Ch.17 Lesson 3 Anatomy and Procedures of the large Intestine Flashcards
Begins at junction of small intestine and ends at anus
Large Intestine
Forms an arch around the loops of small intestine
Large intestine
Four main parts of the large intestine
*cecum
*colon
* rectum
*anal canal
How long is the large intestine
approx five feet long
series of pouches along large intestine
Haustra
Muscular bands that form haustra
Taeniae coli
Pouchlike portion below the junction of the ileum and colon
cecum
What side is the ascending on
Right side
What is the right cotic AKA
Hepatic cotic flexture
what is the left cotic AKA
Splenic cotic flexture
Which cotic flexure sits higher?
The left
Vermiform appendix attched to:
posteromdedial side of cecum
Colon has four portions:
*ascending
*transverse
*descending
*sigmoid
Sharp angle at ascending and transverse
Right colic flecture
sharp angle at junction of transverse and descending
left colic flexure
Forms S shaped loop and ends at rectum at level of third sacral segmant
sigmoid portion
Rectum extends from:
sigmoid to anal canal
Anal canal terminates at the:
Anus
Function of the large intestine :
- reabsorption of fluids
- elimination of waste products
examination methods for large intestine
Single contrast
double contrast
why is air needed for large intestine
to really see the polyp if suspected
Bowel cleansing methods
*complete intestinal cleansing kit
*Gi lavage
*cleansing enema
For Large intestine why must the pt. be completely emptied
Retained fecal matter can simulate small masses
What also may be used for Air
Carbon dioxide
*more rapidly absorbed
what temperature should the suspension be
should be lower than body temperature
85degrees to 90 degrees F
*can cause injury if too warm
*higher temperature uncomfortable for pt and decrease retention
Whose role is it to put the barium and air in the pt
Radiologist
whose role is it to tip the pt
technologist can but if having a problem go to radiologist
parts of the BE apparatus
*disposable soft plastic enema tips
*disposable enema bags
*balloon cuff (balloon inflated with air after insertion)
*special tip for double contrast to be able to insert air as well
* small tips if needed for younger pt. , or for pt that have strictures, fissures, inflamed hemorrhoids
Instruct patient on ways to minimize
discomfort during filling.
Relax abdomen
Deep oral breathing
Communicate cramping so that filling may be
slowed or stopped
what position should pt be for insertion of the enema tip
sims
Steps for enema tip insertion:
- pt on left side
*roll forward 35 to 40 degrees and rest on flexed right knee above and in front of left knee
