Chapter 12 Flashcards
Where is the liver located
RUQ, extends below the 10th rib
How much does the liver weigh?
3-4 pounds
What does the liver produce? Where is it stored? How much is produced?
Produces bile
Stored in the gallbladder
1 quart/day
How many lobes are in the liver?
2 major
2 minor
What are the two major lobes? Which is bigger?
Left and right; right is bigger
What separates the two major lobes?
Falciform ligament
What are the two minor lobes? Where are they located?
Quadrate - between the gallbladder and falciform ligament
Caudate - posterior to the quadrate lobe
What contours over the surface of the caudate lobe
Inferior vena cava
From the liver, bile travels to the _______ or directly to the _______
Gallbladder
Duodenum
What duct is formed from the right and left hepatic ducts combining
Common hepatic duct
What does the common hepatic duct turn into?
The common bile duct
The common bile duct joins the pancreatic duct before it empties into the duodenum through the:
Hepatopancreatic sphincter (sphincter of Oddi)
What percentage of people have a separate opening for the common bile duct and pancreatic duct?
40%
How long is the common bile duct?
3 in (7.5cm)
Where is the common bile duct located
Behind the superior portion of the duodenum and head of the pancreas
Where does the common bile duct empty after connecting with the pancreatic duct
Descending portion of the duodenum
What is the appoximate size of a gallbladder
3-4 in (7-10 cm) long and 1 in (3 cm) wide
What are the 3 parts of the gallbladder
Fundus
Body
Neck
What is the distal end of the gallbladder
Fundus
What is the narrow proximal end of the gallbladder and what duct does it make?
Neck; cystic duct
How much bile is stored in the gallbladder
30-40 CC’s (2-2.5 tbsp)
What is the best position to empty the gallbladder
Supine
What are the 3 functions of the gallbladder
Store bile
Concentrate bile
Contract
How is bile concentrated in the gallbladder
Removal of water - hydrolysis
When does the gallbladder contract
When fats or fatty acids are in the duodenum
What hormone causes the gallbladder to contract and the bile duct to open
Cholecystokinin (CCK)
How long is the cystic duct?
1.5 in (3-4 cm)
What is the spiral valve?
Several membranous folds along the length of the cystic duct
What does the spiral valve prevent
Distention or collapse of the cystic duct
Where is the gallbladder located for an asthenic person?
Near the iliac crest and close to the midline
What position does an asthenic person need to be in to best visualize the gallbladder
35-40 LAO (move spine away from gallbladder)
Where is the gallbladder located for a sthenic/hyposthenic person?
Between xiphoid tip and lower lateral rib margin
What position does an sthenic/hyposthenic person need to be in to best visualize the gallbladder
20-25 degree LAO
Where is the gallbladder located for a hypersthenic person?
Located high and more lateral
What position does an hypersthenic person need to be in to best visualize the gallbladder
15-20 degree LAO
What modality is the best way to visualize the gallbladder
Ultrasound
The gallbladder and biliary ducts cannot be seen on a diagnostic radiograph unless the patient has:
Contrast media
What is an OCG?
Oral cholecystogram
What are possible reasons to have an OCG?
Nausea
Heartburn
Vomitting
What forms gallstones?
Increased levels of bilirubin, calcium, or cholestrol
Who is at a greater risk of getting gallstones?
Women, especially pregnant women
When is milk calcium bile best demonstrated?
Right lateral decub
How long is the esophagus
10 in; 2 cm in diameter
Where does the esophagus start and end
Starts behind the cricoid cartilage (C5-C6)
Stops at the connection to the stomach
Where is the esophagus in relation to the spine
Anterior to the spine
What lies between the t-spine and the distal esophagus
Thoracic aorta
The esophagus and aorta switch position at:
T10
At what level does the esophagus go through the stomach
T10
What is the junction where the esophagus enters the diaphragm
Esophagogastric junction
What are the two indentations in the esophagus
Superior at the aortic arch
Inferior to that at the left primary bronchus
What is the greek term for stomach
Gaster
What is the small, circular muscle called in the esophagogastric junction
Cardiac sphincter
Where is located slighly superior to the esophagogastric junction
Cardiac notch
The opening at the distal stomach is called the:
Pyloric orifice
What are the subdivisions of the stomach
Fundus
Body (corpus)
Pyloric portion
What is the fundus of the stomach
Upper portion, often filled with a bubble of swallowed air called the gastric bubble in the erect position
Where does the body of the stomach start and end
Middle portion of the stomach; ends at with the angular notch
What are the two portions of the pyloric portion of the stomach
Pyloric antrum - located directly after the angular notch
Pyloric canal - ends at the pyloric sphincter
What is the purpose of rugae
Aid in digestion
Help to streamline fluids to the pylorus via the gastric canal
Laterally, the fundus is more ______ than the body, and the pylorus is more _______ than the body
Posterior
Posterior
What positions puts barium in the fundus
AP
LPO
What positions puts air in the fundus
PA
RAO
Erect
What is the first part of the small intestines
Duodenum
How long is the duodenum
8-10 inches
What are the 4 parts of the duodenum
Duodenal bulb or cap
Descending portion
Horizontal portion
Ascending portion
Where does the 4th part of the duodenum end
At the duodenaljejunal flexure
What ligament holds the duodenaljejunal flexure
Ligament of Treitz
What percent of the population is hypersthenic
5%
How does the stomach look in hypersthentic people
Almost transverse
How does the stomach look in asthenic/hyposthenic people?
