Ch. 12 Biliary Tract and Upper Gastrointestinal System Workbook Flashcards
what is the average weight of the adult human liver
3-4 lbs (1.5 kg) (1/36 of total body weight)
which abdominal quadrant contains the gallbladder
RUQ
what is the name of the soft tissue structure that separates the right from the left lobe of the liver
falciform ligament
which lobe of the liver is larger, the right or the left
right
what are the minor lobes of the liver called
-quadrate
- caudate
how much bile does the average healthy adult liver produce in a day
1 quart (800-1000 mL)
what are the 3 primary functions of the gallbladder
- store bile
- concentrate bile
- contracts to release bile into duodenum
what imaging modality produces cholescintigraphy
nuclear medicine
what two terms refer to a radiographic examination of the pharynx and esophagus
- esophagography
- barium swallow
which regions is peristaltic activity not found
- oral cavity
- pharynx
concentrated levels of this in bile may lead to gallstones
cholesterol
a churning or mixing activity that is present in the small bowel is called what
rhythmic segmentation
the end of the common bile duct and the end of the pancreatic duct are totally separated into 2 ducts rather than combining into one single passageway into the duodenum in what percent of the population
40%
what is the end product of digestion of lipids
fatty acids and glycerol
what types of mechanical digestion occur in the oral cavity
- mastication
- delgutition
with the use of this, the number of post fluoroscopy radiographs ordered has greatly diminished
digital fluoroscopy
what is the older term for the main pancreatic duct
duct of Wirsung
is the gallbladder located more anteriorly or posteriorly in the abdomen
anteriorly
what are the 4 advantages of using sonography as a noninvasive means to study the gallbladder and biliary ducts
- no ionizing radiation
- no contrast media required
- less patient prep
- better detection of small calculi
certain salts of barium are poisonous to humans, so barium contrast studies require this for human consumption
pure sulfate salt of barium
a cholecystocholagiogram is a radiographic exam of what
both gallbladder and biliary ducts
surgical removal of the gallbladder
cholecystectomy
condition of having gallstones
cholelithiasis
what are the 4 advantages or unique features and capabilities of digital fluoroscopy over conventional fluoroscopic recording systems
- optional post fluoroscopy overhead images
- multiple frames formatting and multiple original images
- cine loop capability
- image enhancement and manipulation
difficulty in swallowing
dysphagia
benign or malignant tumors
neoplasm
most common form is adenocarcinoma
carcinoma of esophagus
narrowing of the biliary ducts
biliary stenosis
what are the 7 major components of the alimentary canal
- mouth
- pharynx
- esophagus
- stomach
- small intestine
- large intestine
- anus
what are the 4 accessory organs of digestion
- liver
- gall bladder
- pancreas
- salivary glands
what are the 3 primary functions of the digestive system
- ingestion and digestion of food
- absorption of digested food particles
- elimination of solid waste products
which term describes the radiographic study of the distal esophagus, stomach, and duodenum
upper gastrointestinal (UGI) series/ upper GI
what is the act of swallowing called
deglutition
what are the 3 divisions of the pharynx
- nasopharynx
- oropharynx
- laryngopharynx
what structures create the two indentations seen along the lateral border of the esophagus
- aortic arch
- left primary bronchus
what 3 structures pass through the diaphragm
- esophagus
- inferior vena cava
- aorta
blind outpouching of the mucosal wall
diverticula
what term describes the junction between the duodenum and jejunum
duodenojejunal flexure
synonymous with gastric or duodenal ulcer
peptic ulcer
what type of structures are the c-loop of the duodenum and pancreas in relation to the peritoneum
retroperitoneal
how does the body of the stomach curve from the fundus
inferiorly and anteriorly
what are the 3 main subdivisions of the stomach
- fundus
- body
- pylorus
portion of stomach protruding through the diaphragmatic opening
hiatal hernia
speckled appearance of gastric mucus on radiograph
gastritis
the pyloric portion of the stomach is divided into these two parts
- pyloric antrum
- pyloric canal
what is another term for mucosal folds of the stomach
rugae
what are the two anatomic structures implicated in the phrase “romance of the abdomen”
- head of pancreas
- c-loop of duodenum
gastric bubble above diaphragm on radiograph
hiatal hernia
this includes movements of the entire gastrointestinal (GI) tract
mechanical digestion
which specific structure of the GI system is affected by hypertrophic pyloric stenosis (HPS)
antral muscle at the orifice of the pylorus
stomach contents are churned into a semifluid mass called what
chyme
what are the 3 groups of food that are ingested and must be chemically digested
- carbohydrates
- protein
- lipids (fats)
biologic catalysts that speed up the process of digestion are called what
enzymes
esophagography usually begins with fluoroscopy with the patient in which position
erect
what are the 4 radiographic tests that may be performed to detect signs of GERD
- breathing exercises
- water test
- compression (paddle) technique
