Ch 15 - Esophagus & Stomach Flashcards
1
Q
What is the alimentary canal?
A
A musculomembranous tube that extends from the mouth to the anus
2
Q
What are the components of the alimentary canal?
A
Mouth, Pharynx, Esophagus, Stomach, Small Instentine and Large Intenstine
3
Q
What is the esophagus?
A
A long, muscular tube that carries food and saliva to the stomach
4
Q
What body parts does the esophagus run between?
A
Laryngopharynx and stomach
5
Q
What plane does the esophagus lie in?
A
MSP
6
Q
How big is an adult esophagus?
A
10 inches in length and 3/4 inch diameter
7
Q
At what levels does the esophagus begin and end?
A
At the level of C6 and ends at T11
8
Q
At what level does the esophagus pass through the diaphragm?
A
At T10 (esophageal hiatus)
9
Q
What is the expanded terminal end of the esophagus called?
A
Cardiac antrum
10
Q
What is the name of the junction where the esophagus meets the stomach?
A
Esophagogastric junction
11
Q
What is the name of the proximal spinchter of the esophagus?
A
Upper esophogeal sphincter
12
Q
Where does the upper esophageal spincter lie?
A
At the junction between the pharynx
13
Q
What does the upper esophageal spinchter do?
A
Prevents air from entering esophagus during respritation and can let air in when relaxed (causes burping)
14
Q
What is the stomach?
A
Dilated, sac-like portion of the digestive tract that sits between the esophagus and small intestine
15
Q
What are the 4 parts of the stomach?
A
Cardia
Fundus
Body
Pyloric Portion
16
Q
What is the cardia?
A
Section immediately surrounding the esophogeal opening
17
Q
What is the fundus?
A
Superior portion of the stomach that expands superiorly and fills the dome of the left hemidiaphragm
18
Q
What is the fundus filled with in the upright position?
A
Gas and is referred to as the gas bubble
19
Q
What is the body?
A
Begins at the level of the cardiac notch and desends from the fundus
20
Q
What does the inner lining of the body contain?
A
Rugae/folds which become smoothe when the stomach is full
21
Q
What is the pyloric portion?
A
Distal to the body and contains the pyloric antrum and canal which communicate with the duodenal bulb
22
Q
What is the right border of the stomach marked by?
A
Lesser curvature
23
Q
What is the left border of the stomach marked by?
A
Greater curvature
24
Q
What is the cardiac notch?
A
Sharp angle at the esophagogastric junction
25
How much longer is the greater curvature to the lesser curvature?
4-5 times longer
26
What is the entrance and exit of the stomach controlled by?
Spinchters
27
What is the name of the sphinter at the opening of the stomach?
Lower esophageal spincter
28
What does the lower esophageal sphinter control?
Cardiac orifice
29
What is the name of the sphinter at the exit of the stomach?
Pyloric sphincter
30
What does the pyloric sphincter control?
Pyloric orifice
31
What are the functions of the stomach?
- Serves as a storage area for food
- Breaks down food chemically and mechanically
32
What is chyme?
Chemically and mechanically altered food that leaves the stomach
33
What is peristalsis?
Contraction waves by which the digestive tube propels food contents towards the rectum
34
How many peristaltic waves occur per minute in a filled stomach?
3-4 waves per minute
35
What is the average emptying time of a normal stomach?
2-3 hours
36
What type of imaging is used for imaging alimentary canals?
Combo of fluoro and radiography
37
What is the ragiographer responsible for in a Esophogram?
- Prepping the room, equiptment and contrast media
- Readying the patient
- Obtaining patient history
- Communicating and assisting the patient
- Assisting fluroscopist
38
What are the two types of contrast media used in esophograms?
- Barium sulfate
- Water-soluble iodinated contrast
39
What are the benefits of water-soluble iodinated contrast?
They move through the GI tract quicker and clear the stomach in 1-2 hours and can be easily removed by aspiration before/after surgery
40
What are water-soluble iodinated contrast medias good at detecting?
Ulcers
41
What is the exposure time for upright esophageal images?
0.1 seconds or less
42
How does barium pass when swallowed at the end of full inspiration?
Fairly slowly
43
What happens to the rate of passage of barium is swallowed at the end of moderate inspiration?
It becomes increased
44
What happens to the rate of passage of barium swallowed at the end of full expiration?
Barium is delayed for several seconds
45
What is another term for the act of swallowing?
Deglutition
46
What is exposure time for stomach exams?
Exposure time no longer than 0.2 seconds with normal peristatalic activity and never longer than 0.5
47
At what point of respiration should stomach images be taken?
At the end of expiration
48
What type of contrast studies are used for esophogeal exams?
Full column, single contrast or double contrast procedures
49
What is a single contrast procedure?
When barium or water soluble iodinated contrast is used on its own to fill the esophogeal lumen
50
What is a double contrast procedure?
When high-density contrast and carbon dioxiode crytals are used together to full the esophogeal lumen
51
What is the patient prep needed for a esophogreal image?
No patient prep required
52
What type of barium is recommended for single contrast studies?
