10
Pyloric Canal
What is number 10
Angular Notch
What is number 9
Taeniae Coli
What is the Arrow pointing to?
22 feet
What is the length of the small intestine?
2-3 hours
What is the normal emptying time of a normal stomach?
To relax the gastric tract, enabling gastric structures to expand and be better demonstrated
What is the purpose of using glucagon during the double contrast examination?
3 1/2- 4 inches
Approximately how far into the rectum should an enema tip be inserted?
15-30 minutes
Approximately how long after the exposure of the first image should subsequent images be exposed.
1 to 2
Approximately how many inches above the lower rib margin should the IR be centered to the recumbent patient? (Right Lateral)
Reduce production of gas and fecal matter
As part of patient preparation, why should the patient maintain a soft, low-residue diet for 2 days?
L1-L2
At which vertebral level should the central ray enter the patient if the patient is in the recumbent position (Right Lateral)
L3
At which vertebral level should the central ray enter the patient if the patient is moved from the recumbent position to the upright lateral position?
Perpendicular to the center of the IR and midway between the midcoronal plane and the anterior surface of the abdomen
Describe how and where the central ray should be directed to the IR and the patient
Instructed not to belch
During double contrast examinations, what instructions should be given to the patient after the patient swallows the carbon dioxide crystals or tablets to ensures a double contrast effect?
the esophagus was demonstrated through the superimposed thoracic vertebrae
For the AP or PA projections for the esophagus, how is it determined that the selections of exposure factors were acceptable
L2
For the AP projection demonstrating the small intestine of a sthenic patient within 30 minutes after the administration of contrast medium, to which level of the patient should the IR be centered?
At the end of expiration
For the AP projection demonstrating the small intestine, when should the exposure be made?
prependicularly
For the AP projection demonstrating the small intestine, where should the central ray be directed?
Midsagittal
For the AP projection demonstrating the small intestine, which plane of the body should be centered to the grid.
Tilit the table and patient into a full trendelenburg position
For the AP projection with the patient supine, which procedure should be performed to demonstrate best a diaphragmatic herniation
Midsagittal
For the PA axial projection, which plane of the body should be centered to the midline of the table?
Right lateral projection
For the UGI examination with the patient recumbent, which projection best demonstrates the right retogastric space?
at level of ASIS
For the lateral rectum projectio, to what level of the patient should the IR that is 10X12 inch be centered?
midcoronal
For the left lateral projection, which plane of the body should be centered to the midline of the table
2-3 inches lower; gravitational effect
For upright frontal, oblqie, and lateral projections how is the centering of the IR adjsted from that sed for the recumbent positions? Why is the compensation necessary?
Perpendicular to the center of the IR
How and where should the central ray be direct for the RAO UGI projection?
The coating ability of the barium could be diminished because the secretion of gastric juices may be stimulated.
How can the UGI study be affected if the patient smokes cigarettes shortly before the examination?
produce irritation and injure internal tissues
How could the patient be affected if the barium solution is too warm
10 inches
How long is the adult esophagus
6 inches long
How long is the anus?
5 Feet
How long is the large intestine?
partially obscured by thoracic vertebrae
In images of a contrast filled esophagus with the patient in the RAO position, how does the esophagus appear in relation to the surrounding structures when rotation of the patient was insufficient.
between the thoracic vertebrae and the heart
In relation to the surrounding structures, where should the esophagus appear in images with the patient in the RAO position.
Hips and femurs superimposed
In the image of the left lateral projections, how is it determined that the patient was not rotated?
Posterior ribs, they should be superimposed
In the lateral projection (esophagus), what structures are used to determine whether the patient was rotated? How should these structures appear?
Cephalically 30-40 degrees
In which directions and how many degrees should the central ray be directed for the AP axial projection?
Lesser Curvature
Known as the right border of the stomach
Greater Curvature
Left and inferior borders of the stomach
Single and double contrast
List the two general GI studies routinely used to examine the stomach
Small lesions are readily demonstrated, and the mucosal lining of the stomach can be more clearly visualized.
Name 2 advantages of performing the doubles contrast examinations for the UGI
Fundus
Superior portion of the stomach that expands superiorly and fills the dome of the left hemidiaphragm.
PA oblique, RAO
The AP oblique projection, LPO position, produces an image similar to the ___________________________ projection ( __________________________ position)
Right, 45
The AP oblique projection, LPO require the patients ________________ side be elevated away from the table _________________ degrees.
Fundus
The AP oblique projections, LPO position, demonstrates the _________ portion of the stomach filled with barium.
30-50%
What is the range of weight per volume concentration for the barium sulfate suspension usually used for single-contrast examinations.
Cardiac Sphincter
The muscle controlling the cardiac orifice is called the
Upright
To demonstrate swallowing function best, in which position should the patient be placed to begin the fluorocopic phase of a single-contrast examinations of the esophagus.
Inferior margin of the pubic symphsis
To produce coned-down image of the AP axial projection on an IR that is 10X12 inches where on the patient should the central ray enter?
midway between xipoid process and the lower lateral margins of ribs.