- toe-touch maneuver
what position is the patient usually placed during the water test
slight LPO
what is the suggested dose of barium sulfate for an upper GI on a nerborn-1 year old
2-4 oz
what is the end product of digestion of carbohydrates
simple sugars
what is the suggested dosage of barium for an upper GI on a 3-10 year old
6-12 oz
what is the end product of digestion of protein
amino acid
what is the name of the liquid substance that aids in digestion, is manufactured in the liver, and is stored in the gallbladder
bile
what is the suggested dosage of barium for an upper GI on a child older than 10 years old
12-16 oz
what type of fluoroscopy generator is recommended for pediatric procedures
pulsed, grid-controlled fluoroscopy
how does bile assist in emulsification of fat
large droplets are broken down to small fat droplets which have greater surface area and give enzymes greater access for breakdown of lipids
where does absorption of nutrients primarily take place at
small intestine
why is the RAO preferred rather than the LAO for esophagography
places esophagus between vertebral column and heart
some substances are absorbed through the lining of what
stomach
how much rotation of the body is required for the RAO position during an upper GI on a sthenic patient
40-70 degrees
what is the purpose of the PA axial projection for the hypersthenic patient during an upper GI
prevent superimposition of the pylorus over the duodenal bulb and visualize the lesser and greater curvature of stomach better
which of the 3 primary food substances does the digestion begin in the mouth
carbohydrate
what projection during an upper GI will best demonstrate the retrogastric space
lateral
when should respiration be suspended for upper GI radiographs
expiration
any residues of digestion or unabsorbed digestive products are eliminated from this as a component of feces
large intestine
peristalsis is an example of which type of digestion
mechanical
what term describes food after it is mixed with gastric secretions in the stomach
chyme
a high and transverse stomach would be found in what type of patient
hypersthenic
what procedure should be performed to rule out a hiatal hernia
upper GI series
how are most foreign bodies of the esophagus located and removed today
endoscopy
where would you center your CR on an asthenic patient post upper GI on an 11x14 IR
L3-L4 about 1.5-2” above iliac crest
a j-shaped stomach that is more vertical and lower in the abdomen, with the duodenal bulb at the level of L3-L4 would be found on which type of patient
hyposthenic/asthenic
in an erect position, how much will abdominal organs drop on average
1-2” (2.5-5 cm)
if a PA projection during an upper GI series of an infant shows the body and pylorus of stomach superimposed what must be done to fix the repeat
angle CR 20-25 degrees cephalad
what projection during the upper GI series demonstrates possible gastric diverticulum in the posterior aspect of fundus
lateral
what two GI organs are most dramatically affected, in relation to location, by body habitus
- stomach
- gallbladder
would the fundus be more superior or inferior during deep inhalation
inferior
what types of mechanical digestion occur in the pharynx
deglutition
what types of mechanical digestion occur int he esopagus
- deglutition
- peristalsis
what types of mechanical digestion occur in the stomach
- peristalsis
- mixing
what types of mechanical digestion occur in the small intestines
- peristalsis
- rhythmic segmentation
what is another term for a negative contrast medium
radiolucent contrast medium
what substance is most commonly ingested to produce carbon dioxide gas as a negative contrast medium for GI studies
magnesium or calcium citrate
what is the most common form of positive contrast medium used for studies of the GI system
barium sulfate
what type of mixture is barium sulfate
colloidal suspension
what is the ratio of water to barium for a thin mixture of barium sulfate
1:1
what is the chemical symbol for barium sulfate
BaSO4
when is the use of barium sulfate contraindicated
when mixture may escape into peritoneal cavity
what patient condition prevents the use of a water-soluble contrast medium for an upper GI series
sensitivity to iodine
which 3 pairs of salivary glands are accessory organs of digestion associated with the mouth
- parotid
- sublingual
- submandibular
replacement of normal squamous epithelium with columnar epithelium
Barrett esophagus
what is the major advantage for using a double-contrast medium technique for esophagogastric and upper GI series
- better coating and visibility of the mucosa
- polyps, diverticula, and ulcers are better demonstated
what is the purpose of the gas with a double-contrast media technqiue
forces barium sulfate against the mucosa for better coating
what device (found beneath the radiographic table when correctly positioned) greatly reduces exposure to the technologist from the fluoroscopic x-ray tube
bucky slot shield
its presence indicates a possible sliding hiatal hernia on a radiograph
Schatzki’s ring
how is the bucky slot shield activated or placed in its correct position for fluoroscopy
slid all the way to one end
what is the minimum level of protective apron worn during fluoro
0.5mm Pb/Eq
what is the major benefit of using a compression paddle during an upper GI study
