Ch 13 small bowel Flashcards
Exam review:
AP oblique that best demonstrates hepatic flexure + ascending colon?
What is the PA oblique?
What is the CR?
AP: LPO
PA: RAO
at crest
Exam review:
What is the AP oblique that best shows splenic flexure + descending colon?
PA oblique?
AP: RPO
PA: LAO
Exam review:
Which decubitus position best shows the air the splenic flexure + descending colon?
Why?
Right lateral decub
bc splenic flexure is on the left side of the body and to see air levels we need it to be side up
Exam review:
What decubitus position best shows the air in the posterior rectum?
What decubitus position best shows the air in the anterior rectum?
Why?
Ventral decubitus
Dorsal decubitus
bc air/fluid levels move depending on gravity. In prone position, air goes posterior and barium goes anterior
Exam:
Where is the barium while the patient is PA?
Where is the air?
Why?
B: transverse & sigmoid colon
A: ascending & descending colon
Exam review:
Which decubitus position best shows the air the hepatic flexure + ascending colon?
Why?
left lateral decubitus
bc we want to see the air levels on the hepatic (right side) so we must have right side of the body up
Exam:
Where is the barium when the patient is AP?
where is the air?
Why?
B: ascending & descending colon
A: transverse & sigmoid colon
bc of gravity and the ascending & descending colon are retroperitoneal
Exam review:
Splenic flexure is located on ___ side
Ascending colon is location on ___ side
Hepatic flexure is located on ____ side
descending colon is location on ____ side
left
right
right
left
Exam:
Which aspect of the large intestine is the highest?
left colic flexure
Exam:
What part of the large intestine is the widest?
What about the small intestine?
L: cecum
S: duodenum
Exam:
where is the liver located?
where is the ascending, transverse, descending, sigmoid, rectum & anus located?
where is the duodenum, jejuneum, & ileum located?
RUQ*
Exam:
How long should the patient NPO for a barium enema?
8 hours *
Exam:
What are the contraindications for a barium enema?
perforated hollow viscus & large bowel obstruction
(water-soluble could be used for these precautions)
Exam:
When inserting the tip for a barium enema it must be on:
expiration
(relaxes the abdominal muscles)
Exam:
What position is best for a tipped insertion?
sims
Exam:
Where should you aim for when doing a barium enema insertion?
Step 5
aim tip toward umbilicus approximately 1-1/2 inches (3-4 cm)
Exam:
where is the CR for an initial small bowel study?
Where is the CR after 1-2 hours? *
Initial: 2 inches above crest
1-2hr: at crest (bc barium has made its way from the stomach to bowel)
Exam:
What does LPO best show?
Right hepatic flexure + ascending colon
Exam:
Why do we prefer to take our images in PA vs AP during a small bowel study?
compresses the small bowel to best show the loops *
Exam:
What does ventral decubitus best display?
Air in the posterior portion of the rectum
Exam:
What does LAO best show?
What is the CR?
Splenic flexure + descending colon
2 inches superior to crest + 1 inch to the right of MSP
Exam:
What does RPO best display?
Splenic flexure + descending colon
Exam:
What does right lateral best display?
Air in the splenic flexure + descending colon
(The side up)
Exam:
What does left lateral decubitus best display?
air in the hepatic flexure + ascending colon + cecum
(air in side up)
Exam:
What does RAO best display?
what is the CR?
how much oblique?
Hepatic flexure + ascending colon
CR at crest
35-45 oblique
Exam:
What does lateral rectum best show?
what positions achieve this?
what the is the CR?
demonstrates polyps, strictures, & fistulas between rectum & bladder/uterus
left lateral rectum or Ventral decubitus
CR is at ASIS
Exam:
What is the CR for AP axial & LPO oblique?
(butterfly)
What study is this for?
Do you angle the patient or the tube?
AP: supine + 30-40 cephalic + CR 2 inches inferior to ASIS
LPO: 30-40 LPO + 30-40 cephalic + 2 inches inferior & 2 inches medial to right ASIS
Barium enema
angle tube 30-40 cephalic
Exam:
What is the CR for PA axial & RAO? (butterfly)
What study is this for?
PA: prone + 30-40 caudad + CR at ASIS
RAO: 35-45 RAO + 30-40 caudad + CR at ASIS & 2 inches to left of lumbar spinous process
Exam:
Know the different positions and what is being best shown
Exam:
What is the difference between a PA and AP image?
right/left lateral?
(image will not be flipped)
PA: Barium in the transverse & sigmoid with air in the A & D colon
AP: Barium in the Ascending + descending with air in the Sigmoid + transverse
R lateral: Air in the splenic + descending barium in hepatic + ascending
L lateral: Air in the hepatic + ascending barium in the splenic + descending
Exam:
What is the butterfly projection?
What does it show?
What is the CR?
PA axial or PA axial oblique (RAO)
shows the sigmoid colon open
CR at ASIS + 30-40 caudad+ RAO (35-45 oblique)
Exam:
What is Mayo’s protocol?
why is this the reason?
left lateral decubitus
bc we want to see the space under the liver*
Exam:
What is the CR for RPO/LAO?
why?
2 inches superior to crest + 35-45 PO/AO obliques (LAO 1 inch to the right of MSP)
bc the splenic flexure is superior to the hepatic
Exam:
which flexure is always higher?
splenic flexure
(left)
Exam:
What is the CR for LPO/RAO?
RAO: crest + 1 inch to the left of MSP
LPO: crest + 1 inch to elevated side from MSP
35-45 AO/PO oblique
Exam:
what is the obliquity for PO/AO obliques?
35-45 degrees
Exam review:
The enema bag should not be higher than _____
24 inches above table (2 feet)
Exam review:
During small bowel studies how often should images be taken?
every 20-30 minutes
Exam review:
The insertion tip should not exceed _____
3-4 inches (7.5cm-10cm)
Exam:
Which part of the small intestine makes up the 3/5’s?
which part makes up the 2/5’s?
ileum
& jejunum
Exam review:
how are each of these structures in the abdomen?
Cecum:
Ascending:
Transverse:
Descending:
Sigmoid:
Upper Rectum:
Lower rectum:
intraperitoneal
retroperitoneal
intraperitoneal
retroperitoneal
intraperitoneal
retroperitoneal
infraperitoneal
(retro=behind) (intra=within) (infra= below)
Exam review:
What are the small intestines functions?
What are the large intestines functions?
digestion (chemical & mechanical)
Absorption & reabsorption (duodenum/jejunum)
some reabsorption + elimination (defecation)
Exam review:
Contraindications to laxatives?
gross bleeding
severe diarrhea
obstruction
appendicitis