6. Fluoroscopy 1

Question 1

what area of the body is barium used to visualise

Answer 1

GI tract

Question 2

what area of the body is urografin used to visualise

Answer 2

urinary system

Question 3

what area of the body is gastrografin used to visualise

Answer 3

GI tract

Question 4

what area of the body is lipiodol used to visualise

Answer 4

tear ducts

Question 5

what is barium made of

Answer 5

barium sulphate

Question 6

what is the atomic number of barium

Answer 6

56

Question 7

what must be a condition of barium particles and why

Answer 7

must be small enough to make them more stable in suspension

Question 8

what is the relative cost of barium

Answer 8

low cost

Question 9

why is barium better than water soluble CM

Answer 9

better muscosal detail as its better at coating

Question 10

what is needed if CT is needed after Barium

Answer 10

if CR is needed a period of time - up to 2wk - may be required to allow clearance of barium

Question 11

if there is a perforation of the bowel what can happen with barium use

Answer 11

barium escapes into the gut and can cause peritonitis

Question 12

what are the 2 concentrations of omnipaque

Answer 12

300 and 350

Question 13

what is the base of omnipaque

Answer 13

iodine

Question 14

what is the atomic number of iodine

Answer 14

53

Question 15

what are the 3 administration methods for omnipaque

Answer 15

intravenously, orally and rectally

Question 16

what are the 2 administration methods for gastrografin

Answer 16

oral and rectal

Question 17

when is gastrographic indicated

Answer 17

when barium is unsuitable such as when there is a threatening perforation, suspected partial or complete stenosis

Question 18

is gastrografin or barium superior in mucosal coating

Answer 18

barium

Question 19

what is the treatment for minor adverse reaction to ICM

Answer 19

close observation and reassurance

Question 20

what is the treatment for moderate adverse reaction to ICM

Answer 20

prompt treatment with close observation

Question 21

what is the treatment for severe adverse reaction to ICM

Answer 21

immediate treatment

Question 22

what is the effect of body type on positioning

Answer 22

different body habitus have different bowel and stomach orientation

Question 23

what is the difference in bowel position for slender and large patients

Answer 23

slender patient bowel sits more medially

Question 24

where is the stomach located for hypersthenic patients

Answer 24

high and transverse

Question 25

where is the stomach located for sthenic patients

Answer 25

j shaped

Question 26

where is the stomach located for hyposthenic patients

Answer 26

J shaped and low

Question 27

where is the duodenal located for hypersthenic patients in terms of vertebral level

Answer 27

T11-12

Question 28

where is the duodenal located for sthenic patients in terms of vertebral level

Answer 28

L1-2

Question 29

where is the duodenal located for hyposthenic patients in terms of vertebral level

Answer 29

L3-4

Question 30

what is the distribution of the large intestine for hypersthenic patients

Answer 30

widely distributed

Question 31

what is the distribution of the large intestine for sthenic patients

Answer 31

L colic flexure high

Question 32

what is the distribution of the large intestine for hyposthenic patients

Answer 32

low near pelvis

Question 33

what area of the GI tract is barium swallow used to study

Answer 33

from lips to gastric fundus

Question 34

what are the 2 instances where barium swallows are required

Answer 34

SLT or post op

Question 35

what are the 4 types of barium related studies of the GI tract

Answer 35

barium swallow barium meal/follow through gastrografin enema defaecating proctogram

Question 36

what is oesophageal varicies

Answer 36

bleeding varicies - varicose veins Swollen veins on lining of oesophagus

Question 37

what is the risk of oseophageal varicies

Answer 37

Life threatening if they break open Almost like holes In oesophagus

Question 38

what is hiatus hernia

Answer 38

stomach protrudes out of diaphragm

Question 39

what is schatzki ring in terms of what the patient presents with

Answer 39

dysphagia and chest pain secondary to food impaction

Question 40

what is schatzki ring commonly seen with and what are they assocaited with

Answer 40

sliding hiatal hernia and both are associated with peptic oesophagitis

Question 41

what is dysphagia

Answer 41

difficulty swallowing

Question 42

what is an apple core lesion of the GI tract

Answer 42

cancer on large bowel constriction of lumen of colon associated caused by stenosis due to carcinoma

Question 43

what is diverticular disease

Answer 43

small pouches stick out from the walls of the colon and can become inflammed and infected

