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SEM II - Positioning > Contrast/digestive/GI (upper/lower) > Flashcards

Contrast/digestive/GI (upper/lower) Flashcards

0
Q

Differential absorption

A

Different materials absorb X-ray energy to differing degrees.

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1
Q

Purpose of contrast media

A

To visualize the detail of the anatomy

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2
Q

Atomic number

A

As atomic number goes up attenuation goes up.

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3
Q

Negative contrast media

A

Radiolucent
Low atomic number
Decreases attenuation of the X-ray beam
Air/carbon dioxide

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4
Q

Positive contrast media

A

Radiopaque
High atomic number
Increase attenuation of the X-ray beam
Barium sulfate/iodine

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5
Q

Negative contrast agents are rarely used alone

A

Used with:
room air
CO2
Gas crystals (fizzies)

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6
Q

Barium

A

Atomic number 56

Alimentary canal use only

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7
Q

Iodine

A

Atomic number 53

Alimentary canal use or parentarel use

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8
Q

High atomic number contrast media used because density and atomic number than surrounding human tissues such as

A

Vasculature
Kidneys
GI tract
Biliary tree

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9
Q

Barium contrast is not a solution, it is held in suspension

A

Subject to separation like a snow globe

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10
Q

Barium is used in all forms of consistencies/concentrations

A

Dependent upon application.

  • very thin = swallowing eval
  • thin = esophagus, stomach, small intestine
  • moderate = dual contrast esophagus, stomach
  • thick = large intestine
  • very thick/paste = esophagus
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11
Q

When barium can’t be used

A

Water soluble Iodinated contrast should be used if there is any chance of barium mixture escaping the peritoneal cavity, these can be reabsorbed versus barium. Barium could harden in body.

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12
Q

Contraindications to iodine

A

If there is hypersensitivity to iodine should not use water soluble iodine

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13
Q

Indications for iodine based contrast

A

When barium cannot be used, can be used for perforated viscus or bowel or for a presurgical procedures

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14
Q

Dehydration is a potential risk

A

Associated with water soluble contrast agents, especially for geriatric patients. Have patient push fluids for next 48 hours.

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15
Q

Double contrast advantage

A

Small lesions are not obscured

Mucosal lining of alimentary canal more clearly visualized.

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16
Q

Double contrast consists of

A

Barium sulfate and gas crystals

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17
Q

Contrast media is used for

A 
IVP
Cystography
Biliary studies
Vascular imaging
Myelography
Arthrography
CT scanning
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18
Q

Lower concentrations of contrast media

A

Required for bladder studies due to large amount required to fill bladder

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19
Q

Higher concentrations of contrast media

A

Used for excretory urography (IVP)

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20
Q

Non ionic contrast media is

A

Less likely to cause an adverse reaction

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21
Q

The concentration of iodine in ionic contrast media is

A

50-70%

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22
Q

The higher the concentration of iodine

A

The higher the chance of an adverse reaction

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23
Q

KVP controls

A

Both penetration and contrast

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24
Q

Low kvp delivers

A

High contrast

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25
Q

High KVP delivers

A

Low contrast

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26
Q

Parenteral

A

Into or through the skin

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27
Q

Enteral

A

Through the alimentary canal

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28
Q

Ionic

A

Charged particles/molecules

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29
Q

Non ionic

A

Neutral particles/molecules

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30
Q

High osmolarity

A

Many molecules per fluid volume

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31
Q

Low osmolarity

A

Few molecules per fluid volume.

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32
Q

Osmolality

A

The number of milliosmoleser kilogram of water

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33
Q

Osmolarity

A

The number of milliosmoleser per liter of solution

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34
Q

Osmosis

A

The movement of water to equalize solutions levels

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35
Q

Osmolality, osmolarity, osmosis

A

Water follows salt

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36
Q

Excretion

A

Normal renal function: 100% excreted within 24 hours

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37
Q

Impaired renal function

A

May take several days to excrete through bile

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38
Q

High osmolality can lead to

A 
Iodine dilution on images
Diarrhea
Hypovolemia
Dehydration
Electrolyte imbalance
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39
Q

Mouth/oral cavity/tongue/pharynx

A

Where food enters and is masticated, the beginning of digestion. Formation of bolus to the esophagus.

