Ch 12 upper GI Review Flashcards by Donovan Tompkins

Exam:
How does the stomach lie in a hypersthenic patient?
What level is the stomach, pyloric portion, & duodenal bulb?

high & transverse
Stomach: T9-T12
Pyloric portion: T11-T12
Duodenal bulb: T11-T12

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Exam:
How does the stomach lie in a hyposthenic/asthenic patient?
What level is the stomach, pyloric portion, & duodenal bulb?

low & vertical (J shaped)
Pyloric portion: L3-L4
Duodenal bulb: L3-L4

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Exam:
What is bile?

made by the liver
breaks down fats

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Exam:
How does the stomach lie in a sthenic patient?
What level is the stomach, pyloric portion, & duodenal bulb?

Normal stomach
Stomach: T10-L2
Pyloric portion: L2
Duodenal bulb: L1-L2

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Exam:
What does Cysto mean? (on the slide)

bag or sac

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Exam:
What is the CR for Upper GI RAO?
For sthenic?
Hyperstenic?
Asthenic?

40-70 degree RAO prone rotation
Sthenic: 45-55 oblique CR at L1 (duodenal bulb)
Hypersthenic: 70 degree oblique (2 inches superior to L1)
Asthenic: 40 degree oblique (2 inches inferior to L1)
(suspend respiration, expose on expiration)

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Exam:
What is the CR for Upper GI LPO?
Sthenic:
Hypersthenic:
Asthenic:
Expose on?

30-60 degree LPO supine rotation
Sthenic: 45 degree oblique at L1
Hypersthenic: 60 degree oblique 2 inches superior to L1
Asthenic: 30 degree oblique 2 inches inferior to L1
(suspend respiration, expose on expiration)

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Exam:
What is the CR for upper GI AP?
Sthenic:
Hypersthenic:
Asthenic:

Sthenic: at L1 45 LPO
Hypersthenic: 2 inches superior to L1 60 LPO
Asthenic: 2 inches inferior to L1 30 LPO
(suspend respiration, expose on expiration)

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Exam:
What is the CR for an AP/PA esophagogram?
expose on?

T5-T6
1 inches inferior to sternal angle or
3 inches inferior to jugular notch
(suspend respiration, expose on expiration)

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Exam:
What is the CR for LAO/RAO esophagogram?

35-40 degree AO prone oblique
CR: (LAO T5-T6) (RAO T6)
(2-3 inches inferior to jugular notch)

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Exam:
What does LAO esophagogram show?
What does RAO show?

LAO: esophagus is seen between hilar region & thoracic spine
RAO: Esophagus is seen between thoracic spine & heart
(entire esophagus is filled (or lined) with contrast)

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Exam:
What does angio mean?

duct

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Exam:
What is the stomach orientation?

Fundus (most posterior)
Body (anterior/inferior to fundus)
Pylorus (posterior/distal to body)

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Exam:
What does Choles mean?

relationship with bile

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Exam:
What is the CR for right lateral upper GI?
For sthenic?
Hyperstenic?
Asthenic?
what anatomy is shown?

Sthenic: L1(duodenal bulb) 1-1/2 inches anterior to midcoronal
Hypersthenic: 2 inches superior to L1
Asthenic: 2 inches inferior to L1
retrogastric space

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Exam:
What is the CR for an esophagram?

T5-T6

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Exam:
What is the order for all the ducts?
(know what it looks like on a picture)

Left & right hepatic (from liver)
Common Hepatic duct
cystic duct (duct into gallbladder)
Common bile duct
Pancreatic duct (duct of wirsung)
Duodenum (sphincter of Oddi)

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Exam:
How much do you oblique for an esophagogram?

35-40 degree anterior oblique (LAO/RAO)

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Exam:
What do you see in a lateral esophagogram?
What is the CR?

esophagus is seen between the thoracic spine and heart
T6 (2-3 inches inferior to jugular notch)

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Exam:
What do you see in a RAO esophagogram?
What is the CR?

esophagus is seen between the spine and the heart
35-40 anterior oblique + T6 (2-3 inches inferior to jugular notch)

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Exam:
What do you see in LAO esophagogram?
What is the CR?

Esophagus is seen between the hilar region & the thoracic region
35-40 degree anterior oblique + T5-T6 (2-3 inches inferior to jugular notch)

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Exam:
What do you see in a AP/PA esophagogram?
What is the CR?

Esophagus superimposed over the spine
T5-T6 (1 inch inferior to sternal angle)

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Exam:
What is the sphincter of Oddi?
Also known as?

muscle fibers of the duct walls leading into the duodenum
hepatopancreatic sphincter

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Exam:
How do you oblique for an Upper GI study?

40-70 degree anterior oblique for RAO
30-60 degree posterior oblique for LPO

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What is seen in LPO upper GI? What is the CR? For different body habitus?

entire stomach + duodenum (unobstructed view of the duodenal bulb) Sthenic: L1 + 45 degree oblique Hypersthenic: 2 inches superior to L1 + 60 posterior oblique Asthenic: 2 inches below L1 + 30-degree posterior oblique

Exam: What is seen in an RAO upper GI? What is the CR? For different body habitus?

