Chapter 13 BE Flashcards
Ileus
obstruction of the small intestine
Mechanical Ileus
physical blockage of the bowel. May be due to a tumor, adhesions or hernias
Paralytic/Adynamic Ileus
due to cessation of peristalsis- Without these wave-like contractions, the bowel is unable to propel its contents forward.
Causes may be due to infections (peritonitis, appendicitis), presence of certain drugs or a post-surgical complication.
Volvulus
twisting of apportion of the intestine on its own mesentary. Blood supply to the twisted portion is compromised leading to obstruction and necrosis. Most commonly found in the cecum and sigmoid colon
Intussesception
telescoping of one part of the bowel into another. Often seen in infants
Colitis
inflammatory condition of the large intestine- May be caused by many factors including bacterial infection, diet, stress and other environmental conditions
Ulcerative Colitis
severe form of colitis
Chronic condition often leading to coin-like ulcers developing within the mucosal wall
Diverticulitis
Diverticulae (outpouching of the mucosal wall resulting from a herniation of the inner wall of the colon) have become infected
May develop peritonitis if the diverticulum perforates through the mucosal wall
Neoplasm
New growth.
A tumor that may be either benign or malignant
Melena
black tarry stools
Stoma
the opening (mouth) from the bowel to the outside of the body
Malabsorption Syndrome
conditions where the patient’s GI tract is unable to process and absorb certain nutrients
Colostomy
a stoma is surgically created to the abdominal wall to allow drainage of the bowel contents into a closed pouch hung outside the body
Congenital Megacolon
Hirshsprung’s
absence of neurons in the bowel wall prevents the normal relaxation of the colon and subsequent peristalsis which results in gross dilation to the point of narrowing and constriction
Enteritis
inflammation of the small bowel
Crohn’s Disease (Regional Enteritis)
chronic inflammatory disease. Typically located in the lower ileum but may be anywhere in the bowel (string sign)
Gastroenteritis
inflammation of the stomach and small bowel
Appendicitis
inflammation of the vermiform process
Small Bowel
15-23 feet
centrally located
Duodenum, Jejunum, & Ileum
Duodenum
shortest, widest, and most fixed part of small intestine.
Located mostly in RUQ and part in LUQ
1/5th of small bowel
Jejunum
2/5 of small bowel
Starts at duodenjejunal junction located in LUQ under the transverse colon.
springy, tight, circular folds with feathery appearance called plicae circulares.
Ileum
located some in RUQ and mostly in LLQ, and RLQ.
3/5 of small bowel
Terminal ileum joins large intestine at Ileocecal valve in RLQ
Ileum is smoother and less feathery appearance than jejunum.
ileum smaller than other small bowel.
Ileocecal valve is sphincter which controls dumping of it’s contents into cecum. Also prevents reflux
Large Intestine
larger diameter than small intestine
3 muscular bands called taeniae coli which pull colon up like drapes or pouches called Haustra.
Most of large intestine except for rectum possesses haustra.
Large intestine vs Colon
not synonymous
Large intestine consists of cecum, colon, rectum, and anal canal.
Colon consists of ascending colon, right hepatic flexure, transverse colon, left splenic flexure, descending colon, and sigmoid colon.
Cecum
large pouch located inferior to Ileocecal valve
free floating and very movable
appendix is attached to it
Colon:
Ascending Colon
part that ascends towards the liver and ends at the hepatic flexure
Colon:
Transverse Colon
located transverse or horizontal from right hepatic flexure to left splenic flexure
Colon:
Descending Colon
located from left splenic flexure and travels down to sigmoid colon
Colon:
Sigmoid Colon
last part of colon which turns into rectum
Rectum
goes from sigmoid to anus
4.5 inches long
Anal Canal
final 1.5 inches of intestine which terminates at the anus.
Rectal Ampulla
dilated portion of rectum
located anterior to coccyx
initial direction of rectum along sacrum is inferior and posterior
rectal ampulla changes direction to inferior and anterior and once again to inferior and posterior
therefore rectum has two anteroposterior curves.
Barium distribution in large intestine
Supine: Ascending, Descending, & some aspects of Sigmoid colon are barium filled. Transverse and loops of Sigmoid colon are air filled.