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40
Q

Esophagus

A

Muscular tube, collapsible- approximately 10” long.
Carries bolus from laryngopharynx to stomach.
Starts oarastaltic action.

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41
Q

Stomach

A

Expandable muscular sac responsible for the physical and chemical action of digestion.
Chemical - secretion of acid and enzymes
Mechanical - churning or peristalsis
Stores food

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42
Q

Small intestine

A

Function is digestion - breakdown from complex to simple, from bolus to molecules.
Absorbs nutrients, water soluble nutrients into the blood stream, fat soluble nutrients into lymphatic system.

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43
Q

Large intestine

A

Absorption of water and the formation and elimination of food.

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44
Q

Salivary glands

A

Function is to produce saliva. Three types:
Parotid
Submandibular
Sublingual

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45
Q

Saliva

A

Enzymes to begin carbohydrate digestion.

Forms bolus, lubricates, maintains alkaline pH in mouth.

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46
Q

Pancreas

A

Function as both an exocrine and endocrine gland.

Produces digestive enzymes and alkaline fluid (exocrine).
OR
Insulin or glucagon (endocrine).

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47
Q

Liver

A

Largest gland inside the body in the upper right quadrant.
Produces bile.
Function is digestion, metabolism, detoxification, storage, production, immunity.

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48
Q

Gall Bladder

A

Stores bile
Concentration of bile
Expels bile as needed during digestion.

Does not produce bile!

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49
Q

Bile

A

Elimination of waste pigment bilirubin.

Emulsifier - allows oil and water to mix - water based digestive enzymes are able to access and digest fatty nutrients.

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50
Q

Portal system

A

Responsible for directing blood from parts of the gastrointestinal tract to the liver. Substances absorbed in the small intestine travel first to the liver for processing before continuing to the heart.

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51
Q

Digestion

A

The breakdown from complex to simple.

From mouthful to molecule.

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52
Q

Absorption

A

The uptake of nutrients into the body which must be broken down to the level of molecules to be absorbed.

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53
Q

Metabolism

A

The conversion of nutrients into fuel

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54
Q

Alimentary canal

A

Aka digestive tract

A musculomembranous tube that extends from mouth to anus - approximately 30’ long.

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55
Q

Walls of digestive tract

A

Mucosa/mucous membrane
Submucosa
Muscularis
Serosa

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56
Q

Mucosa/mucous membrane

A

Innermost layer of digestive tract, epithelial layer - semi permeable membrane.

Barrier between body and GI tract.

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57
Q

Submucosa

A

2nd layer of digestive tract, just below the mucousa.

Contains glands, blood vessels, nerve and lymph.

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58
Q

Muscularis

A

Muscular layer of the digestive tract, 2 layers of muscles.

Circular and longitudinal.

Function is peristalsis

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59
Q

Serosa

A

Outermost layer of the digestive tract - visceral peritoneum.

Anchored to abdominal wall by mesentry.

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60
Q

Peristalsis

A

Rhythmic muscular contractions

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61
Q

Mouth

A

Where food is masticated

Chewing and the beginning of digestion.

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62
Q

Pharynx and esophagus.

A

Organs of swallowing

Pass bolus

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63
Q

Stomach

A

Where the digestive process begins

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64
Q

Small intestine

A

Digestive and absorption process. Split into three sections:
Duodenum
Jejunum
Ileum

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65
Q

Large intestine

A

Water absorption and prep for waste elimination. About5-6’ long, begins at junction of small intestine and ends at anus.

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66
Q

Anus

A

Elimination of waste

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67
Q

Mastication

A

Act of chewing

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68
Q

Buccal

A

Referring to the mouth

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69
Q

Bolus

A

Ball of chewed food matter

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70
Q

Deglutition

A

The act of swallowing.

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71
Q

Parotid salivary glands

A

Aka stenson’s duct

Largest/most superior located by mandibular ramus

Duct empties into mouth along cheek.

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72
Q

Submandibular salivary glands

A

Aka whartons duct.

Duct empties onto flow of mouth.

Located inside the mandibular angle

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73
Q

Sublingual salivary gland

A

Aka ducts of rivinus

Many small ducts along the floor of the mouth

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74
Q

Pharynx

A

Funnel shapes muscular tube 3 sections:
Naso
Oro
Laryngo

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75
Q

4 parts of stomach

A

Cardia
Fundus
Body
Pylorus

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76
Q

Cardia

A

Portion of stomach immediately surrounding the esophagus opening.