Entire stomach + c-loop of duodenum 40-70 anterior oblique (RAO) Sthenic: L1 45-55 RAO Hypersthenic: 2 inches superior to L1 70 degrees RAO Asthenic: 2 inches inferior to L1 40-degree RAO

Exam: What is the ligament of Treitz? Where is located? Why is this important?

fibrous muscular band superior to the duodenojejunal flexure suspensory muscle of the duodenum

Exam: What is the kvp range for a double contrast exam?

90-100 kVp

Exam: What are the ionated contrasts? What else can you use this for? How does it taste & what is this an example of?

gastrogavin omnipaque visipeg pre-surgical exams bitter + water-soluble contrast

Exam: What is anterior & posterior when it comes to the trachea/esophagus?

trachea is anterior to the esophagus

Exam: Where is the esophagus located? Where does it begin & where does it end?

esophagus is located posterior to trachea & larynx From C5-C6 to T11

Exam: When you inhale diaphragm moves:

moves downwards

Exam: When you exhale diaphragm moves:

moves upwards

Exam: Where is the gallbladder located? What is its main purpose? what are the 3 parts of the gallbladder? how much bile can it hold?

inferior to the liver 1. store bile, 2. concentrate bile (Hydrolysis: removal of water) (choleliths: gallstones), 3. contract 1. Fundus, Body, Neck 30-40 mL of bile

Exam: How do we prep for an upper GI exam?

NPO 8 HRS no gum chewing ** Determine if patient is pregnant (interrogate the patient, collect a history)

Exam: What is the kvp range for a single contrast exam?

110-125 kVp (to increase visibility of barium-filled structures)

Exam review: What is the kVp range for water-soluble contrast studies?

80-90 kVp

Exam: What is the kVp range for double contrast exams?

90-100 kVp (higher contrast images without over penetrating the anatomy)

Exam: In RAO how is the esophagus anatomy positioned? What are we looking for?

esophagus is between the spine & heart

Exam: In LAO how is the esophagus anatomy positioned? What are we looking for?

esophagus is un between the spine & hilar region

Exam: What do these mean? Chole: Cysto: Angio: Choledocho: Cholangio: Cholecyst:

Relationship with bile Bag/sac duct Common bile duct bile ducts gallbladder

Exam: What do these terms mean? Cholecystography: Cholangiography: Cholecystangiography:

Radiography of gallbladder radiographic study of biliary ducts radiography of both gallbladder & biliary ducts

Exam: In LPO how is the barium in the stomach?

Barium in the fundus Air in the pylorus

Exam: In RAO how is the barium in the stomach?

Barium in the pylorus Air in the fundus

Exam: Which oblique places air in the fundus?

RAO

Exam: What oblique puts the esophagus between the heart & thoracic spine?

RAO

Exam: What oblique places barium in the pylorus of the stomach?

RAO (has to be prone)

Exam: What oblique places the esophagus in between the hilar region & thoracic spine?

LAO

Exam: What view superimposes the esophagus over the spine?

AP or (PA)

Exam: Which oblique places barium in the fundus of the stomach?

LPO (has to be supine)

Exam: Which oblique places air in the in the pylorus of the stomach?

LPO (has to be supine)

Exam: What is chymes?

semifluid mass as a result of mixing (churning) of stomach contents & stomach fluids

Exam: Where is the duct or wirsung? Also known as?

Duct leading into the pancreas Pancreatic duct

Exam: Which view of the stomach best displays the retrogastric space?

R lateral (upper GI) view (lateral)

Exam: What is swallowing called?

deglutition

Exam: What is chewing called?

Mastication

Exam: Where does barium go if the patient is lying prone? Where is the air?

barium in pylorus & air in the fundus

Exam: How does the esophagus lie in relation to the larynx? (AP or Inferior/superior)

posterior & inferior to the larynx

Exam: What is peristalsis?

involuntary muscle contractions (wavelike movements that propel solid/semisolid structures)

Exam: What is hostra?

Exam: Where is the barium going if the patient is lying supine? Why?

Fundus

Exam: What is the epiglottis? What does it do?

membrane-covered cartilage that moves down to cover the opening of the larynx during swallowing

Exam: What are the contraindications for water-soluble contrast?

if patient is sensitive to iodine (allergic) experiencing severe dehydration

Exam: How does the fundus lie in the stomach?

fundus is posterior

Exam: Barium is a:

colloidal suspension (not a solution)

Exam: Where is the cardiac notch located? also called:

medial to the fundus (superior to the esophagogastric junction) incisura cardiaca

Exam: What is rugae? where is the location?

internal lining of stomach thrown into numerus mucosal folds (when the stomach is empty) greater curvature

Exam: What helps food gets down the esophagus?

peristalsis (gravity + involuntary movement)

Exam: What is the gastric canal? Where is it located? What is its function?

canal formed by rugae along the lesser curvature funnels fluids directly from the stomach's body to the pylorus

Exam: Where is the cardiac antrum at?

distal portion of esophagus, that curves sharply into expanded portion of the esophagus (right before the esophagogastric junction)

Exam: Where is the esophagogastric junction?

aperture or opening between the esophagus and stomach

Exam review: The fundus is ___ filled

air filled

Exam: Where is the angular notch? also known as:

ring like area that separate the body and pylorus region incisura angularis

Exam: Where is the esophagogastric cardiac region? Also known as?

