Bontrager’s Textbook -Biliary tract and upper gastrointestinal system (s. 616 – 486)

Question 1

The alimentary canal begins at the (1) ---- and continues as the (2) ----- (3), ------------- (4) ------and ------
(5) ; it ends as the (6)----------, which terminates
as the (7) ----.

Answer 1

1. oral cavity (mouth)
2. pharynx
3. esophagus
4. stomach
5. small intestine and the duodenum
6. large intestine
7. anus

Question 2

Accessory organs of digestion include the ———- and ————-, —– and ——–.

Answer 2

1. slivary glands
2. pancreas
3. liver
4. galbladder

Question 3

what are the three primary functions of The digestive system

Answer 3

1. the intake or digestion of food, water, vitamins, and minerals
2. to absorb digested food particles, along with water, vitamins, and essential elements from the alimentary canal, into the blood or lymphatic capillaries
3. to eliminate any unused material in the form of semisolid waste products.

Question 4

Food is ingested in the form of —-, —-, —–

Answer 4

carbohydrates, lipids, and proteins

Question 5

absorption of digested food from alimentary canal essential, into —————–

Answer 5

the blood or lymphatic capillaries

Question 6

what does UGI stand for?

Answer 6

the upper gastrointestinal system

Question 7

what are the two common radiographic procedures involving the upper gastrointestinal (UGI) system

Answer 7

1. Esophagogram or Barium Swallow (Study of Pharynx and Esophagus)
   
   • This procedure studies the form and function of the swallowing aspect of the pharynx and esophagus.
2. Upper Gastrointestinal Series (Study of Distal Esophagus, Stomach, and Duodenum)
   
   • series: in one examination
   • UGI, upper GI

Question 8

————– mixed with water is the preferred contrast medium for the entire alimentary canal.

Answer 8

Barium sulfate

Question 9

what is area with barium sulfate contrast is called

(—-)

Answer 9

The negative density area (appearing white)

Question 10

what is mastication

Answer 10

The salivary glands are accessory organs of digestion associated with the mouth. The teeth and tongue cooperate in chewing movements to reduce the size of food particles and mix food with saliva. These chewing movements, termed mastication (mas″-ti-ka′-shun), initiate the mechanical part of digestion

Question 11

what are the three pair of glands that secret most of the sliva in the oral cavity

Answer 11

Three pairs of glands secrete most of the saliva in the oral cavity (Fig. 12.14). These glands are the (1) parotid (pah-rot′-id), meaning “near the ear,” which is the largest of the salivary glands located just anterior to the external ear; (2) submandibular, sometimes called submaxillary, meaning “below mandible or maxilla”; and (3) sublingual (sub-ling′-gwal), meaning “below the tongue.”

Question 12

what is sliva consited of

Answer 12

Saliva is 99.5% water and 0.5% solutes or salts and certain digestive enzymes

Question 13

which enzym breaks down starches ?

Answer 13

It also contains the enzyme amylase (am′-i-lays), which breaks down starches

Question 14

Mucus lubricates food as it is being chewed so that the food can form into a ball, or —– , for swallowing. The act of swallowing is termed —–

Answer 14

bolus

deglutition (deg″-loo-tish′-un)

Question 15

The salivary glands, especially the ———, may be the site of infection. Mumps is an inflammation and enlargement of the parotid glands caused by a —–virus, which can result in inflammation of the testes in approximately 30% of infected males

Answer 15

parotid glands

paramyxovirus

Question 16

The —— is a membrane-covered cartilage that moves down to cover the opening of the larynx during swallowing.

Answer 16

epiglottis

Question 17

The third portion of the pharynx is called the laryngopharynx, or —–.

Answer 17

hypopharynx

Question 18

The laryngopharynx extends from the level of the epiglottis to the level of the lower border of the larynx (level of C– ? )

Answer 18

C6

Question 19

The pharynx is about 12.5 cm long and is the part of the digestive tube found posterior to the nasal cavity, mouth, and larynx.

what are three portions of the pharynx?

Answer 19

• The nasopharynx is posterior to the bony nasal septum, nasal cavities, and soft palate. This portion of the pharynx is not part of the digestive system
• The oropharynx is directly posterior to the oral cavity proper. The oropharynx extends from the soft palate to the epiglottis (ep″-i-glot′-is). The epiglottis is a membrane-covered cartilage that moves down to cover the opening of the larynx during swallowing
• The laryngopharynx, or hypopharynx. The laryngopharynx extends from the level of the epiglottis to the level of the lower border of the larynx (level of C6, as described in Chapter 2). From this point, it continues as the esophagus. The trachea is seen anterior to the esophagus
  *

Question 20

there are —— cavities, or openings, that communicate with the three portions of the pharynx. The —–cavities and the —- cavities connect to the nasopharynx.

Answer 20

seven

• two nasal cavities
• two tympanic cavaties
• The oral cavity (mouth) connects posteriorly to the oropharynx.
• Inferiorly, the laryngopharynx connects to the openings of both the larynx and the esophagus

Question 21

The tympanic cavities of the middle ears connect to the nasopharynx via ———- tubes

Answer 21

the auditory or eustachian

Question 22

two nasal cavities connects to ———

Answer 22

nasopharynx

Question 23

two tympanic cavities of the middle ears connect to the ———– via auditory or eustachian tubes

Answer 23

nasopharynx

Question 24

oral cavity connects the ————

Answer 24

oropharynx

Question 25

opening of the larynx connects to the ——–

Answer 25

laryngopharynx

Question 26

openings of the esophagus connects to ———–

Answer 26

laryngopharynx

Question 27

Food and fluid travel from the oral cavity directly to the —————– during the act of swallowing, or deglutition. During swallowing, the ——- closes off the nasopharynx to prevent swallowed substances from regurgitating into the nose. The —— prevents this material from reentering the mouth. During swallowing, the ————- is depressed to cover the laryngeal opening like a lid. The vocal folds, or cords, also come together to close off the —- These actions combine to prevent food and fluid from being aspirated (entering the larynx, trachea, and bronchi)

Answer 27

esophagus

soft palate

tongue

epiglottis

epiglottis.

Question 28

The third part of the alimentary canal is the ———. The ——————– is a muscular canal, about 25 cm long and about 2 cm in diameter, extending from the l_aryngopharynx to the stomach_

Answer 28

esophagus.

Question 29

The esophagus begins posterior to the level of the lower border of the ————– (C – to C–), which is at the level of the upper margin of the —— cartilage. The esophagus terminates at its connection to the stomach, at the level of the (T—).

Answer 29

cricoid cartilage of the larynx

C5-C6

thyroid

eleventh thoracic vertebra

Question 30

what is the relationship of the esaphogus to trachea and thoracic

Answer 30

The spatial relationship of the esophagus to both the trachea and the thoracic vertebrae is an important relationship to remember. The esophagus is posterior to the trachea and just anterior to the cervical C5-C6 and thoracic vertebral bodies T11

Question 31

Question 32

The descending thoracic aorta is between the —————-and —————

Answer 32

The descending thoracic aorta is between the distal esophagus and the lower thoracic spine.

Question 33

The heart, within its pericardial sac, is ———– immediately to the sternum, ————- to the esophagus, and to the diaphragm

Answer 33

posterior

anterior

superior

Question 34

The esophagus is essentially vertical as it descends to the stomach. This swallowing tube is the narrowest part of the entire alimentary canal. The esophagus is most constricted first at its proximal end, where it enters the thorax, and second where it passes through the diaphragm at the esophageal ———

Answer 34

hiatus, or opening.

Question 35

The esophagus pierces the diaphragm at the level of T —

Answer 35

10.

Question 36

Question 37

As the esophagus descends within the posterior aspect of the mediastinum, two indentations are present. One indentation occurs at ———-and the second is found where the esophagus crosses the

Answer 37

the aortic arch

left primary bronchus

Question 38

The esophagus passes through the diaphragm slightly to the —— and —-to the midpoint of the diaphragm. The drawing on the left in Fig. 12.19 represents the inferior surface of the diaphragm and indicates the relative positions of the esophagus, inferior vena cava, and aorta

Answer 38

left

posterior

Question 39

The abdominal segment of the esophagus, termed the ———- measures between 1 and 2 cm. The ———– curves sharply to the—- after passing through the diaphragm to attach to the stomach

Answer 39

cardiac antrum

cardiac antrum

left

Question 40

The opening between the esophagus and the stomach is termed the ————– or ———

Answer 40

esophagogastric junction

(cardiac orifice)

Question 41

in what ways respiratory and stomach are related

Answer 41

The junction of the stomach and the esophagus normally is securely attached to the diaphragm; thus, the upper stomach tends to follow the respiratory movements of the diaphragm.

Question 42

the esophagus contains well-developed ————in its upper third, ————– muscle in its middle third, and smooth muscle in its lower third. In contrast to the trachea, the esophagus is a collapsible tube that opens only when swallowing occurs. The process of deglutition continues in the esophagus after originating in the——— and ———-. Fluids tend to pass from the mouth and pharynx to the stomach, primarily by ……. A bolus of solid material tends to pass both by———– and ——.

Answer 42

skeletal muscle layers (circular and longitudinal)

skeletal and smooth

mouth and pharynx

gravity

gravity and by peristalsis

Question 43

——– is a wavelike series of involuntary muscular contractions that propel solid and semisolid materials through the tubular alimentary canal.

Answer 43

peristalsis

Question 44

stomach openings and curvtures

Answer 44

Question 45

The esophagogastric junction (——–) is the aperture, or opening, between the esophagus and the stomach.

Answer 45

cardiac orifice

Question 46

A small, circular muscle, called the ———, allows food and fluid to pass through the cardiac orifice. This opening (esophagogastric junction) is commonly called the —–, which refers to the relationship of this —– to the portion of the diaphragm near the heart, on which the heart rests

Answer 46

cardiac sphincter

cardiac orifice

orifice

Question 47

directly superior to cardiac orifice is a notch called ————–. This distal abdominal portion of the esophagus curves sharply into a slightly expanded portion of the terminal esophagus called ————

Answer 47

the cardiac notch (incisura cardiaca)

the cardiac antrum.

Question 48

the opening, or orifice, of the distal stomach is termed the ———, or —–. The —– sphincter at this orifice is a thickened muscular ring that relaxes periodically during digestion to allow stomach or gastric contents to move into the first part of the small intestine, the duodenum.