77
Q

Fundus

A

Ulterior portion of the stomach, dome shaped under the diaphragm

78
Q

Body of stomach

A

Middle, main portion of the stomach between the fundus and pylorus.

79
Q

Pylorus

A

Distal portion of the stomach, narrows into pyloric Antrum

80
Q

Lesser curvature of stomach

A

The right border of the stomach, concave curve.

81
Q

Greater curvature of stomach

A

On left border of stomach, 4-5x longer than the lesser curvature.

Convex curve.

82
Q

Gastric rugae

A

Thick layer of mucosal lining of the body of the stomach.
Numerous folds.
Blends and churns chyme.

83
Q

Ileocecal valve

A

The opening between the small and large intestine.

84
Q

Duodenum

A

Portion of the small intestine 8-10”, C shaped.

85
Q

Romance of the abdomin

A

The head of the pancreas is adjacent to the c-loop of the duodenum

86
Q

Jejunum

A

Second, smallest portion of the small bowel. Has a coiled spring like and feathery appearance when filled with barium.

87
Q

Ileum

A

The longest portion of the small bowel making up 3/5s it’s entirety.
Smallest in diameter, most distal portion of small bowel

88
Q

Ileocecal valve

A

Opening between the small and large intestine.

89
Q

Cecum

A

Pouch like portion below the junction of the ileum and colon. Approx 2.5” long and 3” in diameter.

90
Q

Vermiform appendix

A

Narrow worm like tube attached to the posteromedial side of the cecum.

91
Q

Ascending colon

A

Passes superiorly from the junction of the cecum

92
Q

Right colic (hepatic) flexure

A

The sharp angle at the ascending and transverse colon

93
Q

Transverse colon

A

Has the greatest amount of potential movement

94
Q

Left colic (splenic) flexure

A

The sharp angle at the junction of the transverse and descending colon.

95
Q

Descending colon

A

Passes inferiorly

96
Q

Sigmoid portion

A

S shaped loop and ends at the rectum at the level of the third sacral segment.

97
Q

Rectum

A

Extends from the sigmoid colon to the anal canal

98
Q

Anal canal

A

Terminates at the colon

99
Q

Haustra

A

Series of pouches along the large intestine

100
Q

Taeniae coli

A

Muscular bands that form the pouches know as the haustra

101
Q

Chole

A

Bile

102
Q

Cysto

A

Savor bladder

103
Q

Cholangi

A

Bile ducts

104
Q

Cholecyst

A

Gall bladder

105
Q

Chioledoch

A

Common bile duct

106
Q

ERCP

A

Endoscopic Retrograde Cholangiopancreatography

107
Q

Cholecystogram

A

Rad exam of gall bladder

108
Q

Cholangiogram

A

Rad exam of the biliary ducts

109
Q

Cholecystectomy

A

Surgical removal of the gallbladder

110
Q

Cholelithiasis

A

Presence of gall stones

111
Q

T-cube Cholangiogram

A

Rad exam of the biliary ducts via a surgically places removable tubing

112
Q

Peritoneum

A

Double walled serous membrane that lines the abdimo-pelvic cavity

113
Q

Omentum

A

Greater and lesser

Peritoneal folds - fatty insulating (like aprons)

114
Q

Mesentery

A

Connects and supports intestines to liver

115
Q

Biliary ducts

A

Any number of tubelike structures that carry bile. Green color do to bile stains (like the gallbladder)

116
Q

Purpose of contrast media

A

To visualize detail of anatomy. Area of interest must differ in density.

117
Q

As atomic number goes up

A

Attenuation goes up.

118
Q

Negative contrast.

A

Low atomic number, decreased attenuation of the X-ray beam.
Air
Carbon dioxide

119
Q

Positive contrast

A

High atomic number, increase attenuation of X-ray beam
Barium sulfate
Iodine

120
Q

Barium

A

High atomic number (56).
Held in suspension and subject to separation (flocculation).
Made in various consistencies/concentrations dependent on application.

121
Q

Iodine

A

High atomic number (53).

Alementary canal use and parentarel use.