Prone: Air rises to rectum, Ascending colon, and Descending colon. Barium fills Transverse and parts of Sigmoid colon.
Functions of Small Intestines
Mostly digestion, absorption and reabsorption
Small Intestine Digestion: Chemical and Mechanical
Duodenum and jejunum (primarily): Absorption of nutrients, H2O, salts, and proteins. Reabsorption of H2O and salts
Functions of Large Intestines
mostly does elimination of fecal matter
Some reabsorption of H2O and inorganic salts, vitamins B & K, and amino acids.
Produced by bacterial action the release of gases (flatus)
Digestive movements of small intestine
Peristalsis and rhythmic segmentation.
Barium propels from the stomach and reaches the Ileocecal valve in about 2-3 hours.
Digestive movements of large intestine
peristalsis, haustral churning, mass peristalsis, and defecation.
SBFT or small bowel follow through
studies form and function of small bowel system. Must be timed to check the function
Contraindications: perforated bowel & bowel obstructions, pregnancy. Should not be done on pregnant women unless absolutely necessary and most likely a limited study would be performed.
SBFT Procedure
Pt. should have NPO for at least 8 hrs.
Prelim- scout film of stomach & small bowel (chabdomen)
2 cups of barium (timed start)
15-30 min.
1 hr
1.5 hr
2 hr
If barium has reached Ileocecal valve, fluoro is performed and spot films taken
Pt. sent home with post small bowel directions
Pt. is encouraged to walk halls during process to get bowels to move barium better. May be encouraged to drink 1-2 glasses of water to better move barium.
If barium doesn’t reach Ileocecal valve in 2 hrs. radiologist may ask for hourly films. If process takes significant time pt. may be asked to return next day.
SBFT films taken
Mostly high abdominal films
Need to visualize stomach and small intenstines.
Films taken on 14 x 17 and often prone to push and spread out the intestines for visualizing the Ileocecal valve.
UGI w/ SBFT
still take a prelim xray before the start of the UGI.
Pt. will drink one cup of barium during the UGI and will count as one of the two SBFT cups of barium. Once the UGI is finished, give pt. other cup of barium and start your time. (check protocol from site to site may differ)
Barium Enema aka BE or Lower GI
includes both single and double contrast.
Read the Dr orders. Does it say colonoscopy or sigmoidoscopy? this could mean possible perfs. Let rad know about this.
Contraindications: perforated bowel and bowel obstructions, positive pregnancy as well. If pt is pregnant this procedure should not be done.
Single Contrast BE
Thinner barium mixture
Pt. prep: laxatives to cleanout pt and make large intestine free of fecal matter
Few contraindications of prep include severe diarrhea, gross bleeding (blood in stool appears as black tar), bowel obstruction, and appendicitis.
NPO
Tap water enema may also be another prep used to fully clean out pt before exam.
Perform KUB and show Rad. give Rad pt. history. Rad may decide to change to dbl. contrast.
BE prep
First take Patient History and explain exam before you do anything with patient. Perform KUB and show Rad they will make final decision on single or double contrast. Prepare everything ready to use. Correct barium bag mixed or poured into bag have the tip ready lubricant ready trash can F or compression paddle gloves towels, washcloths, extra gowns lead shields & films overhead tube set in park and console ready for fluoro with pt. information. Bucky tray down by feet footboard attached extra clamps for enema bag Barium boat if needed
BE
Single contrast needs single contrast bag of barium which is often a powder in the bag that you add water and mix.
Little red ball in end of bag once released opens the flow of barium into tube
Have this clamped off and ready.
Mix barium with warm H2O 2200-2500cc’s about 2/3 to 3/4 of the bag full.
On single contrast there is only one extra tube to hook the balloon inflation device. Double has two one for balloon inflation and one for air.
Once barium is mixed let flow through tube until it reaches the tip and clamp off, hang on IV pole.
Check the balloon on end of enema tip inflation several times before inserting. If balloon bursts inside pt. may cause possible serious perforations.
BE introduction in PT
lay pt in Sim’s position, tip patient in the hole closest to you. Make sure you are in the right location. Have pt take 3 deeps breaths and insert on 3rd expiration. Inflate the balloon and clamp everything including enema tube and balloon tube.