Exam: What is GERD?

gastroesophageal reflux disease

Exam: What is an accessory organ? What is an example?

not a digestive organ but aids in digestion salivary glands, pancreas, liver, & gallbladder

Exam: What is used to prevent scatter radiation in fluro?

Bucky slot shield (lead drape shield, exposure patterns, lead aprons)

Exam: What is the 3 cardinal rules of radiation protection: (3)

Time Shielding Distance (most crucial)

Exam: What is the C loop of the duodenum? What is inside of this area? What is it referred to as?

The head of the pancreas Called the romance of the abdomen (stomach)

Exam: What is the special name for having gallstones?

choleliths (biliary calculi)

Exam: What is best shown in a RAO stomach?

barium in the pylorus air in the fundus

Exam: What is a trichobezoar? (cool/ scary thing)

Mass of ingested hair

Exam review: What are the 3 parts of the pharynx?

Nasopharynx (nose area) Oropharynx (mouth) Laryngopharynx (throat area)

Exam 2: In which body habitus is the stomach most horizontal (transverse)?

Hypersthenic

Exam 2: What is bile a product of?

Liver (stored in the gallbladder)

Exam 2: What does Chole mean?

relation to bile

Exam 2: Where is the CR for RAO stomach on a sthenic patient?

Exam 2: Common hepatic duct & cystic duct come together to form what?

common bile duct

Exam 2: How much do you oblique for an AP oblique stomach? How much do you oblique for PA stomach?

LPO 30-60 RAO 40-70

Exam 2: The distal end of the duodenum is fixed in position because of:

the ligament of trietz

Exam 2: Esophagus begins at? Ends at the level:

C5/C6 to T11

Exam 2: Esophagus is _____ to the trachea

posterior

Exam 2: When prepping for an adult upper GI study, how long should the patient be NPO for?

8 hours

Exam 2: What is the kVp range for single contrast study? How much for double?

Single: 110-125 Double: 90-100

Exam 2: RAO position of the esophagus is preferred over LAO because it places the esophagus where?

places the esophagus between the heart & spine

Exam 2: How does LAO place the esophagus?

between the spine & hilar region

Exam 2: Once food enters the stomach and mixes with gastric secretions, it creates:

Chyme

Exam 2: Wavelike involuntary muscular contractions that propel food forward is?

peristalsis

Exam 2: What is the esophagus's location in relation to the larynx:

inferior & posterior

Exam 2: Where does barium go: Prone: Supine: RAO: LPO:

Pylorus Fundus Pylorus Fundus

Exam 2: Where is the cardiac antrum?

distal portion of esophagus that curves sharply into terminal end of esophagus (Inferior to the cardiac orifice (esophagogastric) junction)

Exam 2: When would we use water-soluble contrast?

Post-op or perforated viscus (if there is any chance that the barium mixture might escape into the peritoneal cavity)

Exam 2: What kind of suspension or solution is barium?

colloidal suspension (not a solution) (never dissolves in water)

Exam 2: What helps contrast flow downwards?

gravity

Exam 2: What is the difference between rugae & gastric canal?

Gastric canal located on lesser curvature (formed by fundus) allows for fluids to flow directly from body to pylorus

Exam 2: What are the accessory organs?

Salivary glands liver gallbladder pancreas

Exam 2: Where is the esophagogastric junction? Where is the cardiac notch? where is the cardiac antrum?

where the esophagus & stomach meet (aka cardiac orifice) superior to cardiac orifice (EG junction) inferior to cardiac orifice (EG junction)

Exam 2: Define these terms: Chole: Cysto: Angio:

Relation to bile bag or sac duct

Exam 2: What is GERD?

Gastroesophageal reflux disease

Exam 2: What do we use to reduce scatter?

bucky slot shield (lead apron + lead drape shield, exposure patterns)

Exam 2: What are the 3 cardinal rules for radiation protection?

time shielding distance (most effective)

Exam 2: What is another name for gallstones?

Choleilths

Exam 2: Where's the difference between the head and tail of the pancreas location in relation to the small bowel?

head of pancreas is located in right upper quadrant (in C-loop of duodenum) tail of pancreas is located in the left upper quadrant **

Exam 2: Where is the sphincter of Oddi located (hepatopancreatic sphincter)?

muscle fibers located near the terminal opening into the duodenum

Exam 2: What is Trichobezoar? Phytobezoar?

Mass of hair clumped up in the stomach (vegetable fibers or wood products)

Exam 2: Where should the CR be for an RAO position of the stomach on a hyposthenic patient? Hypersthenic?

2 inches inferior to L1 2 inches superior to L1

Exam 2: In double contrast what is radiopaque? what is radiolucent?

barium (positive contrast) air (negative contrast) (polyps, diverticula, & ulcers are best shown with DC)