Low density
53
What type of barium is recommended for double contrast studies?
High density
54
What is the standard process for single contrast esophogeal exams?
- Fluoro and spot imaging exam is started with the patient in the upright position
- Fluoro exam of heart and lungs completed, with cup provided to the patient to drink at radiologist request
- AP, PA, Oblique or Lateral positions to follow
55
What is the standard procedure for a double contrast esophogeal exam?
- Carbon crystals are added to barium or given by mouth to the patient immediately beore barium suspension
- Spot images taken and delayed images take on request
- AP, PA, Oblique or Lateral positions to follow
56
What is the basic positioning for all Esophogeal images?
Patient starts in the upright positiong and then moves to recembent position
57
What oblique image is preferred for esophogeal exams?
RAO to allow for a wider and unobstructed image of the esophagus between vertebra and heart
58
How is the patient placed for an AP/PA esophagus projection?
- Patient in supine or prone position with arms above their head
- MSP centered to the grid
- Head turned slightly
59
How is the patient placed for an AP/PA Oblique esophagus projection?
- Patient placed in an RAO or LPO position at a 45 degree angle to the grid device
- For both positions, side down arm is placed at their side and side up arm placed over their head
- Elevated side is centered to the grid via a plan 2 inches lateral to the MCP
60
How is the patient placed for a Lateral esophagus projection?
- Patient placed on their side with arms forward
- MCP to the center of the grid
61
Where is the central ray for all Esophogeal positions?
Perpendicular to the midpoint of the IR at the level of T5-T6
62
What are the structures demonstrated in Esophogeal exams?
Contrast filled esophogus from the lower neck to the esophagogastric junction
63
What are the general evaluation criteria for all esophogeal exams?
- Evidence of proper collimation and side marker
- Esophagus from the lower part of the neck to the entrance of the stomach
- Esophagus filled with Barium
- Penetration of the Barium
64
What are the evaluation criteria for AP/PA Esophagus?
- Esophagus is seen through the superimposed thoracic vertebrae
- No rotation of the patient
65
What are the evaluation criteria for oblique esophagus?
Esophagus seen between the vertebrae and heart
66
What are the evaluation criteria for Lateral Esophagus?
- Proximal esophagus without superimposition from the patients arm
- Ribs poster to the vertebrae and superimposed to show no rotation
67
What are the barium administration instruction for esophogeal exams?
- Give the patient barium by spoon, cup or straw
- Ask patient to swallow several mouthfuls in rapid success and hold a mouthful
- Have patient swallow remaining bolus using different breathing instructions to show varying conditions
68
How should the barium be swallowed to show varices?
Have patient exhale and then swallow barium and avoid inspiration until exposure is made
69
How should the barium be swallowed for general esophogeal exams?
Have patient swallow the bolus on moderate inspriation
70
What are UGI tract images used to evaluate?
The distal esophagus, stomach and some of the small intestine
71
What does a gastrointestinal (GI) series include?
- A preliminary image of the abdomen to delineate the liver, spleen, etc
- A combination of fluoro and radiography after contrast to view all anatomy
72
What is the patient prep for a Gastrointestinal series?
- Patient's should be informed of the testing length and processes
- Patient NPO after midnight for 8-9 hours
- Cease use of nicotine or gum in the same window
73
How is the barium solution given for a stomach exam?
Barium sulfate mixed with water
74
What is the exposure time based on for stomach exams?
The region being image
- Peristalsis is greatest in the stomach and duodenum and slows in the distal GI tract
75
What is perstalsis affected by?
Body habitus, pathology, use of narcotics, body position and respiration
76
What are the standard imaging projections for Upper GI Series?
- RAO
- PA
- Right lateral
- LPO
- AP
77
What are the standard procedures for an Upper GI series?
- Patient in upright position
- Heart and lungs are examined fluoroscopy and abdomen checked for food and feces content
- Patient given barium and ased to drink at request
- Patient asked to drink 2-3 mouthfuls and body is manipulated to coat the stomach
- Remainder of mixture is swalled to observe filling of the stomach
78
What is being examined as part of the Upper Gi series?
- Determination of the size, shape and position of stomach
- Changing contour of stomach during peristalsis
- Filling/empyting of duodenal bulb
- Abnormal functions of esophagus, stomach or duodenum
79
Where is the duodenal bulb located in an average patient?
Near the L2 region, which is 1-2 inches above the lateral rib cage margin
80
How is the patient position for a PA stomach?
In the prone position with the IR centered midway between spine and left later border of body
81
What are the breathing instructions for PA stomach?
Respiration suspended at the end of expiration
82
Where is the central ray for PA Stomach?
Perpendicular to the center of the IR and at the level of L2 midway between the spine and left lateral border of body
83
What are the structures shown in a PA Stomach?
- A PA projection of the contour of barium filled stomach and duodenal bulb
- Pyloric canal and duodenal bulb
84
What are the general features of the stomach seen in an upright PA stomach?
Size, shape and position of the stomach, but not the unfilled fundus
85
How is the stomach seen in the prone position of the PA stomach?