Answer 48

pyloric orifice

pylorus

pyloric

Question 49

The ——-, which is found along the —- border of the stomach, forms a concave border as it extends between the cardiac and pyloric orifices

Answer 49

lesser curvature

medial

Question 50

The ———is found along the —– border of the stomach. This ———— is four to five times longer than the lesser curvature. It extends from the ——— and the ——–.

Answer 50

lateral

the greater curvature

greater curvature

cardiac notch

pylorus

Question 51

he stomach is composed of three main subdivisions:

—-, —-, —-

Answer 51

(1) the fundus, (2) the body, and (3) the pylorus

Question 52

The fundus is the ballooned portion that lies —–and —— to the cardiac orifice. The upper portion of the stomach, including the cardiac antrum of the esophagus, is relatively fixed to ——— and tends to move with motion of the—— .

Answer 52

lateral

superior

the diaphragm

diaphragm

Question 53

In the upright, or erect, position, the fundus is usually filled by a bubble of swallowed air; this is referred to as a —–

Answer 53

gastric bubble

Question 54

The lower end of the large body of the stomach has a partially constricted area that separates the body from the pyloric portion of the stomach. This “notch,” or constricted ringlike area, is called the ——. The smaller terminal portion of the stomach to the right, or medial, of the angular notch is the —- portion of the stomach.

Answer 54

angular notch (incisura angularis)

pyloric

Question 55

The pyloric portion of the stomach frequently is divided into two parts: —- , —–

Answer 55

(1) the pyloric antrum, shown as a slight dilation immediately distal to the angular notch, and (2) the narrowed pyloric canal, which ends at the pyloric sphincter

Question 56

Question 57

When the stomach is empty, the internal lining is thrown into numerous longitudinal mucosal folds termed ———– ———–are most evident in the lower body of the stomach along the greater curvature. They assist with mechanical digestion of food within the stomach

Answer 57

rugae (roo′-je); singular is ruga (roo′-gah).

Rugae

Question 58

A ————-, formed by rugae along the lesser curvature , funnels fluids directly from the body of the stomach to the pylorus

Answer 58

gastric canal

Question 59

pyloric sphincter is also called ——–

Answer 59

pyloric valve

Question 60

how does distribution of barium contrast media and air/gas is affected by the position of patient

supine or prone

Answer 60

if an individual swallows a barium sulfate and water mixture, along with gas-producing crystals, as seen in Figs. 12.27 and 12.28, the position of the person’s body determines the distribution of barium and air/carbon dioxide (CO2) gas within the stomach.

1. In the supine position, the fundus of the stomach is the most posterior portion and is where the heavy barium settles (see Fig. 12.27). Note the collection of gas in the body and pylorus of the stomach
2. the RAO, recumbent position, the fundus is in the highest position, causing the gas to fill this portion of the stomach, as can be seen in Fig. 12.28. The barium settles in the more anterior body and pylorus portions of the stomach

Question 61

how would air be like in a barium asssisted radiograpg of stomach?

Answer 61

depending on the position of the pasient, the air will be seen in a different portion of the stomach

supine: pyloric portion
prone: fundus

erect:

The drawing on the right depicts the stomach of a person who is in an erect position. In the erect position, air/gas rises to fill the fundus, whereas barium descends by gravity to fill the pyloric portion of the stomach. The air-barium line tends to be a straight line in the erect position compared with the prone and supine positions.

Question 62

—- the first portion of the small intestine,

commonly called the———

Answer 62

duadenum

Question 63

the small intestine, is commonly called the———

Answer 63

small bowel

Question 64

The duodenum is about —– to —– cm long and is the shortest, widest, and most fixed portion of the small intestine. The C-shaped duodenum is closely related to the head of the ——-.

Answer 64

20 to 24

pancreas

The head of the pancreas, nestled in the C-loop of the duodenum, has been affectionately labeled the “romance of the abdomen” by some authors.

Question 65

Most of the duodenum and the pancreas are —– structures; that is, they are located ——–

,

Answer 65

retroperitoneal

posterior to the parietal peritoneum

Question 66

The duodenum is shaped like the letter—–

Answer 66

“C”

Question 67

Duodenum consists of ——parts (Fig. 12.31).

Answer 67

4

Question 68

what are the different parts of duodenum?

Answer 68

1. The first part of the superior portion is termed the duodenal bulb, or cap.
2. The next part of the duodenum is the second (descending) portion, the longest segment. The descending portion of the duodenum possesses the duodenal papilla, which is the opening for the common bile and pancreatic ducts into the duodenum.
3. The third part of the duodenum is the horizontal portion. This portion curves back to the left to join the final segment,
4. the fourth (ascending) portion of the duodenum.

Question 69

The first (superior) portion of duodenum begins at the —–of the stomach.

Answer 69

pylorus

Question 70

why the first portion of duodenum needs to be carefully studied during barium studies?

Answer 70

The duodenal bulb is easily located during barium studies of the upper gastrointestinal tract and must be carefully studied because this area is a common site of ulcer disease.

Question 71

duonedal bulb or cap is ——– while the rest of duonedum is retroperitoneal

Answer 71

intraperitoneal

Question 72

duodenal bulb, or cap is intraperitoneal; the remainder of the duodenum is ——

Answer 72

retroperitoneal

i. e posterior to the parietal peritoneum

Question 73

which section of duodenum is the longest segment?

Answer 73

The next part of the duodenum is the second (descending) portion, the longest segment.

Question 74

where is the duodenal papilla located ?

Answer 74

The descending portion of the duodenum possesses the duodenal papilla

Question 75

how does the common bile and pancreatic ducts opens into duodenum?

Answer 75

The descending portion of the duodenum possesses the duodenal papilla, which is the opening for the common bile and pancreatic ducts into the duodenum.

Question 76

The third part of the duodenum is the ——— portion.

Answer 76

horizontal

1. cap
2. descending
3. horizental
4. ascending

Question 77

The third portion of duodenum curves back to the left to join the final segment, which is …………….. .

Answer 77

the fourth (ascending) portion of the duodenum

Question 78

what is the second portion of small intestin called?

Answer 78

the jejunum (je-joo′-num)

Question 79

what is the junction of duodenum with jejunum is called

Answer 79

is termed the duodenojejunal flexure

Question 80

what does hold back the duodenojejunal flexure hold back?

Answer 80

This portion is relatively fixed and is held in place by a fibrous muscular band, the ligament of Treitz (suspensory muscle of the duodenum). This structure is a significant reference point in certain radiographic small bowel studie

Question 81

what does the suspensory muscle of the duodenum is called?

Answer 81

ligament of Treitz

Question 82

Answer 82

A. Distal esophagus

B. Area of esophagogastric junction (cardiac orifice)

C. Lesser curvature of stomach

D. Angular notch (incisura angularis) of stomach

E. Pylorus of stomach

F. Pyloric valve or sphincter

G. Duodenal bulb (cap)

H. Second (descending) portion of duodenum

I. Body of stomach

J. Greater curvature of stomach

K. Mucosal folds, or rugae, of stomach

L. Fundus of stomach

Question 83

mechanical process of digestion are (), () (),() and ()

Answer 83

metastication

degultition

Peristalsis

Mixing (chyme)

Rhythmic segmentation (churning)

Question 84

Peristalsis moves the gastric contents toward the pyloric valve, but this valve opens selectively. If it is closed, the stomach contents are churned or mixed with stomach fluids into a semifluid mass termed _____________

Answer 84

chyme

Question 85

.The small intestine (small bowel) continues mechanical digestion with a churning motion within segments of the small bowel. This churning or mixing activity is termed —————. Rhythmic segmentation is intended to mix food and digestive juices thoroughly. The digested food is also brought into contact with the intestinal lining, or mucosa, to facilitate absorption

Answer 85

rhythmic segmentation.

Question 86

Substances Ingested, Digested, and Absorbed

Answer 86

1. Carbohydrates (complex sugars) × simple sugars (mouth and stomach)
2. Proteins × amino acids (stomach and small bowel)
3. Lipids (fats) × fatty acids and glycerol (small bowel only)

Question 87

Substances Ingested but Not Digested

Answer 87

4. Vitamins 5. Minerals 6. Water

Question 88

Enzymes (Digestive Juices)

Answer 88

Biologic catalysts

Question 89

Enzymes are biologic catalysts found in various digestive juices produced by ————and by ——, ——–, —– .

Answer 89

salivary glands in the mouth

the stomach, small bowel, and pancreas

Question 90

Carbohydrate digestion of starches begins in the ——and

—— and is completed in the ——-. The end products of digestion of these complex sugars are ——.

Answer 90

mouth

stomach

small intestine

simple sugars

Question 91

Protein digestion begins in the —— and is completed in the ———. The end products of protein digestion are ——-

Answer 91

stomach

intestine

amino acids

Question 92

Lipid, or fat, digestion essentially occurs only in the , although small amounts of the enzyme necessary for fat digestion are found in the ——-. The end products of lipid digestion are —– and —–

Answer 92

small bowel

stomach

fatty acids and glycerol (glis′-er-ol)

Question 93

what is bile ?

where is it manufactured?

where does it get sorted?

where will it be secreted?

Answer 93

Bile, manufactured by the liver and stored in the gallbladder, is released into the duodenum to assist in the breakdown of lipids (fats). Bile contains no enzymes, but it does emulsify fats. During emulsification, large fat droplets are broken down to small fat droplets, which have greater surface area (to volume) and give enzymes greater access for the breakdown of lipids. The end products of fat (or lipids) during digestion are fatty acids and glycerol

Question 94

what is emulsification?

Answer 94

Bile contains no enzymes, but it does emulsify fats. During emulsification, large fat droplets are broken down to small fat droplets, which have greater surface area (to volume) and give enzymes greater access for the breakdown of lipids. The end products of fat (or lipids) during digestion are fatty acids and glycerol

Question 95

where does most of the digestive end product occur?

Answer 95

Most of the absorption of digestive end products occurs in the small intestine. Simple sugars, amino acids, fatty acids, glycerol, water, and most salts and vitamins are absorbed into the bloodstream or the lymphatic system through the lining of the small intestine. Limited absorption takes place in the stomach and may include some water, alcohol, vitamins, and certain drugs but no nutrients. Any residues of digestion or unabsorbed digestive products are eliminated from the large bowel as a component of feces.

Question 96

what factors affect the position of stomach?

Answer 96

In addition to body habitus, other factors that may affect the position of the stomach include stomach contents, respiration, body position (erect vs. recumbent), previous abdominal surgeries, and age.

