BA Swallow, UGI, Small Bowel Fluoro Flashcards
Single Contrast study
using one type of contrast
ex: thin barium
double contrast study
using two or more types of contrast
ex: thick barium and crystals (create air)
Patient prep for barium swallow - ugi - small bowel
esophagus - no prep needed
esophagus with UGI - NPO 8 hrs prior (looking for polyps and surface of stomach)
UGI/Small Bowel - NPO 8 hrs prior
fluoro room prep
place foot board
fluoro generator
table position starts erect (after scout image if needed), remove tray/bucky tray to bottom end of table
wearing lead and lead skirt is placed
fluoro carriage in position
Barium swallow anatomy
pharynx and esophagus
upper GI
distal esophagus and stomach
small bowel study
small intestine
Pre-prep
room set up
contrast preparation
obtain accurate history
patient care/change the patient
scout image if needed
SCOUT image
pre-procedure image, to just survey the area being examined
contrast prep
per dept protocol
barium is non-soluble
water soluble - absorbed to body, possible perforation or obstruction
cups, straw, napkins
Valsalva maneuver
breathing/muscular technique where you bear down like doing a BM
esophagus overhead images
RAO
Lateral
AP/PA
Technique: high kvp 90-125 needed to adequately penetrate and visualize barium filled structures
What would you do to adjust your technique with a barium filled tract?
increase to compensate for barium
How is the stomach situated in the body
fundus tilts toward the spine (posterior)
body is inferior
in supine position - where is the air and barium
Barium - fundus
air - body
in prone position - where is the air and barium
barium - body
air - fundus
erect position - where is the air and barium
barium - body (inferior)
air - fundus
stenic patient where do you center
L1 around duodenal bulb
hypersthenic patient where is centering
2in higher/superior
stomach sits higher and is more transverse
hyposthenic/asthenic where is centering
2 in lower/inferior
stomach sits longer in body, more J shaped stomach
achalasia
“cardiospasm”
can be visualized on a swallow study
motor disorder of the esophagus where peristalsis is reduced along the distal 2/3 of esophagus
evident at the esophagogastric sphincter
common in males and females 20-40 yrs old
barrett esophagus
severe reflux which erosion of squamosal lining of esophagus is seen
lining erodes and replaced by columnar epithelium
stricture in lower esophagus
peptic ulcer can develop in distal esophagus
anorexia can cause this
nuclear med can differentiate between irritation v erosion
contrast study is recommended
dysphagia
difficulty swallowing
many reasons/causes
congenital or acquired condition, trapped bolus, paralysis of muscles or inflammation
narrowing or enlarged, flaccid appearance of the esophagus
esophageal varices
dilated veins in distal esophagus and caused by portal hypertension associated with cirrhosis of the liver
veins dilated and engorged with blood
pt may have hememesis
double contrast study, upright and recumbent vws
wormlike or cobblestone appearance (like rosary beads) of esophagus
Gastroesophageal reflux disease (GERD)
backflow of stomach acid into esophagus
result of inflammation of the esophagus
dilated esophagus w/low peristalsis
ulcerations and erosions appear as streaks
outer borders of distal esophagus hazy appearance
valsalva maneuver
Valsalva maneuver
when a pt takes a deep breath and “bears down” like they are taking a BM
hiatal hernia
protrusion of a portion of the stomach into the thoracic cavity through the esophageal hiatus within the diaphragm
commonly causes GERD
Swallow and UGI study combo is done
can be seen on Chest XR
zenker diverticulum
“out pouch”
large pouching of the esophagus above the esophagus sphincter (upper portion)
cause: weakening of the muscle walls
symptoms: dysphagia, aspiration, regurgitation
Treatment: surgery in some cases
bezoar
mass of undigested material trapped in the stomach
usually hair, vegetable fibers, or wood (pyka disorder)
obstruction in stomach
trichobezoar - hair
phytobezoar - vegetable
Study: UGI
diverticula
out pouches of the mucosal wall (weakened muscles of stomach)
1/2 - 3 inches in diameter
70-80% of gastric diverticula arise in posterior aspect of fundus
asymptomatic
may cause infection, possible burst
Study: UGI, seen on Lateral vw in retrogastric space
gastritis
inflammation of the mucosa of stomach lining
cause: various physiologic and environmental conditions (air)
seen on image as inflamed rugae or absence of rugae (lining is inflamed)
treatment: meds in severe cases
ulcers
erosions of the stomach or duodenal mucosa
cause: excessive gastric secretions, stress, diet, smoking, etc
overactive chemical digestion
Treatment: the cause of ulcer
peptic ulcer
overactive pepsin enzyme cause erosion
inflammatory processes in the esophagus, stomach, duodenum
severe cases will cause bleeding
treatment: medication, diet change, lifestyle change
preceded by gastritis
esophagus goes through the diaphragm at the level of what?
T10
through the esophageal hiatus