To what level of the patient should the IR be centered for the AP oblique projections?
Iliac Crests
To what level of the patient should the IR be centered for the AP projection?
Iliac Crests
To which level of the patient should the IR be centered for the PA oblique projections, LAO position?
Iliac Crests
To which level of the patient should the IR be centered?
AP, Right lateral Decub
Whcih BE projection requires that the patient be placed in the right lateral recumbent positions and that a horizontal central ray be directed to the mid-line of the patient at the level of the iliac crests?
T5-T6
When demonstrating the entire esophagus, to what level of the patient should the IR be centered?
cecum
When examining images of a small bowel series, which structure usually indicates adequate demonstration of the entire small bowel?
Vertebrae
When examining images of the right lateral projection, which osteologic structures should be examined to determine rotation?
1-2 inches above lower rib margin
When performing the PA projection on a prone patient, to what level of the patient should the IR be centered?
Gas
When the patient is in the upright position, the fundus is usually filled with?
midway between xipoid process and the lower lateral margins of ribs.
Where exactly should the central ray enter the patient
duodenum
Where in the small intestine should the tube be inserted for the enterolysis method of performing a small bowel series
Rectosigmoid
Which are of the large intestine is best demonstrated with the PA axial projection?
Pylorus
Which area is the most inferior pat of the stomach?
Fundus
Which area is the most superior part of the stomach?
Supine
Which body position should be used for the AP projection?
right colic flexure
Which colic flexure should be well demonstrated with the AP oblique projections, LPO position?
Smal bowerl series
Which examination of the alimentary canal requires that a series of images be taken at specific time intervals after the ingestion of barium
Left colic
Which flexure should be well demonstrated with the AP oblique projection, RPO position?
double contrast
Which method of examination (single of double) is performed first as part of a biphasic examination?
Midsagittal
Which plane of the body should be centered to the grid for the AP projection?
tilt the table to the trendelenburg angulation
Which procedure should be performed to help demonstrate a diaphragmatic herniation (Hiatal hernia)
Recumbent Right Lateral Position
Which radiographic position should be used to demonstrate best the duodenal loop and the duodenojejunal junction filled with contrast medium?
Enterolysis
Which small bowel series method injects contrast medium through an intestinal tube?
Left colic flexure and descending colon
Which two structures of the large intestine are demonstrated primarily with the PA oblique projection LAO position?
15 Minutes
approximately how long after the patient swallows the barium sulfate mixture should the first images be made
Large Intestine
begins in the right iliac region, where is joins the ileum of the samll intestine, forms an arch surronding the loops of the small intestines, and ends at the anus
Peristalsis
contractions of waves by which the digesive tubes propels its contents toward the rectum
Orally, reflux filling, and intubation
list the 3 common methods by which a barium sulfate mixture can be administered for a small bowel series
AP, RAO, and Lateral Projection
list the projections that comprise the typical esophageal study.
Esophagus
long muscular tube that carries food and saliva from the laryngopharynx to the stomach
Transverse colon
longest and most moveable part of the colon, crosses the abdomen to the undersurface of the spleen, makes a sharp curve into the left clic flexure
Right lateral decub
name the lateral decub position that demonstrates the left colic flexures
left lateral decub
name the lateral decub position that demonstrates the right colic flexures
descending colon
passes inferiorly and medially to its junction with the sigmoid portions at the suprior aperture of the lesser pelvis
ascending colon
passes superiorly from its junction with the cecum to the undersurface of the live, where is joins the transverse colon at an angle called the right colic flexure
Cardia
section immediately surronding the esophageal opening
Hypersthenic
stomach is horizontal and is high, with most dependent portion well above the umbilicus
Asthenic
stomach is vertical and occupies a low positions, with the most dependent portion well below the transpyloric line.
24 Hours
the barium usually reaches the rectum within how many hours?
cardiac antrum
the distal esophagus empties its contents into
Cardiac Orifice
the esophagus joins the stomach at the esophagogastric junction through the opening termed
Cardiac Orifice
the esophagus should be clearly see from the lower neck to the _____________________
Cardiac Antrum
the expanded portion of the terminal esophagus which lies in the abdomen is called the
4-5 hours
the last portion of bariums reaches the ileocecal valve in how many hours?
Pyloric Sphincter
the muscle controlling the pyloric orifice is called the
Pyloric Orifice
the opening between the stomach and the small intestine is called the
Cardia, Fundus, Body, Pylorus
the stomach is divided into four parts. What are those four parts.
Rugae
this is known as the inner mucosal layer of the body of the stomach.
ileocecal orifice
this opening is at the distal end of the small intestine
pyloric orifice
this opening is located between the stomach and the small intestine
Transverse colon
this part of the large intestine is located between the ascending colon and the desceding parts of the colon
right colic flexure
this structure is located between the ascending colon and the transverse colon
cecum
this structure is the proximal part of the large intestines
duodenum
this structure is the proximal part of the small intestine
ileum
this strucutre is the distal part of the small intestine