Because the upper stomach is attached to the diaphragm, whether one is in full inspiration or expiration affects the superior extent of the stomach. All abdominal organs tend to drop 2.5 to 5 cm in an erect position, or even farther with age and loss of muscle tone

Question 97

Hypersthenic.

General stomach—high and transverse, level T– to T–. Pyloric portion—level T— to T—, at midline.

Duodenal bulb location level T–to T–, to right of midline.

Answer 97

T9-T12

T11-T12

T11 to T12,

Question 98

Sthenic. General stomach—level T–to L–. Pyloric portion—level L–, near midline. Duodenal bulb location—level L– to L–, near midline

Answer 98

T10 to L2.

L2

L1

L2

Question 99

Hyposthenic/asthenic. General stomach—low and vertical, level T— to L—. Pyloric portion—level L– to L–, to left of midline. Duodenal bulb location—level L– to L–, at midline.

Answer 99

T11 to L5.

L3 to L4

L3 to L4

Question 100

what parts of the alimentary canal can be seen on a plain radiographs

Answer 100

Ordinarily, the only parts of the alimentary canal that can be easily identified on plain radiographs are the fundus of the stomach (in the upright position), because of the gastric air bubble, and parts of the large intestine, because of pockets of gas and collections of fecal matter.

Question 101

Radiographic procedures or examinations of the entire alimentary canal are similar in three general aspects.

name them…………

Answer 101

1. first, because most parts of the gastrointestinal tract are comparable in density with the tissues surrounding them, some type of contrast medium must be added to visualize these structures.
2. A second similarity is that the initial stage of each radiographic examination of the alimentary canal is carried out with fluoroscopy
3. third similarity is that radiographic images are recorded during and after the fluoroscopic examination to provide a permanent record of the normal or abnormal findings.

Question 102

how does fluorocscopy helps the radiologist in examination the gastrointenstinal tract

Answer 102

Fluoroscopy allows the radiologist to (1) observe the gastrointestinal tract in motion, (2) produce radiographic images during the course of the examination, and (3) determine the most appropriate course of action for a complete radiographic examination. Radiographic examination of the upper gastrointestinal tract requires dynamic viewing of organs in motion. The structures in this area assume a wide variety of shapes and sizes, depending on body habitus, age, and other individual differences.

Question 103

——- and ———- contrast media are used to render the gastrointestinal tract visible radiographically

Answer 103

Radiolucent and radiopaque

Question 104

give som examples for radioluscent media

Answer 104

Radiolucent, or negative, contrast media include swallowed air, CO2 gas crystals, and the normally present gas bubble in the stomach. Calcium and magnesium citrate carbonate crystals are frequently used to produce CO2 gas.

Question 105

The most common positive, or radiopaque, contrast medium used to visualize the gastrointestinal system is —————, which is also referred to simply as ———-.

Answer 105

barium sulfate (BaSO4)

barium

Question 106

what does it mean that barium and water creates colloidal suspension

Answer 106

A mixture of barium sulfate and water forms a colloidal suspension, not a solution. For a solution, the molecules of the substance added to water must actually dissolve in the water. Barium sulfate never dissolves in water. In a colloidal suspension, the particles suspended in water tend to settle over time when allowed to sit.

Question 107

what is thin barium

Answer 107

Barium sulfate may be prepared or purchased in a relatively thin or thick mixture. The thin barium sulfate and water mixture contained in a cup, as illustrated in Fig. 12.48, contains 1 part BaSO4 to 1 part water. Thin barium has the consistency of a thin milkshake and is used to study the entire gastrointestinal tract. Thin barium mixtures, on average, consist of 60% weight-to-volume (w/v) of barium sulfate to water

Question 108

what does the motility with which the barium sulfate passes through gastrointestinal tract depends on?

Answer 108

The motility, or speed, with which barium sulfate passes through the gastrointestinal tract depends on

the suspending medium and additives,

the temperature,

and the consistency of the preparation

as well as

the general condition of the patient and the gastrointestinal tract.

Mixing the preparation exactly according to radiologist preferences and departmental protocol is most important. When the mixture is cold, the chalky taste is much less objectionable.

Question 109

what is thick barium?

Answer 109

Thick barium contains 3 or 4 parts BaSO4 to 1 part water and should have the consistency of cooked cereal (Fig. 12.49). Thick barium is more difficult to swallow but is well suited for use in the esophagus because it descends slowly and tends to coat the mucosal lining. Some commercially prepared thick barium sulfate may possess a 98% w/v of barium to water.

Question 110

what are the contraindications to barium sulfate

Answer 110

Barium sulfate mixtures are contraindicated if there is any chance that the mixture might escape into the peritoneal cavity. If large amounts of barium sulfate escape into the peritoneal cavity, this can lead to intestinal infarcts or peritonitis. This escape may occur through a perforated viscus or during surgery that follows the radiographic procedure. In either of these two cases, water-soluble, iodinated contrast media should be used. One example of this type of contrast media is MD-Gastroview, which is shown in Fig. 12.50. This water-soluble contrast agent contains 37% organically bound iodine, which opacifies the gastrointestinal tract. It can be removed easily by aspiration before or during surgery. If any of this water-soluble material escapes into the peritoneal cavity, the body can readily absorb it. Barium sulfate is not absorbed.

Question 111

what is double-contrast

Answer 111

he radiolucent contrast medium is either room air or CO2 gas. To introduce room air, small pinprick holes are placed in the patient’s straw. As the patient drinks the barium mixture, air is drawn in with it. CO2 gas is created when the patient ingests gas-producing crystals. Two common forms of these crystals are calcium and magnesium citrate. On reaching the stomach, these crystals form a large gas bubble. The gas mixes with the barium and forces the barium sulfate against the stomach mucosa, providing better coating and visibility of the mucosa and its patterns (Fig. 12.51). Longitudinal mucosal folds (rugae) of the stomach are seen in Fig. 12.52 (arrows). Potential polyps, diverticula, and ulcers are better demonstrated with a double-contrast technique

Question 112

what is recomended to help remove barium after UGI examination?

Answer 112

Some patients may require a laxative after these examinations to help remove the barium sulfate. If laxatives are contraindicated, the patient should increase fluid or fiber intake until stools are free from all traces of the white barium

Question 113

what is Mltiple Frame Formatting and Multiple “Original” Films

Answer 113

multiple images can be formatted and printed on one piece of laser film. This format can be 4 on 1 (Fig. 12.55), 6 on 1, 9 on 1, or 12 on 1.

Multiple “Original” Films

“Hard-copy” films can be printed at any time and as often as desired. If radiographs are lost or misplaced or if duplicates are needed, additional “original” films can be reprinted at any time.

Question 114

Cine Loop Capability

Answer 114

Individual images also can be recorded in rapid succession and displayed as moving or cine images

Question 115

Image Enhancement and Manipulation

Answer 115

These image enhancement and manipulation features include edge enhancement, window and leveling, dynamic range control, and dual energy subtraction. Other options include inverting the image contrast, motion artifact control, and smoothing.

Question 116

Worker Protection During Fluoroscopy?

Exposure Patterns

Answer 116

which remind the assisting technologist not to stand close to the table on either side of the radiologist, but rather to stay back from the higher scatter fields as much as possible throughout the fluoroscopy procedure

Question 117

One of the best ways to reduce worker dose during fluoroscopy is to apply the following three “cardinal principles of radiation protection.”

Answer 117

1. Shielding: Follow all shielding precautions described previously, including correct use of the lead drape shield, the bucky slot shield, and lead gloves
2. Time: Reduce the amount of time the fluoroscopy tube is energized. The use of “intermittent fluoroscopy” reduces dose to the patient and workers. With digital fluoroscopy, the “image freeze” function should be used, which allows the last energized image to remain visible on the monitor. Then the fluoroscopy tube is activated only when a new image is required.
3. Distance: The most effective method of reducing dose during fluoroscopy procedures is to increase the distance between the x-ray tube and the technologist. By applying the inverse square law, technologists can significantly reduce dose to themselves. Doubling the distance between the x-ray tube and the worker can reduce dose by a factor of 4. Technologists should maximize their distance from the x-ray tube when not assisting the radiologist or managing the patient

Question 118

“image freeze” function

Answer 118

the “image freeze” function should be used, which allows the last energized image to remain visible on the monitor. Then the fluoroscopy tube is activated only when a new image is require

Question 119

what are the most two common radiographic prosedures of upper GIT

Answer 119

Two common radiographic procedures of the upper gastrointestinal system involving the administration of contrast media are the esophagogram (esophagram), or barium swallow, as it is sometimes called, and the upper GI series.

Question 120

what is barium swallow

Answer 120

An esophagogram, or barium swallow the common radiographic procedure or examination of the pharynx and esophagus in which a radiopaque contrast medium is used.

Question 121

Achalasia (ak″-a-la′-zha), also termed cardiospasm

Answer 121

is a motor disorder of the esophagus in w_hich peristalsis is reduced along the distal two-thirds of the esophagus._ Achalasis is evident at the esophagogastric sphincter because of its inability to relax during swallowing. The thoracic esophagus may also lose its normal peristaltic activity and become dilated (megaesophagus). Digital fluoroscopy is most helpful in diagnosis of achalasia. It occurs equally in males and females and most common between the ages of 20 and 40 years

Question 122

Anatomic anomalies of esaphagus

Answer 122

Anatomic anomalies may be congenital or may be caused by disease, such as cancer of the esophagus. Patients who have a stroke often develop impaired swallowing mechanisms. Certain foods and contrast agents are administered during the examination for evaluation of swallowing patterns

Question 123

what is Barrett esophagus, or Barrett syndrome,

Answer 123

is the replacement of the normal squamous epithelium with columnar-lined epithelium ulcer tissue in the mid-to-lower esophagus (Fig. 12.61). This replacement may produce a stricture in the distal esophagus. In advanced cases, a peptic ulcer may develop in the distal esophagus.

Question 124

what examination is suitable for Barret Syndrome diagnosis ?

Answer 124

The esophagogram may demonstrate subtle tissue changes in the esophagus, but nuclear medicine is the modality of choice for this condition. The patient is injected with technetium-99m pertechnetate to demonstrate the shift in tissue types in the esopha

Question 125

what is carsinoma of the esophagus

Answer 125

Carcinoma of the esophagus includes one of the most common malignancies of the esophagus, adenocarcinoma (Fig. 12.62). Advanced symptoms include dysphagia (difficulty in swallowing), localized pain during meals, and bleeding. Other tumors of the esophagus include carcinosarcoma, which often produces a large, irregular polyp, and pseudocarcinoma. An esophagogram and endoscopy are performed to detect these tumors. The esophagogram may demonstrate atrophic changes in the mucosa caused by invasion of the tumor and stricture. CT may be performed in staging of the tumor and determining whether it has extended beyond the inner layer of mucosa of the esophagus.