Single BE Exam
Put on lead, put pt. in starting position preferred by Dr. turn on fluoro and console or fluoro tube
Go get Dr. tell him pt is ready
Introduce Dr. to pt.
Doc will say go or start barium. Repeat to Rad so they know you heard them.
Once Rad is finished take your x-rays. Have Rad’s protocol ready before you start exam. Take lead off. Start patient in the position where Rad left off for ease in movement and discomfort.
Drain barium before the final postevac picture.(ildy discussed her way in lecture)
Give patient post BE orders and clean up everything
Fistula
bridge formed from one organ to another.
Single contrast study only used if patient has a fistula
Double Contrast BE
Barium is thicker & heavier.
Everything is almost identical to single contrast BE except for the use of a double contrast media and bag, double contrast enema tip, and different overheads.
Double Contrast BE bag
You will pour the already made barium from the jug into it. Barium mixture is a little less than single. 1/2 to 2/3 of the bag full.
Run the barium, close to enema tip and clamp off.
Attach the air pumper (usually royal blue bulb) into the other tube hooked to the barium tip.
Small Bowel Films
Chabdomens
High abdomen to include the stomach on first shot. 14 x 17 lengthwise. Abdomen shots after the first will center over the small bowel and may need to move further down as barium moves.
Mostly done prone but can be done supine.
100-120 kVp
Don’t forget to chart start time and follow up pic times in case another tech has to finish exam.
BE’s Single and Double
Single kVp at 100-120
Double kVp at 80-90
BE films
AP/PA 14 x 17 CR to Iliac Crest like KUB
LPO/RPO 45 degree obliques 14 x 17 CR one inch upside of midsagital plane to include splenic flexure. May need 2 shots.
Left Lateral Recturm Single Contrast ONLY
10 x 12 with pt in a left lateral position CR between ASIS and Sacrum. Bottom of film where tube enter anus. Include anus, rectur, sigmoid. Not looking for Air levels. IR in bucky.
Prone (Ventral)Rectum Decubitis X-table 10 x 12 with a grid. Same centering as L. Lateral Rectum. Mark side closest to film. CR between ASIS and Sacrum. Some sites require Dorsal (Supine) Rectum Decubitis.
Double BE films
Right Lateral Decubitus 14 x 17 w/grid. Pt. lying on R side on table. X-table. CR to Iliac Crest. Mark L side up and decub marker. Must include flexure and the anus. Large person might need 3-4 x’s mAs from AP/PA
Left Later Decubitus 14 x 17 w/grid. Same as R. Lat Decub. Both Right and Left Lateral Decub looking for air/fluid levels.
Must do BOTH Right and Left Lateral Decubs
BE films
Sigmoids (butterfly) Remember patient up/angle up.
Pt. face down/ angle down. 40 degree angle.
CR 2 inches below ASIS for Supine.
CR at ASIS for Prone
This view can also be done LPO & RAO to visualize Sigmoid colon better.
Duodenum
Located in RUQ & LUQ
1/5 of small intestines
Jejunum
Located in LUQ & LLQ
2/5 of small intestines
Mucosal folds called Plicae Circulares
Ileum
Located in RLQ & LLQ
3/5 of small intestines
smoother appearance than duodenum & jejunum
Location of Large Intestines
Cecum Intraperitoneal
Ascending Colon Retroperitoneal
Transverse Colon Intraperitoneal
Descending Colon Retroperitoneal
Sigmoid Colon Intraperitoneal
Upper Rectum Retroperitoneal
Lower Rectum Infraperitoneal
Cecum
Proximal end of large intestine
Widest portion of largeintestine
Rectum
Begins at S3
Follows curvature of Sacrum
Large vs Small Intestines
Large Intestine has greater internal diameter
Large Intestine have Taeniae Coli & Haustrum except Rectum
Large Intestine extend around periphery
Small Intestine is more centrally located
What parts of the Large Intestine lay more anterior in the body?
Cecum
Transverse Colon
Sigmoid Colon
What parts of the Large Intestine lay more posterior in the body?
Ascending Colon
Descending Colon
Rectum
Small Intestines
Perisalsis
Rhythmic Segmentation
Large Intestines
Peristalsis, Mass Peristalsis
Haustral Churning
Defecation