122
Q

When barium cannot be used

A

Water soluble iodine is used in place, except if hypersensitive to iodine.

123
Q

Advantage of double contrast

A

Small lesions are not obscured

Mucosal lining of alimentary canal more clearly visualized.

124
Q

The concentration of iodine in ionic contrast media is

A

50-70%

125
Q

The higher concentration of iodine

A

The higher risk of adverse reaction

126
Q

KVP controls

A

Both penetration and contrast.
Low KVP delivers high contrast.
High KVP delivers low contrast.

127
Q

Parentarel

A

Into or though the skin.

128
Q

Enteral

A

Through the alimentary canal

129
Q

Ionic

A

Charged particles/molecules

130
Q

Nonionic

A

Neutral particles/molecules

131
Q

High osmolarity

A

Many molecules per fluid volume

132
Q

Low osmolarity

A

Few molecules per fluid volume.

133
Q

Osmolality

A

The number of milliosmoles per kilogram of water

134
Q

Osmolarity

A

The number of milliosmoles per liter of solution

135
Q

Osmosis

A

The movement of water to equalize solution levels

136
Q

Water follows salt

A

Water follows salt

137
Q

Excretion with normal renal function

A

100% excreted within 24 hours, minimal excretion through bile

138
Q

Excretion through impaired renal function

A

May take several days, increased excretion through bile

139
Q

Adverse reaction risk increases with

A

Ionic contrast and high osmolarity contrast

140
Q

Esophagus patient prep

A

NPO after midnight or 8 hours prior
No chewing gum
No smoking

141
Q

Different types of body habitus

A

Hyposthenic - long stomach
Sthenic - “normal”
Hypersthenic - short and fat

142
Q

Esophagus studies are preferred

A

To bed one recumbent as the varicose are better demonstrated

143
Q

Why do a scout exam?

A

To see residual barium, pre-barium comparison, success of prep

144
Q

What is seen during a RAO esophagus exam

A

Entire esophagus barium filled

Esophagus midway between spine and heart shadow

145
Q

What is seen with a lateral esophagus?

A

Entire esophagus barium filled

Esophagus midway between spine and heart shadow

146
Q

What is seen with a AP esophagus?

A

Entire barium filled esophagus

Esophagus midway between spine and heart shadow

147
Q

What is seen in a pa esophagus exam

A

Entire barium filled esophagus

Esophagus midway between spine and heart shadow

148
Q

What is seen on an LAO esophagus exam

A

Entire barium filled esophagus

Esophagus midway between spine and hilum

149
Q

Esophageal varices

A

Dilating, bulging, and twisting of veins in the distal esophagus usually due to portal hypertension which may lead to internal bleeding as veins are vulnerable to stomach acid. Cobblestone appearance.

150
Q

Schatzkis ring

A

Indicated hiatal hernia, actually the cardiac sphincter muscle above the diaphragm, normally seen below the diaphragm

151
Q

Zenkers diverticulum

A

Enlarged recess, pocket, or out pouching of the proximal esophagus

152
Q

Esophagitis

A

Caused by either infectious process or by GERD.
Infection common in those with impaired immune system.
Results in lesions along mucosa of esophagus causing filling defects.

153
Q

GERD

A

Gastroesophogeal reflux disease.

154
Q

Loss of motility

A

Uncoordinated peristalsis of the esophagus

  • Barrett’s esophagus - dilated proximal and narrowed distal esophagus
  • corkscrew esophagus - due to uncoordinated esophageal peristalsis
155
Q

Upper GI patient prep

A

NPO after midnight or 8 hours prior
No gum chewing
No smoking

156
Q

What is seen in a RAO stomach exam

A

Entire stomach and Cloop of duodenum
Barium filled body and pylorus
Air in Fundus

157
Q

CR for sthenic patient for RAO stomach

A

CR to L1-2 located 1-2” above lower lateral rib and midway between the spine and the upside mid coronal plane, 45-55* oblique

158
Q

CR for RAO stomach Asthenic patient

A

CR 2” below L2 located at lower lateral rib margin, and midway between the spine and the upside mid coronal plane, 40* oblique

159
Q

CR for RAO stomach for hypersthenic patient

A

CR to T12 located 3-4” above lower lateral rib margin, and nearer to the midsaggital plane, 70* oblique