Question 126

dysphagia

Answer 126

difficulty in swallowing

Question 127

what diagnositic technique is used to detect carcinoma of esophagus?

Answer 127

An esophagogram and endoscopy

Question 128

what are the causes of dysphagia

Answer 128

Dysphagia (dis-fa′-je-a) is difficulty swallowing. This difficulty may be due to

a congenital or acquired condition,:

• a trapped bolus of food,
• paralysis of the pharyngeal or esophageal muscles, or inflammation.

Narrowing or an enlarged, flaccid appearance of the esophagus may be seen during the esophagogram, depending on the cause of the dysphagia. Digital fluoroscopy is the modality of choice

Question 129

what is esophagial varices

Answer 129

Esophageal varices are characterized by dilation of the veins in the wall of the distal esophagus (Fig. 12.63). This condition is often seen with acute liver disease, such as cirrhosis secondary to increased portal hypertension. With restriction in venous flow through the liver, the coronary veins in the distal esophagus become dilated, tortuous, and engorged with blood. In advanced cases, the veins may begin to bleed. Advanced esophageal varices manifest with narrowing of the distal third of the esophagus and a “wormlike” or “cobblestone” appearance caused by enlarged veins during an esophagogram

Question 130

what is Gastroesophageal reflux disease

Answer 130

Gastroesophageal reflux disease (GERD), or esophageal reflux, is the entry of gastric contents into the esophagus, irritating the lining of the esophagus. Esophageal reflux is reported as heartburn by most patients. This condition may lead to esophagitis demonstrated by an irregular or ulcerative appearance of the mucosa of the esophagus. Although specific causes for GERD or esophageal reflux have not been confirmed, cigarette smoking and excessive intake of aspirin, alcohol, and caffeine increase the incidence of reflux. It is also common in newborns up to 3 months but often resolves on its own.3

Question 131

zenker diverticulum

Answer 131

Zenker diverticulum is characterized by a large outpouching of the esophagus just above the upper esophageal sphincter (Fig. 12.65). It is believed to be caused by weakening of the muscle wall. Because of the size of the diverticulum, the patient may experience dysphagia, aspiration, and regurgitation of food eaten hours earlier. Although medication can reduce the symptoms of Zenker diverticulum, surgery may be required.

Question 132

under what conditions of diseases, esophagogram can be usefull?

Answer 132

Question 133

The first part of an esophagogram involves —————

Answer 133

fluoroscopy with a positive-contrast medium.

Question 134

Esophagograms generally use both———— Additional items useful in the detection of a radiolucent foreign body are (1)———–(2) ————— and (3) —————–.

Answer 134

Esophagograms generally use both thin and thick barium. Additional items useful in the detection of a radiolucent foreign body are (1) cotton balls soaked in thin barium, (2) barium pills or gelatin capsules filled with BaSO4, and (3) marshmallows.After swallowing any one of these three substances, the patient is asked to swallow an additional thin barium mixture

Question 135

The use of thick barium allows better visualization of ————————-

Answer 135

mucosal patterns and any lesion within the esophagus

Question 136

The pharynx and the cervical esophagus usually are studied ————-, whereas the main portion of the esophagus down to the stomach is studied both ———— and ———-

Answer 136

fluoroscopically with spot images

with fluoroscopy and with postfluoroscopy “overhead” radiographs

Question 137

what techniques are used to determine esophogeal refulx or regurgitation of gastric content ?

Answer 137

The diagnosis of possible esophageal reflux or regurgitation of gastric contents may occur during fluoroscopy or an esophagogram. One or more of the following procedures may be performed to detect esophageal reflux:

1. Breathing exercises

2. Water test

3. Compression paddle technique

4. Toe-touch maneuve

Question 138

Various breathing exercises are designed to increase both ————– and .

Answer 138

intrathoracic

intra-abdominal pressures

Question 139

decribe valsalva manuver (breathing exercise)

Answer 139

The most common breathing exercise is the Valsalva maneuver. The patient is asked to take a deep breath and, while holding the breath in, to bear down as though trying to move the bowels. This maneuver forces air against the closed glottis. A modified Valsalva maneuver is accomplished as the patient pinches off the nose, closes the mouth, and tries to blow the nose. The cheeks should expand outward as though the patient were blowing up a ball

Question 140

what is Mueller maneuver exercise

Answer 140

A Mueller maneuver also can be performed as the patient exhales and then tries to inhale against a closed glottis.

Question 141

what are the effects of valsalva maneuver and mueller maneuver breathing methods?

Answer 141

With both methods, the increase in intra-abdominal pressure may produce the reflux of ingested barium that would confirm the presence of esophageal reflux. The radiologist carefully observes the esophagogastric junction during these maneuvers.

Question 142

when does water test is applied ?

Answer 142

Water Test

The water test is done with the patient in the supine position and turned up slightly on the left side. This slight left posterior oblique (LPO) position fills the fundus with barium. The patient is asked to swallow a mouthful of water through a straw. Under fluoroscopy, the radiologist closely observes the esophagogastric junction. A positive water test occurs when significant amounts of barium regurgitate into the esophagus from the stomach

Question 143

why is the patien asked to slightly turn up on the left side i.e LPO position.

Answer 143

The water test is done with the patient in the supine position and turned up slightly on the left side. This slight left posterior oblique (LPO) position fills the fundus with barium.

Question 144

what is compression technique ?

when is it applied?

Answer 144

A compression paddle can be placed under the patient in the prone position and inflated as needed to provide pressure to the stomach region. The radiologist can demonstrate the obscure esophagogastric junction during this process to detect possible esophageal reflux.

Question 145

what is the toe.touch maneuver?

Answer 145

The toe-touch maneuver also is performed to study possible regurgitation into the esophagus from the stomach. Under fluoroscopy, the cardiac orifice is observed as the patient bends over and touches the toes. Esophageal reflux and hiatal hernias sometimes are demonstrated with the toe-touch maneuver. Although the procedures described above still are performed, most cases of esophageal reflux are confirmed through endoscopy

Answer 146

Postfluoroscopy Imaging

After the fluoroscopy portion of the esophagogram, radiographs of the entire barium-filled esophagus are obtained. postfluoroscopy “overhead” imaging.

Question 147

what is uper GI Series prosedure

what is the purpose of this examination

Answer 147

Radiographic examination of the distal esophagus, stomach, and duodenum is called an upper GI or UGI

Question 148

the purpose of uper GI Series prosedure

Answer 148

The purposes of the upper GI are to study radiographically the form and function of the distal esophagus, stomach, and duodenum and to detect abnormal anatomic and functional conditions

Question 149

what are the contraindications for upper GI examinations

Answer 149

Contraindications for upper GI examinations apply primarily to the type of contrast media used. If the patient has a history of bowel perforation, laceration, or rupture of the viscus, the use of barium sulfate may be contraindicated. An oral, water-soluble, iodinated contrast medium may be used in place of barium sulfate

Question 150

what are the indications for using upper GI tract examination with barium

Answer 150

1. Bezoar
   
   • trichobezoar
   • trichobezoar
   • Diverticula
2. Emesis
3. Hematemesis
4. Gastric carcinomas
5. Hiatal hernia
6. Gastritis
7. Hypertrophic pyloric stenosis (HPS)
8. gastric ulcer
9. peptic ulcer
10. Perforating ulcer

Question 151

what is bezoar?

Answer 151

Bezoar describes a mass of undigested material that becomes trapped in the stomach. This mass usually is made up of hair, certain vegetable fibers, or wood products. The material builds up over time and may form an obstruction in the stomach

Question 152

what is trichobezoar

Answer 152

trichobezoar, made up of ingested hair,

Question 153

what is ohytobezoar?

Answer 153

phytobezoar, which is ingested vegetable fiber or seeds.

Question 154

what is dirverticula

Answer 154

Diverticula are pouchlike herniations of a portion of the mucosal wall. They can occur in the stomach or small intestine. Gastric diverticula generally are 1 to 2 cm but may range in size from a few millimeters to 8 cm in diameter. Of gastric diverticula, 70% to 90% arise in the posterior aspect of the fundus. Consequently, the lateral position taken during an upper GI study may be the only projection that demonstrates gastric diverticula. Most gastric diverticula are asymptomatic and are discovered accidentally.

Question 155

which projection can visualize deverticula?

Answer 155

Of gastric diverticula, 70% to 90% arise in the posterior aspect of the fundus. Consequently, the lateral position taken during an upper GI study may be the only projection that demonstrates gastric diverticula. Most gastric diverticula are asymptomatic and are discovered accidentally.

Question 156

what complications can happen with development of verticula?

Answer 156

Although benign, diverticula can lead to perforation if untreated. Other complications include inflammation and ulceration at the site of neoplasm formation. A double-contrast upper GI is recommended to diagnose any tumors or diverticula.

Question 157

what does Emesis (em′-e-sis) mean

Answer 157

Emesis (em′-e-sis) is the act of vomiting

Question 158

what is hematemesis?

Answer 158

Blood in vomit is called hematemesis and may indicate that other forms of pathologic processes are present in the gastrointestinal tract

Question 159

what is the most common type of Gastric carcinomas and what are its radiographic signes?

Answer 159

Gastric carcinomas account for over 70% of all stomach neoplasms with 95% of them being adenocarcinomas.3 Radiographic signs include a large, irregular filling defect within the stomach, marked or nodular edges of the stomach lining, rigidity of the stomach, and associated ulceration of the mucosa

Question 160

what is the gold standard for detection of gastric carcinoma?

Answer 160

The double-contrast upper GI remains the gold standard for the detection of gastric carcinoma. CT or endoscopy may be performed to determine the degree of invasion of the tumor into tissues surrounding the stomach

Question 161

what is gastritis ?

Answer 161

Gastritis is an inflammation of the lining or mucosa of the stomach

Question 162

what are the teo types of gastritis ?

Answer 162

Gastritis may develop in response to various physiologic and environmental conditions. Acute gastritis manifests with severe symptoms of pain and discomfort. Chronic gastritis is an intermittent condition that may be brought on by changes in diet, stress, or other factors.

Question 163

what are the radiographic signs of gastritis?

Answer 163

Gastritis. A, Appearance includes thickening of rugal folds throughout stomach. B, Appearance includes some absence of rugal folds.