“j” shaped, located in lower abdomen
What percent of the population is sthenic?
50%
What is radiolucent contrast and how does it show up on an image?
Negative contrast; black
What is used to produce negative contrast
Air, CO2, gas crystals
What are the crystals composed of create gas bubbles in the stomach
Calcium and magnesium citrate
What is the atomic number for barium
56
What is radiopaque contrast and how does it appear on an image?
Positive contrast; white
What is the compound formula for barium sulfate
BaSO4
Barium sulfate is mixed with water to form a:
Colloidal suspension
What is the water to barium ratio for thin barium
1:1
What is the water to barium ratio for thick barium
4:1
What contrast should be used if a perforation is suspected
Water-soluble iodinated contrast (often called Gastrografin or gastroview)
What is the difference between ionic and non-ionic contrast
Ionic breaks apart in the bloodstream
When is single vs double contrast used
Single - functions and structures
Double - Polyps, diverticula, and ulcers
What does the alimentary canal include
Oral cavity (mouth)
Pharynx
Esophagus
Stomach
Duodenum and small intestine
Large intestine
Anus
Accessory organs of the alimentary canal
Salivary glands
Pancreas
Liver
Gallbladder
Functions of the alimentary canal
Intake and digestion
Absorption
Elimination
What are the salivary glands associated with the mouth
Parotid
Submandibular
Sublingual
What is saliva composed of
99.5% water
.5% solutes or salts
How much saliva does the salivary glands produce daily
1000 to 1500mL
What are the cavities that communicate with the pharyx
Two nasal cavities
Two tympanic cavities
Oral cavity
Larynx
Esophagus
What is used to stop spasms in the abdomen
Glucagon
During swallowing, the soft palate closes off the:
Nasopharynx
During swallowing, the epiglottis is depressed to cover the:
Laryngeal opening
What type of muscle is throughout the esophagus to help with swallowing
Upper 1/3 - skeletal muscle (circular and longitudinal)
Middle 1/3 - skeletal and smooth
Lower 1/3 - smooth
Mechanical digestion that happens in the oral cavity
Mastication
Deglutition
Mechanical digestion that happens in the pharynx
Deglutition
Mechanical digestion that happens in the esophagus
Deglutition
Peristalsis (1 second for liquids; 4-8 seconds for solids)
Mechanical digestion that happens in the stomach
Mixing (chyme)
Peristalsis (2-6 hours)
Mechanical digestion that happens in the small intestine
Rhythmic segmentation (churning)
Perstalsis (3-5 hours)
What substances are ingested through chemical digestion
Carbs
Proteins
Fats
Vitamins
Minerals
Water
Substances ingested, digested, and absorbed. Where does digestion take place?
Carbs (mouth and stomach)
Proteins (stomach and small bowel)
Lipids (small bowel only)
The end products of digestion of carbs (complex sugars) is
Simple sugars
The end products of digestion of proteins
Amino acids
The end product of digestion of lipids
Fatty acids and glycerol
Substances ingested but not digested
Vitamins
Minerals
Water
Protocol for OCG
Scout film (prone)
LAO
Right lateral decub
Fluoro
Spot films
Protocol for Esophagography
RAO
Lateral
AP
Protocol for Upper GI
RAO
PA
Right lateral
LPO
AP
Breathing exercises for esophageal reflux
Valsalva maneuver - hold breath in while bearing down or pinches the nose, closes the mouth and blows out
Mueller maneuver - exhales and inhales against a closed glottis
Water test for esophageal reflux
Patient in supine position and turned up slightly on left side - fills fundus with barium
Swallow water through a straw to see if barium comes back up
Compression technique for esophageal reflux
Patient prone and the paddle is inflated as needed to put pressure on the stomach
Toe-touch maneuver for esophageal reflux
Cardiac orifice is observed as patient bends over to touch toes
Reflux and hernias are sometimes demonstrated
What is choledocholithiasis?
Stones in the bilary ducts
AP Supine - where is barium?
Fundus and pylorus
RAO - where is barium?
Body and pylorus
What two things affect contrast resolution?
Beam restriction
Grids
What does ERCP stand for?
Endoscopic retrograde cholangiopancreatogram
For an ERCP - what position is the patient?
RAO
Does negative contrast have a low or high atomic number?
Low
Does positive contrast have a low or high atomic number?
High
What is osmolarity?
Ability to draw water out of cells
What type of water-soluble contrast has a higher osmolarity (ionic or non-ionic?
Ionic
LPO - where is barium?
Fundus
RT Lat - where is barium?
Pylorus
PA - where is barium?
Body
What is extravasation?
Leakage of contrast outside the vessel