Stomach moved superiorly 1-4 inches and spreading horizontally
86
What is the evaluation criteria for a PA stomach?
- Entire stomach and duodenal loop
- Stomach centered at the level of the plyoris
- No rotation
87
How is the patient positioned for a PA Oblique stomach projection - RAO position?
Patient in the prone position with left side obliqued 40-70 degrees and right arm abducted near the patients head
88
What are the breathing instructions for PA Oblique stomach?
Respiration suspended at the end of expiration
89
Where is the central ray postioned for PA Oblique stomach projection - RAO position?
Perpendicular to the center of the IR and at the level of L2 (1-2 inches above the lower rib margin) and at the midpointhalfway between the spine and lateral border of the elevated side of the body
90
What are the structures demonstrated in the PA Oblique stomach projection - RAO position?
Entire stomach and duodenal loop
91
What is the evaluation criteria for PA Oblique stomach projection - RAO position?
- Entire stomach and duodenal loop
- No superimposition of the plyorus and duodenal bulb
- Duodenal bulb and loop in profile
- Stomach centered at the level of the pylorus
92
What pathology is demonstrated in the PA Oblique stomach projection - RAO position?
Polyps and ulcers of the pylorus, duodenal bulb and C-loop
93
How is the patient position for AP Oblique stomach projection - LPO position?
Patient placed in the supine position with the right side oblique 45 degrees to the table and left arm abducted and placed near patients head.
94
What are the breathing instructions for AP Oblique stomach?
Respiration suspended on the end of expiration
95
Where is the central ray directed for AP Oblique stomach projection - LPO position?
Perpendicular to the midpoint fo the IR and at a point in the middle of the spine and left lateral margin of the abdomen at the level of a point midway between xiphoid process and lower rib margin
96
What are the structures demonstrated in AP Oblique stomach projection - LPO position?
Fundic portion of the stomach with pyloric canal and duodenal bulb not as filled with the barium
97
What pathology is demonstrated in a AP Oblique stomach projection - LPO position?
When a double contrast technique is used, air-filled pylorus and duodenal bulbs to demonstrate gastritis and ulcers
98
What is the evaluation criteria for AP Oblique stomach projection - LPO position?
- Entire stomach and duodenal loop
- Fundic portion of stomach
- No superimposition of pylorus and duodenal bulb
99
What is the patient position for a Lateral stomach?
Right or left lateral recumbent
100
What is the right lateral stomach image intended for?
- Recumbent right lateral demonstrates right retrogastric space, dupdenal loop and duodenal junction
101
What is the left lateral stomach intended for?
- Upright left lateral demonstrates left retrogastric space
102
Where is the central ray directed in the Lateral stomach?
Perpendicular to the IR with the Central ray at the level of L1/L2 for recumbent positiones and L3 for upright
103
What are the structures demonstrated in a Lateral Stomach?
Anterior and posterior aspects of the stomach, pyloric canal and duodenal bulb
104
What are the evaluation criteria for lateral stomach?
- Entire stomach and duodenal loop
- No rotation of the patient as seen by the vertebrae
- Stomach centered at the level of the pylorus
105
How is the patient positioned for AP Stomach?
Supine position with midline of the grid centered with point midway between MSP and left lateral margin of the abdomen
106
Where is the central ray positioned for the AP Stomach?
- CR centered to a level midway between the xiphoid process and lower rib margin and between spine/left lateral border of body
107
What are the structures demonstrated in AP Stomach?
A well-filled fundic portion and usually a double contrast deliniation of the body, pyloric portion and duodenum
- AP projection of the retrogastric position of duodenum and jejunum
108
What is the evaluation criteria for AP stomach?
- Entire stomach and duodenal loop
- Double contrast visualization of the gastric body, pylorus and duodenal bulb
- Retrogastric portion of the duodenum and jejunum
- Stomach centered at the level of the pylorus
- No rotation of the patient
109
How is barium distributed when patient is in the supine position?
Barium appears in the entire fundus, with air at the pyloric portion
110
How does barium appear when patient is in the prone position?
Air rises to the level of the very top fundus, while barium coats the body and pyloric portion
111
How is barium distributed with the patient erect?
Air rises to the entire fundus, while barium coats the body and pyloric portion
112
What body type is associated with a Hypersthenic patient?
Large and obese (5% of population)
113
Where is the stomach located in a Hypersthenic patient?
High and transverse
114
Where is the duodenal bulb/GB located in a Hypersthenic patient?
At the level of T11-T12
115
What body type is associated with a Sthenic body habitus?
Average body type 50% of population
116
Where is the stomach located in Sthenic patients?
Stomach and intestines are in midabdomen and slightly J shaped
117
Where is the duodenal bulb/GB located in a Sthenic patient?
At the level of L1-L2
118
What body type is associated with Hyposthenic/Asthenic body habitus?
Slender/very slender (35-10% population?
119
Where is the stomach located in a Hyposthenic/Asthenic patient?
Stomach is stretched and almost vertical in a low position
120
Where is the duodenal bulb/GB located in a Hyposthenic/Asthenic patient?
At the level of L3-L4