Gastritis is best demonstrated with a double-contrast upper GI. The fine coating of barium demonstrates subtle changes to the mucosal lining. Specific radiographic appearances may include, but are not restricted to, absence of rugae, a thin gastric wall, and “speckled” appearance of the mucosa. Endoscopy also may be performed to inspect the mucosa visually for signs of gastritis

Question 164

what is the ebst way to detect gastritis?

Answer 164

Gastritis is best demonstrated with a double-contrast upper GI.

Question 165

what is hiatal hernia

Answer 165

Hiatal hernia is a condition in which a portion of the stomach herniates through the diaphragmatic opening. The herniation may be slight, but in severe cases, most of the stomach is found within the thoracic cavity above the diaphragm.

Question 166

what are the reason that may lead to appearance of hiatal hernia ?

Answer 166

Hiatal hernia may be due to a congenitally short esophagus or weakening of the muscle that surrounds the diaphragmatic opening, allowing passage of the esophagus.5 They are common in 50% of the U.S. population over the age of 50 years.3 This form of hiatal hernia may occur in both pediatric and adult patients. An adult moderate-size hiatal hernia is shown in Fig. 12.75, in which a portion of the stomach containing air and barium is seen above the diaphragm

Question 167

what is sliding hiatal hernia?

Answer 167

sliding hiatal hernia is a second type of hiatal hernia that is caused by weakening of a small muscle (esophageal sphincter) located between the terminal esophagus and the diaphragm. The purposes of the esophageal sphincter are to keep the cardiac portion of the stomach below the diaphragm and to produce a high-pressure zone to prevent esophageal reflux. As a result of aging or other factors, this sphincter may weaken and permit a portion of the stomach to herniate through the esophageal hiatus. Because the degree of herniation may vary from time to time, it is termed a sliding hiatal hernia. The condition is frequently present at birth, but symptoms of difficulty in swallowing usually do not begin until young adulthood

Question 168

what is the purpose of esophageal sphincter?

Answer 168

The purposes of the esophageal sphincter are to keep the cardiac portion of the stomach below the diaphragm and to produce a high-pressure zone to prevent esophageal reflux

Question 169

what is schatzki ring?

Answer 169

• A sliding hiatal hernia may produce a radiographic sign termed Schatzki ring, which is a ring of mucosal tissue (which lines the distal esophagus) t_hat protrudes into the lumen of the esophagus_
  *

Question 170

what is Hypertrophic pyloric stenosis (HPS)?

Answer 170

Hypertrophic pyloric stenosis (HPS) is the most common type of gastric obstruction in infants. It is caused by hypertrophy of the antral muscle at the orifice of the pylorus. Hypertrophy of this muscle produces an obstruction at the pylorus. Symptoms of HPS include projectile vomiting after feedings, acute pain, and possible distention of the abdomen. HPS can be diagnosed during an upper GI. HPS often manifests as distention of the stomach with a small channel (if any at all) of barium passing through the pylorus into the duodenum. Sonography has become the modality of choice in diagnosing HPS. Sonography can measure the diameter and length of the antral muscle to determine whether it is larger (hypertrophic) than normal. It is reported that a muscle thickness greater than 4 mm is a positive sign of HPS.6 In addition, sonography does not require radiation exposure to the infant or use of contrast media.

Question 171

what are the symptoms of HPS?

Answer 171

ymptoms of HPS include projectile vomiting after feedings, acute pain, and possible distention of the abdomen.

Question 172

what does HPS stand for?

Answer 172

hypertrophic pyloric stensis

Question 173

which modality is the best for diagnosis of HPS

Answer 173

Sonography has become the modality of choice in diagnosing HPS. Sonography can measure the diameter and length of the antral muscle to determine whether it is larger (hypertrophic) than normal. It is reported that a muscle thickness greater than 4 mm is a positive sign of HPS.6 In addition, sonography does not require radiation exposure to the infant or use of contrast media.

Question 174

what is an ulcer and what are the reasons behind development of ulcers?

Answer 174

Ulcers are erosions of the stomach or duodenal mucosa that are caused by various physiologic or environmental conditions, such as excessive gastric secretions, stress, diet, and smoking. Some more recent studies suggest that ulcers may be caused by bacteria and can be treated with antibiotics. If untreated, an ulcer may lead to perforation of the stomach or duodenum.

Question 175

what are the radiographic signs of an ulcer?

Answer 175

During an upper GI study, the ulcer appears as a punctate barium collection that may be surrounded by a “lucent-halo” appearance. A small peptic ulcer filled with barium is seen in Fig. 12.77. A double-contrast upper GI is recommended for most ulcer studies. It may be preceded or followed by endoscopy of the upper gastrointestinal tract.

Question 176

what are different types of ulcers?

Answer 176

1. Duodenal ulcer is a peptic ulcer situated in the duodenum. These ulcers frequently are located in the second or third aspect of the duodenum. Duodenal ulcers are rarely malignant.
2. Peptic ulcer describes ulceration of the mucous membrane of the esophagus, stomach, or duodenum, caused by the action of acid gastric juice. The term peptic ulcer can be synonymous with gastric ulcer or duodenal ulcer. Peptic ulcer disease often is preceded by gastritis and is secondary to hyperacidity
3. Gastric ulcer is an ulcer of the gastric mucosa. • Perforating ulcer is an ulcer that involves the entire thickness of the wall of the stomach or intestine, creating an opening on both surfaces. Only 5% of all ulcers lead to perforation. If an ulcer becomes perforated, it creates an opening between the intestine and the peritoneal cavity. Radiographic signs include the presence of free air under the diaphragm, as seen with an erect abdomen radiograph. If untreated, this type of ulcer may lead to peritonitis and eventual death

Question 177

What are the Patient Preparation for Upper GI Series

Answer 177

The goal of patient preparation for an upper GI series is for the patient to arrive in the radiology department with a completely empty stomach. For an examination scheduled during the morning hours, the patient should be NPO from midnight until the time of the examination. Food and fluids should be withheld for at least 8 hours before the examination. The patient also is instructed not to smoke cigarettes or chew gum during the NPO period. These activities tend to increase gastric secretions and salivation, which prevents proper coating of barium to the gastric mucosa. The upper GI series is often a time-consuming procedure, so the patient should be forewarned about the time the examination may take when the appointment is made. This is especially true if the UGI is to be followed by a small bowel series. The importance of an empty stomach also should be stressed when the appointment is made so that the patient arrives properly prepared both physically and psychologically

Question 178

what are the Pregnancy Precautions for upper GIT examination

Answer 178

If the patient is female, a menstrual history must be obtained. Irradiation of an early pregnancy is one of the most hazardous situations in diagnostic radiography. Radiographic examinations such as the upper GI series that include the pelvis and the uterus in the primary beam as well as fluoroscopy should be done on pregnant women only when absolutely necessary. In general, abdominal radiographs of a known pregnancy should be delayed at least until the third trimester or, if the patient’s condition allows (as determined by the physician), until after the pregnancy. This waiting period is especially important when fluoroscopy, which greatly increases patient exposure, is involved.

Question 179

what are the Room Preparation and Fluoroscopy Procedure for upper GIT series?

Answer 179

Room setup for a UGI series is very similar to that for an esophagogram. The thin barium sulfate mixture is the typical contrast medium of choice for an upper GI series. Occasionally, thick barium may be used in addition to some type of gas-forming preparation. Rarely, water-soluble contrast media are used in preference to the barium sulfate mixture. The fluoroscopy table is raised to the vertical position, although with some very ill patients, the examination must be started with the table horizontal. Therefore, the footboard should be placed at the end of the table. The room should be clean and tidy, and the control panel should be set up for fluoroscopy. If conventional fluoroscopy is being used, the spot film mechanism should be properly loaded and in working condition. All image receptors for the entire examination should be set aside for easy access. Lead aprons, lead gloves, and the compression paddle should be available for radiologist as well as lead aprons for all other personnel in the room. Before introduction of the patient and the radiologist, the patient’s history must be obtained, and the examination procedure must be carefully explained to the patient. General duties during fluoroscopy for an upper GI series are similar to those for an esophagogram. The technologist should follow the radiologist’s instructions, assist the patient as needed, and expedite the procedure in any manner possible. The fluoroscopic routine followed by radiologists varies greatly but usually begins with the patient in the upright position (Fig. 12.78). A wide variety of table movements, patient positions, and special maneuvers follow until the fluoroscopy portion of the procedure is complete

Question 180

what are the Pediatric Patient Preparation for Upper GI

Answer 180

• Pediatric Patient Preparation for Upper GI :The following guidelines are suggested, but department protocol should be followed: • Infant younger than 1 year—NPO for 4 hours • Children older than 1 year—NPO for 6 hours
• Barium Preparation: Dilution of the barium may be required if the child will be fed through a bottle. A larger hole in the nipple may be required to ensure a smooth flow of barium. Some suggested barium volume guidelines are listed next, but specific department protocol should be followed. • Newborn to 1 year—2 to 4 oz • 1 to 3 years—4 to 6 oz • 3 to 10 years—6 to 12 oz • Older than 10 years—12 to 16 oz
• Room Preparation Most upper GI series for pediatric patients are performed with the table in the horizontal position. Protective aprons must be provided for all persons in the fluoroscopy room (Fig. 12.81). Individuals who feed or restrain the child during fluoroscopy should wear protective gloves and should be instructed not to stand at the head or foot of the table, where radiation exposure is greatest. Pulsed, grid-controlled fluoroscopy should be used to reduce doses for all patients, especially children.

Question 181

what are the geriatric applications for upper GIT series?