160
Q

What is seen in a PA Stomach exam

A

Entire stomach and Cloop of duodenum, barium in body and pylorus, air in Fundus

161
Q

Central Ray for PA stomach for sthenic and hypersthenic patients

A

CR to L1, located 1-2” abover lower rib margin, and about half way between the vertebral column and mid coronal plane

162
Q

Central ray for Asthenic patient for PA stomach

A

CR to L2, located 1-2” below lower rib margin, and about half way between the vertebral column and mid coronal plane

163
Q

What is seen on a right lateral stomach exam

A

Entire stomach and duodenum
Air filled Fundus
Retrogastric space
Vertebrae in true lateral

164
Q

CR for Right Lateral Stenich patient

A

CR to L1, located 1-2” above lower rib margin and 1.5” anterior to the mid coronal plane

165
Q

CR for right lateral stomach exam for Asthenic patient

A

CRto the lower rib margin and 1.5” anterior to the mid coronal plane

166
Q

CR for right lateral stomach hypersthenic patient

A

CR to T12, located about 3-4” above lower rib margin and 1.5” anterior to the mid coronal plane

167
Q

What is seen on a LPO stomach exam?

A

Pylorus and duodenal bulb uninstructed and in profile.

Fundus willed w/barium, pylorus and duodenum air filled.

168
Q

What is seen on an AP stomach

A

Entire stomach and duodenum in full contour

Fundus and body barium filled

True AP, no rotation

169
Q

Why is an AP stomach done in recumbent supine position?

A

Trandellenburg places stress on the cardiac sphincter

170
Q

What is seen on a small bowel follow through?

A

Entire small intestine
Stomach on initial images
Timer marker on post barium images

171
Q

Banjo

A

Inflatable compression paddle with a metallic ring around the balloon to highlight area of interest.

172
Q

Bezoar

A

A mass of undigested material in the stomach. Usually hair - a trichobezoar.

173
Q

What issue on an AP or PA barium enema

A

Entire large intestine

174
Q

What is seen on a RAO barium enema

A

Entire large intestine

Right colic flexure, ascending, and sigmoid colon open

175
Q

What is seen on a LAO barium enema

A

Entire large intestine
Left colic flexure, and descending colon open
Recto-sigmoid

176
Q

What issue on a LPO barium enema

A

Entire large intestine

Right colic flexure, ascending, and sigmoid colon open

177
Q

What is seen on a RPO barium enema

A

Entire large intestine

Left colic flexure and descending colon open

178
Q

What is see on an ap axial barium enema

A

Recto-sigmoid area

Transverse and flexures are of required to be seen.

179
Q

What’s seen on a PA axial barium enema

A

Recto-sigmoid area

Transverse and flexures are not required to be seen

180
Q

What is seen on a left lateral decubutus abdomin

A 
Entire colon
No rotation of body
Supine/MSP centered
CR to level of iliac crest
Medial descending, lateral ascending best seen
181
Q

What is seen on a right lateral decubutus abdomen exam?

A 
Entire colon
No rotation of body
Spine/MSP centered
CR at level of iliac crest
Medial ascending, lateral descending best seen
182
Q

What is seen on a lateral rectum exam?

A

Recto-sigmoid centered
No rotation
Superior colon NOT SEEN

183
Q

What is seen in a ventral decubutus lateral rectum

A

Rectum air-filled
Recto-sigmoid area
No rotation

184
Q

The enema tip

A

Often removed for ventral decubutus exam to better see rectal area.
Should be the last image before getting patient to bathroom.

185
Q

Why do a post evacuation exam?

A

Check for residual barium.
To have a barium filled comparison.
Good view of mucosa.

186
Q

What is seen on a post evacuation abdomen?

A

Entire colon
Shows how much barium was evacuated from colon
Mucosa seen better than when barium filled

187
Q

Apple core

A

Sign indicative of carcinoma of the colon seen on a barium enema

188
Q

Post barium instructions

A

Drink water to help flush through barium and minimize risk of concrete colon
Mild laxative only if necessary
Call X-ray dept./doctor with and questions.

189
Q

What is the amount of KVP used for barium studies?

A

100 KVP for all barium studies.

SEM II - Positioning (5 decks)

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