reduces exposure to arms and hands of the fluoroscopist
what are the 3 cardinal principles of radiation protection
- time
- distance
- shielding
which region of the GI tract is better visualized when the radiologist uses a compression paddle during esophagography
esophagogastric junction
which cardinal principle is most effective in reducing exposure to the tech during a fluoroscopic procedure
distance
common site for impaction, or lodging, of gallstones
duodenal papilla
which capability on most digital fluoroscopy systems demonstrates a dynamic flow of contrast media through the GI tract
cine loop capability
inflammation of lining of stomach
gastritis
undigested material trapped in stomach
bezoar
only 5% of ulcers lead to this condition
perforating ulcer
may be secondary to cirrhosis of the liver
esophageal varices
stricture of esophagus on radiograph
achalasia
enlarged recess in proximal esophagus on radiograph
Zenker’s diverticulum
which imaging modality is most effective in diagnosing hypertrophic pyloric stenosis (HPS) while reducing dose to the patient
ultrasound
what does NPO stand for and mean
non per os; nothing by mouth
patients must be NPO for what study
upper GI
what materials may be used for swallowing to aid in diagnosis of radiolucent foreign bodies in the esophagus
- barium soaked cotton balls
- barium pills
- marshmellows followed with thin barium
what type of contrast medium should be used if the patient has a history of bowel perforation
water-soluble iodinated contrast
what is the minimum amount of time that the patient should be NPO before an upper GI
8 hours
why should cigarette use and gum chewing be restricted before an upper GI
they increase gastric secretions
what hand does the patient usually hold the barium cup with during the start of an upper GI
left hand
what is the suggested dosage of barium for an upper GI on a 1-3 year old
4-6 oz
what optional position should be performed to demonstrate the mid-to-upper esophagus located between the shoulders
optional swimmers lateral
what is the average kVp range for esophagography and an upper GI when using barium sulfate (single contrast)
110-125 kVp
which aspects of the upper GI tract will be filled with barium in the PA projection (prone)
body and pylorus of stomach and duodenal bulb
what is the recommended kVp range for a double-contrast upper GI projection
90-100 kVp
what position does the upper GI series usually begin with the patient and table in
erect
what are the 5 most common routine projections for an upper GI series
- RAO
- PA
- R lateral
- LPO
- AP
the major parts of the stomach on an average patient are usually confined to which abdominal quadrant
LUQ
most of the duodenum is usually found to which side of the midline on a sthenic patient
right
if the fundus of the stomach is filled with barium is the projection AP or PA
AP (supine)
what radiographic study should be performed to demonstrated bezoar
upper GI study
if the RAO projection during esophagography shows the esophagus superimposed over the vertebral column what is the problem
under-rotation
what part of the upper GI tract is a common site for ulcer disease
duodenal bulb or cap
inflammation of the gallbladder
cholecystitis
also called cardiospasm
achalasia
double-contrast upper GI is recommended for this type of tumor
gastric carcinoma
irregular filling defect within stomach on radiograph
gastric carcinoma
what modality is an alterative to esophagography in detecting esophageal varices
endoscopy
what are the 3 most common routine projections for esophagography
- RAO
- L lateral
- AP
for an RAO projection during upper GI, do hypersthenic patients need more or less rotation in order to see the duodenal bulb in profile
more (70 degrees)
what position during an upper GI will cause the fundus to be filled with barium, but the duodenal bulb to be air filled and seen in profile
LPO (supine)
what imaging modality is most effective in diagnosing hemochromatosis
MRI (abnormal iron deposits in the liver parenchyma)
the speed with which barium sulfate passes through the GI tract is called what
gastric motility
large outpouching of the esophagus
Zenker diverticulum
“lucent-halo” sign during upper GI on radiograph
ulcers
which procedure is often performed to detect early signs of GERD
endoscopy
a breathing technique in which the patient takes in a deep breath and bears down is called what
valsalva maneuver
what are gastric emptying studies performed using
radionuclides
how much rotation of the body should be used for the RAO projection of the esophagus
35-40 degrees
which aspect of the GI tract is best demonstrated with an RAO position during an upper GI
pylorus and c-loop of duodenum
what CR angle is required for the PA axial projection for a hypersthenic patient during an upper GI
35-45 degrees cephalad
may lead to esophagitis
gastroesophageal reflux disease (GERD)
“wormlike” appearance of esophagus on radiograph
esophageal varices
other than esophagography what other imaging modality is ideal to demonstrate Barrett esophagus
nuclear medicine
which of the following devices on a digital fluoroscopy system convers the analog into a digital signal
CCD - charge coupled device
enlargement or narrowing of the biliary ducts because of the presence of stones
choledocholithiasis
blood in vomit
hematemesis