Answer 181

Geriatric Applications

The risk of dehydration during GI studies is a concern for geriatric patients. These patients may require additional attention and monitoring with the normal patient preparation of withholding fluids and ingesting barium. The use of water-soluble contrast agents such as Gastrografin or MD-Gastroview may increase the risk of dehydration further. Geriatric patients should be scheduled for GI studies early in the morning to permit a return to normal fluid and dietary intake after the procedure. Geriatric patients may require additional time and assistance while changing positions on the table. Geriatric patients may feel nervous and express fear of falling off the examination table. A decrease in exposure factors is required for geriatric patients with lower tissue density and asthenic-type body habitus

Question 182

Summary of Positioning Tips for Upper GI Examination

Answer 182

1. Clinical History Obtain a clinical history from the patient, and record the clinical indications for the study. Note any past or recent abdominal surgery, especially surgeries involving the gastrointestinal tract. Surgery or resection of the bowel or stomach may alter its normal position. Pay close attention to the fluoroscopy monitor to detect such differences, which may affect positioning and centering on postfluoroscopy imaging. Review the patient’s chart to ensure that the correct procedure has been ordered. Also identify specific allergies and other pertinent information.
2. Body Habitus Consider the body habitus of the patient. The stomach is high and transverse with a hypersthenic patient but low and vertical with a hyposthenic patient. A sthenic or average patient has the duodenum bulb near the L2 region. Usually, L2 is located 2.5 to 5 cm above the lower margin of the lateral rib cage. Centering points in this text are designed for the average, sthenic patient.
3. Fluoroscopy During fluoroscopy, identify the stomach on the fluoroscopy monitor. Pinpoint surrounding structures to gain clues about the location of the stomach and duodenum. For example, if the body of the stomach is adjacent to the iliac wing, center lower than the average or sthenic patient.
4. High kV and Short Exposure Time High kV of 110 to 125 is required to penetrate adequately and increase visibility of barium-filled structures. A kV less than 100 would not provide visibility of the mucosa of the esophagus, stomach, or duodenum. Short exposure times are needed to control peristaltic motion. With double contrast, reduction of the kV to 90 to 100 is common to provide higher contrast images without overpenetrating the anatomy (determine departmental kV preferences). Iodinated, water-soluble contrast studies often require a kV range of 80 to 90 kV.

Question 183

what are The Alternative Modalities and Procedures for upper GIT examination

Answer 183

1. CT
   
   • CT is an excellent modality that may be used to demonstrate tumors of the gastrointestinal tract, liver, spleen, and pancreas. With the use of diluted oral contrast media, CT can demonstrate diverticula, hiatal hernia, and bowel perforation. CT has become the modality of choice for demonstrating trauma and tumors of the gastrointestinal tract and accessory organs.
2. MRI
   
   • ​​Tumor and vascular disease of the liver and esophageal varices are demonstrated well on MRI with the use of a flow-sensitive, short flip angle pulse sequence. Hemochromatosis, or iron overload, may be a genetic condition or may be due to multiple blood transfusions and is well visualized with MRI. This condition leads to deposition of an abnormal amount of iron within the liver parenchyma. Excessive iron deposited in the tissue produces a strong signal on MRI.
3. Medical Sonography
   
   • Intraesophageal sonography for esophageal varices and carcinoma of the esophagus is becoming an alternative to the esophagogram. With passage of a small transducer into the esophagus, detailed images of the inner mucosal layer can be acquired. Small varices and polyps of the esophagus and upper stomach can be evaluated. As stated earlier, ultrasound has become an effective diagnostic tool for HPS in infants. Doppler ultrasound can be used to detect vascular flow to specific accessory organs in the gastrointestinal tract.
4. Nuclear Medicine
   
   • With the use of specific radionuclides, nuclear medicine scans demonstrate cirrhosis of the liver, splenic tumors, gastrointestinal bleeding, and gastric emptying studies. Gastric emptying studies are performed to determine the rate of emptying of food from the stomach. Also, esophageal reflux can be diagnosed by the addition of a radionuclide to a drink, such as milk. With a compression band placed along the upper abdomen, the nuclear medicine camera can measure any return of gastric contents through the esophagogastric junction. Nuclear medicine is also very effective in demonstrating Barrett esophagus

Question 184

If the entire small intestine were removed from the body at autopsy, separated from its mesenteric attachment, uncoiled, and stretched out, it would average — m in length. During life, with good muscle tone, the actual length of the small intestine is shorter, measuring — to — m. However, tremendous individual variation exists. In one series of 100 autopsies, the small bowel ranged in length from —- to — m. The diameter varies from —- cm at the proximal aspect to about — cm at the distal end

Answer 184

7

4. 5 to 5.5
5. 5 to 9.5 meter
6. 8
7. 5

Question 185

The large intestine (large bowel) begins in the —— with its connection to the small intestine. The large intestine extends around the periphery of the abdominal cavity to end at the anus. The large intestine is about —– long and about in diameter

Answer 185

right lower quadrant (RLQ)

1.5 m (5 feet)

6 cm

Question 186

what are the two common radiographic procedures involving the lower gastrointestinal system ?

Answer 186

• Small Bowel Series—Study of Small Intestine
• Barium Enema (Lower GI Series, Colon)—Study of Large Intestine

Question 187

Radiographic examination specifically of the small intestine is called a ——

Answer 187

small bowel series (SBS)

Question 188

SBS examination often is combined with an upper GI series and under these conditions may be termed a ———–

Answer 188

small bowel follow-through.

Question 189

what is BE, BaE,

Answer 189

barium enema

Lower GI series.

Question 190

what is situs invertus?

Answer 190

situs inversus, in which abdominal and thoracic organs are reversed from their normal orientation within the body

Question 191

small intestine begins at ——— of the stomach,

Answer 191

the pyloric valve

Question 192

what are the three parts of small intestine in order?

Answer 192

the three parts of the small intestine, in order, are the duodenum, jejunum, and ileum

Question 193

what is the shortes, widest and most fixed portion of the bowel?

Answer 193

duodenum-It is the shortest, widest, and most fixed portion of the small bowel.

Question 194

where is duodenumclandmark on the belly ?

Answer 194

It is located primarily in the RUQ. It also extends into the LUQ, where it joins the jejunum at a point called the duodenojejunal flexure. It represents the shortest aspect of the small intestine and averages 20 to 25 cm in length

Question 195

at which anatomic landmark does duodenum joins jejunum?

Answer 195

LUQ ,where it joins the jejunum at a point called the duodenojejunal flexure. It represents the shortest aspect of the small intestine and averages 20 to 25 cm in length

Question 196

how long is duodenum?

Answer 196

It represents the shortest aspect of the small intestine and averages 20 to 25 cm in length

Question 197

at which anatomic landmard the jejunum is located?

Answer 197

The jejunum is located primarily to the left of midline in the LUQ and LLQ, making up about two-fifths of the remaining aspect of the small intestine.

Question 198

what portion of the small bowel is consisted of jejunum?

Answer 198

The jejunum is located primarily to the left of midline in the LUQ and LLQ, making up about two-fifths of the remaining aspect of the small intestine.

2/5

Question 199

what is the inner diameter of the jejunum?

Answer 199

Its inner diameter is approximately 2.5 cm.

Question 200

what is the mucosal folds of jejunum called?

Answer 200

The jejunum contains numerous mucosal folds (plicae circulares), which increase the surface area to aid with absorption of nutrients.

Question 201

what is the function of plicae circularis in jejunum?

Answer 201

increase the surface area to aid with absorption of nutrients.

Question 202

why does jejunum has a feathery appearance?

Answer 202

“feathery appearance of the jejunum.”is due to numerous mucosal folds called plicae circulares

Question 203

what is the radiographic reference point during a small bowl study?

Answer 203

The jejunum begins at the site of the duodenojejunal flexure, slightly to the left of midline in the LUQ (under the transverse colon as seen in Fig. 13.4). This relatively fixed site of the small bowel may become a radiographic reference point during a small bowel study

Question 204

what is the radiographic reference for the ileum

Answer 204

The ileum is located primarily in the RUQ, RLQ, and LLQ.

Question 205

what portion of the remaining aspect of the small intestine is occupied by ileum?

Answer 205

he ileum makes up the distal three-fifths of the remaining aspect of the small intestine and is the longest portion of the small intestine.

Question 206

what is the longest portion of the small intestine?

Answer 206

ileum

the ileum makes up the distal three-fifths of the remaining aspect of the small intestine and is the longest portion of the small intestine.

Question 207

where does the terminal ileum joins the large intestine? at which radiographic reference?

Answer 207

The terminal ileum joins the large intestine at the ileocecal valve (sphincter or fold) in the RLQ,

Question 208

what are the structural differences between jejunum and ilieum?

Answer 208

Although it is longer than the jejunum, the ileum possesses a thinner wall and has fewer mucosal folds (plicae circulares). At the point of the ileocecal valve (sphincter), the inner lumen of the ileum is nearly smooth.

Question 209

what is villi

Answer 209

The C-shaped duodenum is fairly fixed in position immediately distal to the stomach and is recognized easily on radiographs. The internal lining of the second and third (descending and horizontal),portions of the duodenum is gathered into tight circular folds formed by the mucosa of the small intestine, which contains numerous small, finger-like projections termed villi, resulting in a “feathery” appearance when filled with barium

Question 210

how does duodenum, jejum and ileum look like on radiographic image? or what are the observable differences between these three anatomic structures?

Answer 210

duodenum

The C-shaped duodenum is fairly fixed in position immediately distal to the stomach and is recognized easily on radiographs. The internal lining of the second and third (descending and horizontal) portions of the duodenum is gathered into tight circular folds formed by the mucosa of the small intestine, which contains numerous small, finger-like projections termed villi, resulting in a “feathery” appearance when filled with barium

jejunum

The mucosal folds of the distal duodenum are found in the jejunum as well. Although there is no abrupt end to the circular feathery folds, the ileum tends not to have this appearance.

lieum

he internal lining of the ileum appears on a radiograph as smoother, with fewer indentations and a less “feathery” appearance. Another observable difference in the three sections of small intestine is that the internal diameter gets progressively smaller from duodenum to ileum

Question 211

The large intestine begins in the ——-, just —to the ileocecal valve

Answer 211

RLQ

lateral

Question 212

what are the different portions of the large intestines ?

Answer 212

he large intestine consists of four major parts: cecum, colon, rectum, and anal canal

Question 213

is colon and large intestine synonyms?

Answer 213

Large intestine and colon are not synonyms, although many technologists use these terms interchangeably. The colon consists of four sections and two flexures and does not include the cecum and rectum

Question 214

how many parts does colon has?

Answer 214

four section

• ascending
• transverse
• descending
• sigmoid colon

two flextures

• hepatic
• splenic

The colon consists of four sections and two flexures and does not include the cecum and rectum. The four sections of the colon are (1) the ascending colon, (2) the transverse colon, (3) the descending colon, and (4) the sigmoid colon. The right (hepatic) and left (splenic) colic flexures also are included as part of the colon

Question 215

At the proximal end of the large intestine is the,——— a large blind pouch located inferior to the level of the ———.

Answer 215

cecum,

ileocecal valve

Question 216

The ——-appendix (commonly referred to as just the appendix) is attached to the cecum

Answer 216

vermiform

Question 217

The most distal part of the small intestine, the ileum, joins the cecum at the————, which consists of two lips that extend into the large bowel

Answer 217

ileocecal valve

Question 218

what is the function of ileocecal valve?