Question 44

what are the 4 clinical indications for a barium swallow

Answer 44

dysphagia foreign body haematemesis oesophageal varices

Question 45

what is modified barium swallow performed for in terms of dysfunction

Answer 45

oropharyngeal dysfunction

Question 46

what does a modified barium swallow involve in terms of staff

Answer 46

Speech and language therapist

Question 47

what is given to patients in a modified barium swallow

Answer 47

substances of a variety of consistencies

Question 48

how is a patient positioned for SLT swallow

Answer 48

erect, right ant oblique projection

Question 49

why is a right ant oblique projection used for SLT swallow

Answer 49

positions the oesophagus clear of the spine

Question 50

what views are taken for the modified barium SLT swallow

Answer 50

AP, lateral and coned

Question 51

what is the aftercare for barium swallows 4 things

Answer 51

give patient cloth to wipe mouth patient can eat/drink normally warn patient about pale/white stools encourage patient to drink extra fluid

Question 52

what are double contrast barium enemas

Answer 52

both air and barium are put into the large bowel rectally

Question 53

how was a double contrast barium enema set up

Answer 53

Tube placed in rectum and bag of barium from drip pole drip into bowel and once reached transverse colon they drop bag to allow gravity to let barium move back down and coat mucosa Air pumped in to push barium through to caecum and provide double contrast look

Question 54

why are gastrografin enemas done

Answer 54

query anastomotic leak following low resecton

Question 55

what part of the colon does gastrografin enema investigate

Answer 55

signoid colon

Question 56

how much gastrografin is used for enemas in volume

Answer 56

50-60mLs

Question 57

what are the 4 projections taken for gastrografin enema

Answer 57

AP LAO30 RAO30 Lateral

Question 58

what was the small bowel studied with previously

Answer 58

enteroclysis

Question 59

where is the NJ tube placed in enteroclysis

Answer 59

placed at DJ flexure or just beyond

Question 60

how is the small bowel investigated now without fluro

Answer 60

patient drinks approx 100ml of gastrografin followed by pain xray 4-6hrs post introduction of CM

Question 61

what is small bowel xray with CM used to assess

Answer 61

small intestine for abnormalities in size and shape and evaluate transit of CM

Question 62

what is a defecating proctogram

Answer 62

contrast placed into rectum and have to defecate during procedure

Question 63

why are defecating proctograms taken

Answer 63

functional study of anus and the rectum during the evacuation and rest phases of defecation

Question 64

what are the 2 clinical inidications of defecating proctogram

Answer 64

prolapses and rectal intussusception

Question 65

what are 2 types of prolapses

Answer 65

rectocoeles and enterocoeles

Question 66

what is rectocele

Answer 66

rectum lower part of large bowel bulges into back of vaginal wall due to weakening of supporting tissues such as the ant/post wall

Question 67

what is rectal intussusception

Answer 67

bowel telescopes in on itself

Question 68

anorectum functions as what

Answer 68

coordinated unit to maintain faecal continence and facilitate defecation

Question 69

faecal continence is the result of what

Answer 69

complex combo of concious and unconcious control

Question 70

what is patient preparation for defecating proctogram

Answer 70

patient required to insert a suppository one hr prior | they must retain it for 10-15mins

Question 71

what does the suppository ensure in defecating proctogram preparation

Answer 71

makes sure that part of bowel is as clean as possible

Question 72

what is the procedure for defecating proctogram in terms of how many catethers are needed

Answer 72

2 x 50ml catheter tip syringes containing thick barium paste

Question 73

what is the procedure for defecating proctogram in terms of patient positioning

Answer 73

patient placed in lateral position and the barium is introduced into rectum

Question 74

where else is barium placed in for females in a defecating proctogram and why

Answer 74

in the vagina to see if there is a gap between the vagina and rectum

Question 75

in a defecating proctogram when is an image taken and what position is the patient in

Answer 75

taken after barium is administered and patient is in slightly oblique position

Question 76

when are images taken during defecating proctograms x 3 times

Answer 76

during patient resting and straining and post evacuation image is taken

Question 77

what is the pelvic coccygeal line in terms of where it is

Answer 77

runs from base of symphysis to tip of coccyx

Question 78

what is the pelvic coccygeal line used for

Answer 78

equate to the anatomical location of the pelvic floor

Question 79

what lies at 90 degree to the pelvi-coccygeal line

Answer 79

rectoanal canal

Question 80

when straining the pelvic floor muscles do what and the rectum should not drop more than how much below what when straining

Answer 80

pelvic floor muscles contract and hold everything in place rectum should not drop more than 2cm below the pelvi-coccygeal line when straining

Question 81

if the pelvic floor muscles are weak the rectum does what during straining

Answer 81

rectum is pushed down during straining

Question 82

in the defecating proctogram the post evacuation image is taken for what

Answer 82

to see how far the rectum drops below the pelvi-coccygeal line during straining when the bowel is not loaded

Question 83

in the defecating proctogram what is measurement calibration and what does this allow

Answer 83

radio opaque ruler is placed between the buttocks and this allows for all measurements taken from the images to be calibrated so that image magnification is not a factor