*adjust height of bag
*expose anal region
*run barium into basin to remove air from tubing
*lubricate enema tip
*instruct pt to take deep breaths
how high should the bag be hung
18-24 inches
how far should the tip go in
no more than four inches
if barium is in the fundus how is the pt positioned
AP
if air is in the pyloric how is the pt positioned
Supine
what is the cecum connected to
ascending
roles of technologist during enema
*be control of the clamp
* watch the tubing
*assist radiologist as needed
* help pt position
when removing enema tube what should be done first
**deflate the balloon!!
*you can also put the bag on the floor below pt to release some of the barium so its less tension for pt before going to the bathroom
After pt evacuates stool what do you do next
another radiograph is taken to check mucosa
if evacuation is inadequate at the end, what might help
pt may be given a hot beverage for stimulation
what type of system is the contrast BE
Closed system
essential projections for large intestine
PA
PA axial
PA oblique (RAO or LAO)
Lateral
AP
AP axial
AP oblique projections for large intestine
RPO or LPO
AP or PA essential projections for large intestine
right lateral decubitus position
left lateral decubitus position
why does the right clic flexure usually sitting lower than the left
bc of the liver
CR for PA or AP large intestine
perp to center of IR
enters MSP at level of iliac crest
part position for AP or PA large intestine
MSP centered to midline
IR centered at level of iliac crests
criteria for AP/PA large intestine
*No rotation
* Vertebral column centered so that ascending
and descending portions included
* Entire colon, including flexures and rectum
* 2 IRs may be needed for tall or hypersthenic
patients
* Exposure technique that shows the anatomy
pt position for PA axial large intestine
prone
part position for PA axial large intestine
MSP in midline
IR at level of iliac crests
cr for pa axial large intestine
angled 30 to 40 degrees caudad
enters msp at level of anterior superior iliac spine
criteria for PA axial large intestine
*No rotation
* Rectosigmoid area centered
* Rectosigmoid demonstrated with less
superimposition than PA
* Transverse colon and flexures not
necessarily included
what is the PA axial large intestine view for
rectosigmoid area
patient position for ap axial large intestine
supine
part position for ap axial large intestine
*msp aligned to midline of grid
*IR centered to 2 inches below iliac crests
cr for ap axial large intestin
angle 30 to 40 degrees cephalic
criteria for ap axial large intestine
*Rectosigmoid area centered
* Rectosigmoid area with less superimposition
than in AP because of CR angle
* Transverse colon and flexures not
necessarily included
*Exposure technique that shows the anatomy
patient position for PA oblique large intestine
*35 to 45 degrees RAO or LAO
Which oblique best demonstrates right colic flexure, ascending colon and sigmoid
RAO
which oblique best demonstrates the left colic flexure and descending colon
LAO
part position for PA oblique large intestine
Supported by flexed
knee and arm of
elevated side
MSP centered to
midline
IR centered to level of
iliac crests
CR for PA oblique large intestine
Perpendicular to IR
Enters 1 to 2 inches
(2.5 to 5 cm) lateral to
midline of body on
elevated side at level
of iliac crests
criteria for PA oblique large intestine
RAO
Entire colon
Right colic flexure
with less
superimposition
than PA
Ascending colon,
cecum, and
sigmoid colon
criteria for PA oblique large intestine
LAO
Entire colon
Left colic flexure
with less
superimposition
than PA
Descending colon
Patient position for AP oblique large intestine
35 to 45 degrees LPO or RPO
which oblique demonstrates right colic flexure and ascending and sigmoid colon
LPO
Which oblique demonstrates left colic flexure and descending colon
RPO
part position for AP oblique large intestine
MSP centered to midline
Sponge supporting elevated side
Dependent knee flexed for support
IR centered to level of iliac crests
CR for AP oblique large intestine
Perpendicular to IR
Enters patient 1 to 2 inches (2.5 to 5 cm) lateral to
midline of MSP on elevated side at level of iliac
crests
Criteria for LPO large intestine
Entire colon
Right colic flexure less superimposed or open as
compared with AP
Ascending colon, cecum, and sigmoid colon
Criteria for RPO large intestine
Entire colon
Left colic flexure and descending colon
CR for for lateral large intestine
perp to IR
enters MCP at level of ASIS
what position must the pt be in for cross table rectum
prone
criteria for lateral large intestine
Rectosigmoid area in
center
Superimposed hips
and femurs
Superior portion of
colon not necessarily
included when
rectosigmoid of
primary interest
for double contrast studies for right or left lateral decubitus what is the side of interest
air or side “up”
what decubitus position demonstrates medial side of ascending colon and lateral side of descending colon
right lateral decubitus
what decubitus position demonstrates lateral side of ascending colon and medial side of descending colon
left lateral decubitus
CR for AP/PA large intestin R or LF lateral decubitus
Horizontal and perpendicular to IR
Enters midline of body at level of iliac crests
part position for AP/PA Large Intestine
Right or Left Lateral Decubitus
Body elevated on
radiolucent support
to center MSP to
midline of grid
IR centered to level
of iliac crests
patient position for AP/PA Large Intestine
Right or Left Lateral Decubitus
Recumbent lateral
Back or abdomen in
contact with grid
criteria for Left/Right Lateral Decubitus Position
Large Intestine
Area from the left colic flexure to the rectum
No rotation; evidenced by symmetry of the
ribs and pelvis
Single-contrast: barium penetrated
Double-contrast: air side of interest and
should not be overpenetrated