Answer 218

the ileocecal valve acts as a sphincter to prevent the contents of the ileum from passing too quickly into the cecum. A second function of the ileocecal valve is to prevent reflux, or a backward flow of large-intestine contents, into the ileum.

Question 219

what is apendicitis?

Answer 219

The vermiform appendix (appendix) is a long (2 to 20 cm), narrow, worm-shaped tube that extends from the cecum. The term vermiform means “wormlike.” The appendix usually is attached to the posteromedial aspect of the cecum and commonly extends toward the pelvis. However, it may pass posterior to the cecum. Because the appendix has a blind ending, infectious agents may enter the appendix, which cannot empty itself. Also, obstruction of the opening into the vermiform appendix caused by a small fecal mass may lead to narrowing of the blood vessels that feed it. The result is an inflamed appendix, or appendicitis. Appendicitis may require surgical removal, which is termed an appendectomy, before the diseased structure ruptures, causing peritonitis. Acute appendicitis accounts for about 50% of all emergency abdominal surgeries and is 1.5 times more common in men than in women. Occasionally, fecal matter or barium sulfate from a gastrointestinal tract study may fill the appendix and remain there indefinitely

Question 220

where does rectum starts and where does it end?

Answer 220

The rectum extends from the sigmoid colon to the anus.

Question 221

at what level of the sacral segments is rectume located?

radiographic reference point/lanmark

Answer 221

The rectum begins at the level of S3 (third sacral segment) and is about 12 cm ( inches) long. The final 2.5 to 4 cm (1 to inches) of large intestine is constricted to form the anal canal. The anal canal terminates as an opening to the exterior, the anus.

Question 222

how large is the rectum?

Answer 222

The rectum is about 12 cm long. The final 2.5 to 4 cm of large intestine is constricted to form the anal canal. The anal canal terminates as an opening to the exterior, the anus.

Question 223

where rectal ampula located

Answer 223

The rectal ampulla is a dilated portion of the rectum located anterior to the coccyx.

Question 224

what directions the curves of rectum have?

Answer 224

The initial direction of the rectum along the sacrum is inferior and posterior. However, in the region of the rectal ampulla, the direction changes to inferior and anterior. A second abrupt change in direction occurs in the region of the anal canal, which is directed again inferiorly and posteriorly. Therefore, the rectum presents two anteroposterior curves. This fact must be remembered when the technologist inserts a rectal tube or enema tip into the lower gastrointestinal tract for a barium enema procedure. Serious injury can occur if the enema tip is forced at the wrong angle into the anus and anal canal.

Question 225

Large Versus Small Intestine

what are the three characteristics which readily differentiate the large intestine from the small intestine?

Answer 225

1. . The internal diameter of the large intestine is usually greater than the diameter of the small bowel
2. The muscular portion of the intestinal wall contains three external bands of longitudinal muscle fibers of the large bowel that form three bands of muscle called taeniae coli, which tend to pull the large intestine into pouches. Each of these pouches, or sacculations, is termed a haustrum. Most of the large intestine except for the rectum possesses haustra. Therefore, a second primary identifying characteristic of the large bowel is the presence of multiple haustra.
3. The third differentiation is the relative positions of the two structures. The large intestine extends around the periphery of the abdominal cavity, whereas the small intestine is more centrally located

Question 226

what is taeniae coli?

Answer 226

The muscular portion of the intestinal wall contains three external bands of longitudinal muscle fibers of the large bowel that form three bands of muscle called taeniae coli, which tend to pull the large intestine into pouches. Each of these pouches, or sacculations, is termed a haustrum. Most of the large intestine except for the rectum possesses haustra. Therefore, a second primary identifying characteristic of the large bowel is the presence of multiple haustra

Question 227

how does the large intestine get pulled together into pouches?

Answer 227

by three external bands of longitudinal muscle fibers of the large bowel that form three bands of muscle called taeniae coli, which tend to pull the large intestine into pouches. Each of these pouches, or sacculations, is termed a haustrum. Most of the large intestine except for the rectum possesses haustra. Therefore, a second primary identifying characteristic of the large bowel is the presence of multiple haustra

Question 228

the large intestine gets pulled together into pouches, or ——–

Answer 228

which tend to pull the large intestine into pouches. Each of these pouches, or sacculations, is termed a haustrum. Most of the large intestine except for the rectum possesses haustra. Therefore, a second primary identifying characteristic of the large bowel is the presence of multiple haustra

Question 229

taeniae coli pulles the large intestine into pouches or sacculations, whcih are termed ——-

Answer 229

taeniae coli tend to pull the large intestine into pouches. Each of these pouches, or sacculations, is termed a haustrum. Most of the large intestine except for the rectum possesses haustra. Therefore, a second primary identifying characteristic of the large bowel is the presence of multiple haustra

Question 230

does rectum has haustra?

Answer 230

no

Most of the large intestine except for the rectum possesses haustra. Therefore, a second primary identifying characteristic of the large bowel is the presence of multiple haustra

Question 231

The large intestine extends around the ———- of the abdominal cavity, whereas the small intestine is more

——– located.

Answer 231

The large intestine extends around the periphery of the abdominal cavity, whereas the small intestine is more centrally located.

Question 232

The cecum, transverse colon, and sigmoid colon are more ———— than other aspects of the large intestine.

(location)

Answer 232

The cecum, transverse colon, and sigmoid colon are more anterior than other aspects of the large intestine.

Question 233

what is the distribution of air and barium is influenced most often by?

Answer 233

The distribution of air and barium is influenced most often by the location of each portion of the large intestine in relation to the peritoneum. Aspects of the large intestine are more anterior or more posterior in relation to the peritoneum

Question 234

how is the distribution of air and barium in supine and prone positions in a lower GIT examination?

Answer 234

The simplified drawings in Fig. 13.13 represent the large intestine in supine and prone positions. If the large intestine contained both air and barium sulfate, the air would tend to rise and the barium would tend to sink because of gravity. Displacement and the ultimate location of air are shown as black, and displacement and the ultimate location of the barium are shown as white

When a person is supine, air rises to fill the structures that are most anterior—that is, the transverse colon and loops of the sigmoid colon. The barium sinks to fill primarily the ascending and descending colon and aspects of the sigmoid colon. When a patient is prone, barium and air reverse positions. The drawing on the right illustrates the prone position—air has risen to fill the rectum, ascending colon, and descending colon. Recognizing these spatial relationships is important during fluoroscopy and during radiography when barium enema examinations are performed

Question 235

describe the of LOCATION OF LARGE INTESTINE STRUCTURES IN RELATION TO PERITONEUM

Answer 235

Question 236

Answer 236

a. Cecum b. Ascending colon c. Right colic (hepatic) flexure (usually located lower than the left colic flexure because of the presence of the liver) d. Transverse colon e. Left colic (splenic) flexure f. Descending colon g. Sigmoid colon h. Rectum

Question 237

what are the four digestive functions of the small and large intestines?

Answer 237

. Digestion (chemical and mechanical) 2. Absorption 3. Reabsorption of water, inorganic salts, vitamin K, and amino acids 4. Elimination (defecation)

Question 238

RESPONSIBLE COMPONENT OF INTESTINEFUNCTION

Small intestine —–> Chemical and mechanical

Duodenum and jejunum —> (primarily) Absorption: Nutrients, H2O, salts, and proteins 3. Reabsorption: H2O and salts

Large intestine

• Some reabsorption of H2O and inorganic salts; vitamins B and K; amino acids
• Elimination (defecation)

Question 239

what is the function of large intestine

Answer 239

Most digestion and absorption take place within the small intestine. Also, most salts and approximately 95% of water are reabsorbed in the small intestine. Minimal reabsorption of water and inorganic salts occurs in the large intestine, as does the elimination of unused or unnecessary materials. The primary function of the large intestine is the elimination of feces (defecation). Feces consist normally of 65% water and 35% solid matter, such as food residues, digestive secretions, and bacteria. Other specific unctions of the large intestine include absorption of water, inorganic salt, vitamin K, and certain amino acids. These vitamins and amino acids are produced by a large collection of naturally occurring microorganisms (bacteria) found in the large intestine. The last stage of digestion occurs in the large intestine through bacterial action, which converts the remaining proteins into amino acids. Some vitamins, such as B and K, are synthesized by bacteria and absorbed by the large intestine. A by-product of this bacterial action is the release of hydrogen, carbon dioxide, and methane gas. These gases, called flatus (fla′-tus), help to break down remaining proteins to amino acids.

Question 240

describe DIGESTIVE MOVEMENTS AND ELIMINATION in the large and small intestine

Answer 240

Small Intestine

Digestive movements throughout the length of the small bowel consist of (1) peristalsis (per″-i-stal′-sis) and (2) rhythmic segmentation. Peristalsis describes wavelike contractions that propel food from the stomach through the small and large intestines and eventually expel it from the body. Barium sulfate enters the stomach and reaches the ileocecal valve 2 to 3 hours after ingestion. Rhythmic segmentation describes localized contractions in areas or regions that contain food. For example, food within a specific aspect of the small intestine is contracted to produce segments of a particular column of food. Through rhythmic segmentation, digestion and reabsorption of select nutrients are more effective.

Large Intestine

In the large intestine, digestive movements continue as (1) peristalsis, (2) haustral (haws′-tral) churning, (3) mass peristalsis, and (4) defecation (def″-e-ka′-shun). Haustral churning produces movement of material within the large intestine. During this process, a particular group of haustra (bands of muscle) remains relaxed and distended while the bands are filling up with material. When distention reaches a certain level, the intestinal walls contract or “churn” to squeeze the contents into the next group of haustra. Mass peristalsis tends to move the entire large bowel contents into the sigmoid colon and rectum, usually once every 24 hours. Defecation is a so-called bowel movement, or emptying of the rectum

Question 241

why upper GIT and Small bowel series procedure must be be timed?

Answer 241

because this study also examines function of the small bowel, the procedure must be timed. The time when the patient has ingested a substantial amount (at least 8 oz) of contrast medium should be noted

Question 242

what are the clinical indications of small intestine examination with contrast media?

Answer 242

1. Enteritis
   
   1. Small bowel series, enteroclysis
      
      1. Thickening of mucosal folds and poor definition of circular folds
2. Regional enteritis (Crohn disease)
   
   1. Small bowel series, enteroclysis
      
      1. Segments of lumen narrowed and irregular; “cobblestone” appearance and “string sign” common
3. Giardiasis
   
   1. Small bowel series, enteroclysis
      
      1. Dilation of intestine, with thickening of circular folds
   2. iIleus (obstruction) Adynamic Mechanical
      
      1. Acute abdomen series, small bowel series, enteroclysis
         
         1. Abnormal gas patterns, dilated loops of bowel, “circular staircase” or “herringbone” pattern
            
            1. (−) Decrease if large segments of intestine are gas-filled
4. Malabsorption syndromes (sprue)
   
   1. Small bowel series, enteroclysis, or CT of abdomen
      
      1. Thickening of mucosal folds and poor definition of normal “feathery” appearance
5. Meckel diverticulum
   
   1. Nuclear medicine scan, small bowel series, enteroclysis
      
      1. Large diverticulum of ileum, proximal to ileocecal valve; rarely seen on barium studies
6. Neoplasm
   
   1. Small bowel series, enteroclysis, or CT of abdomen
      
      1. Narrowed segments of intestine; “apple-core” or “napkin-ring sign”; partial or complete obstruction
7. Whipple disease
   
   1. Small bowel series
      
      1. Dilation and distorted loops of small bowel

Question 243

what is Enteritis and gastroentritis?

what are the symptoms and causes?

Answer 243

Enteritis (en″-ter-i′-tis) describes inflammation of the intestine, primarily of the small intestine. Enteritis may be caused by bacterial or protozoan organisms and other environmental factors. When the stomach is also involved, the condition is known as gastroenteritis. Chronic irritation may cause the lumen of the intestine to become thickened, irregular, and narrowed

Question 244

what is a Regional enteritis (segmental enteritis or Crohn disease) ?

Answer 244

Regional enteritis (segmental enteritis or Crohn disease)

• is a form of inflammatory bowel disease of unknown origin, involving any part of the gastrointestinal tract but commonly involving the terminal ileum.
  
  • This condition leads to scarring and thickening of the bowel wall. This scarring produces the “cobblestone” appearance visible during a small bowel series, or enteroclysis. Radiographically, these lesions resemble gastric erosions or ulcers seen in barium studies as minor variations in barium coating. In advanced cases, segments of the intestine become narrowed as the result of chronic spasm, producing the “string sign” evident during a small bowel series. Regional enteritis frequently leads to intestinal obstruction, fistula, and abscess formation. This disorder also has a high rate of recurrence after treatment

Question 245

what is giardiasis?

Answer 245

Giardiasis (je″-ahr-di′-a-sis) is a common infection of the lumen of the small intestine that is caused by

• t_he flagellate protozoan Giardia lamblia_.

It is often spread by contaminated food and water. It can also be spread via person-to-person contact.

Symptoms of giardiasis include

• nonspecific gastrointestinal discomfort,
• mild to profuse diarrhea,
• nausea,
• anorexia,
• and weight loss.
• The presence of this organism usually affects the duodenum and jejunum with spasms, irritability, and increased secretions. A small bowel series typically demonstrates giardiasis as dilation of the intestine, with thickening of the circular folds. Laboratory analysis of a stool specimen can confirm the presence of the Giardia organism

Question 246

what is Ileus?

Answer 246

ileus (il′-e-us) is an obstruction of the small intestine, Two types of ileus have been identified: (1) adynamic, or paralytic, and (2) mechanical

Question 247

what is adynamic illeus and what is its eticology of the desease?

Answer 247

Adynamic, or paralytic, ileus is due to the cessation of peristalsis. Without these involuntary, wavelike contractions, the bowel is flaccid and is unable to propel its contents forward. Causes for adynamic ileus include

• infection, such as peritonitis or appendicitis;
• the use of certain drugs;
• and postsurgical complications.

Adynamic ileus usually involves the entire gastrointestinal tract. With adynamic ileus, usually no fluid levels are demonstrated on the erect abdomen projection. However, the intestine is distended with a thin bowel wall

Question 248

what is the eticology of a mechanical obstruction(ileus) ?

Answer 248

A mechanical obstruction is a physical blockage of the bowel that may be caused by

• tumors,
• adhesions,
• or hernia.

The loops of intestine proximal to the site of obstruction are markedly dilated with gas. This dilation produces the radiographic sign commonly called the “circular staircase” or “herringbone” pattern, which is evident on an erect or decubitus abdomen projection. Air-fluid levels usually are present, as can be seen on these projections

Question 249

what does the “circular staircase” or “herringbone” pattern, which is evident on an erect or decubitus abdomen projection indicates?

Answer 249

A mechanical obstruction is a physical blockage of the bowel that may be caused by tumors, adhesions, or hernia. The loops of intestine proximal to the site of obstruction are markedly dilated with gas. This dilation produces the radiographic sign commonly called the “circular staircase” or “herringbone” pattern, which is evident on an erect or decubitus abdomen projection. Air-fluid levels usually are present, as can be seen on these projections

Question 250

what is meckel diverticum?

Answer 250

Meckel diverticulum is a common birth defect caused by

• the persistence of the yolk sac (umbilical vesicle) resulting in a saclike outpouching of the intestinal wall. This outpouching is seen in the ileum of the small bowel. It may measure 10 to 12 cm in diameter and is usually 50 to 100 cm proximal to the ileocecal valve.

Meckel diverticulum is found incidentally in approximately 3% of adults. The condition does not typically cause symptoms unless inflammation (diverticulitis) or bowel obstruction develops. Pain may mimic acute appendicitis. Surgical removal is often recommended to prevent possible diverticulitis, obstruction, or blood loss. Meckel diverticulum is rarely seen on barium studies of the small bowel because of rapid emptying during a barium study. It is best diagnosed with a radionuclide (nuclear medicine) scan

Question 251

what are the possible neoplasm in the small intestine ?

Answer 251

Neoplasm (ne′-o-plazm) is a term that means “new growth.” This growth may be benign or malignant (cancerous). Common benign tumors of the small intestine include adenomas and leiomyomas. Most benign tumors are found in the jejunum and ileum

Question 252

what is Carcinoid tumors

Answer 252

Carcinoid tumors, the most common tumors of the small bowel, have a benign appearance, although they have the potential to become malignant. These small lesions tend to grow submucosally and frequently are missed radiographically

Question 253

what are the two examples of maligne tumors of small intestine?

Answer 253

Lymphoma and adenocarcinoma are malignant tumors of the small intestine. Lymphomas are demonstrated during a small bowel series as the “stacked coin” sign.

• This sign is caused by thickening, coarsening, and possible hemorrhage of the mucosal wall. Other segments of the intestine may become narrowed and ulcerative.

Adenocarcinomas produce short and sharp “napkin-ring” defects within the lumen, which may lead to complete obstruction. These radiographic signs of neoplasm are demonstrated during a barium enema procedure. The most frequent sites for adenocarcinoma are the duodenum and the proximal jejunum. The small bowel series, or enteroclysis, may demonstrate stricture or blockage caused by the neoplasm. CT of the abdomen may further ascertain the location and size of the tumor

Question 254

what is malabsorbtion syndrome and sprue ?

Answer 254

Sprue (spru) and malabsorption syndromes are

• conditions in which the gastrointestinal tract is unable to process and absorb certain nutrients.

Sprue

• consists of a group of intestinal malabsorption diseases that involve an inability to absorb certain proteins and dietary fat.
• The malabsorption may be due to
  
  • an intraluminal (digestive) defect,
  • a mucosal abnormality,
  • or a lymphatic obstruction.

Malabsorption syndrome is often experienced by

• patients with lactose and
• sucrose sensitivities.
• Deficiency syndromes may result from excessive loss of
  
  • vitamins,
  • electrolytes,
  • iron,
  • or calcium.

During a small bowel series, the mucosa may appear

• thickened as a result of constant irritation.

Celiac disease is a form of sprue or malabsorption disease that affects the proximal small bowel, especially the proximal duodenum. It commonly involves the insoluble protein (gluten) found in cereal grains.

Question 255

what is whipple desease?

Answer 255

Whipple disease is a rare disorder of the proximal small bowel whose cause is unknown.

Symptoms include

• dilation of the intestine,
• edema,
• malabsorption,
• deposits of fat in the bowel wall,
• and mesenteric nodules.

Whipple disease is best diagnosed with a small bowel series, which shows distorted loops of small intestine.

Question 256

name Small Bowel Procedures:

Answer 256

1. Upper GI–Small Bowel Combination
   
   • Routine
     
     • Routine upper GI first
     • Notation of time patient ingested first cup (8 oz) of barium
     • 30-minute PA radiograph (centering high for proximal small bowel)
     • Half-hour interval radiographs, centered to iliac crest, until barium reaches large bowel (usually 2 hours)
     • 1-hour interval radiographs, if more time is needed after 2 hours
   1. Optional
      
      • Fluoroscopy and spot imaging of ileocecal valve and terminal ileum (compression cone may be used)
2. ​​Small Bowel–Only Series
   
   1. ​Routine
      
      • Plain abdomen radiograph (scout)
      • 2 cups (16 oz) of barium ingested (noting time)
      • 15- to 30-minute radiograph (centered high for proximal small bowel)
      • Half-hour interval radiographs (centered to crest) until barium reaches large bowel (usually 2 hours)
      • 1-hour interval radiographs, if more time is needed (some routines including continuous half-hour intervals)
   2. optional
      
      • Fluoroscopy with compression sometimes required
3. Enteroclysis (Double-Contrast Small Bowel Series)
   
   1. Procedure
      
      • Special guidewire and catheter advanced to duodenojejunal junction
      • Thin mixture of barium sulfate instilled
      • Air or methylcellulose instilled
      • Fluoroscopic spot images and conventional radiographs taken
   2. Optional
      
      • Patient may have CT scan of gastrointestinal tract
      • On successful completion of examination, intubation tube removed
4. Intubation Method (Single-Contrast Small Bowel Series)
   
   1. ​Procedure
      
      • ​​Single-lumen catheter advanced to proximal jejunum (double-lumen catheter used for therapeutic intubation)
      • Water-soluble iodinated agent or thin mixture of barium sulfate instilled
      • Time at which contrast medium is instilled noted
      • Conventional radiographs or optional fluoroscopic spot films taken at specific time intervals
   2. Optional
      
      1. ​Patient may have CT scan of gastrointestinal tract following the small bowel series. In those cases, an iodinated contrast media or dilute barium sulfate (such as VoLumen) must be given

Question 257

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