Contrast/digestive/GI (upper/lower) Flashcards
0
Q
Differential absorption
A
Different materials absorb X-ray energy to differing degrees.
1
Q
Purpose of contrast media
A
To visualize the detail of the anatomy
2
Q
Atomic number
A
As atomic number goes up attenuation goes up.
3
Q
Negative contrast media
A
Radiolucent
Low atomic number
Decreases attenuation of the X-ray beam
Air/carbon dioxide
4
Q
Positive contrast media
A
Radiopaque
High atomic number
Increase attenuation of the X-ray beam
Barium sulfate/iodine
5
Q
Negative contrast agents are rarely used alone
A
Used with:
room air
CO2
Gas crystals (fizzies)
6
Q
Barium
A
Atomic number 56
Alimentary canal use only
7
Q
Iodine
A
Atomic number 53
Alimentary canal use or parentarel use
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
9
Q
Barium contrast is not a solution, it is held in suspension
A
Subject to separation like a snow globe
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
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.
12
Q
Contraindications to iodine
A
If there is hypersensitivity to iodine should not use water soluble iodine
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
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.
15
Q
Double contrast advantage
A
Small lesions are not obscured
Mucosal lining of alimentary canal more clearly visualized.
16
Q
Double contrast consists of
A
Barium sulfate and gas crystals
17
Q
Contrast media is used for
A
IVP Cystography Biliary studies Vascular imaging Myelography Arthrography CT scanning
18
Q
Lower concentrations of contrast media
A
Required for bladder studies due to large amount required to fill bladder
19
Q
Higher concentrations of contrast media
A
Used for excretory urography (IVP)
20
Q
Non ionic contrast media is
A
Less likely to cause an adverse reaction
21
Q
The concentration of iodine in ionic contrast media is
A
50-70%
22
Q
The higher the concentration of iodine
A
The higher the chance of an adverse reaction
23
Q
KVP controls
A
Both penetration and contrast
24
Low kvp delivers
High contrast
25
High KVP delivers
Low contrast
26
Parenteral
Into or through the skin
27
Enteral
Through the alimentary canal
28
Ionic
Charged particles/molecules
29
Non ionic
Neutral particles/molecules
30
High osmolarity
Many molecules per fluid volume
31
Low osmolarity
Few molecules per fluid volume.
32
Osmolality
The number of milliosmoleser kilogram of water
33
Osmolarity
The number of milliosmoleser per liter of solution
34
Osmosis
The movement of water to equalize solutions levels
35
Osmolality, osmolarity, osmosis
Water follows salt
36
Excretion
Normal renal function: 100% excreted within 24 hours
37
Impaired renal function
May take several days to excrete through bile
38
High osmolality can lead to
```
Iodine dilution on images
Diarrhea
Hypovolemia
Dehydration
Electrolyte imbalance
```
39
Mouth/oral cavity/tongue/pharynx
Where food enters and is masticated, the beginning of digestion. Formation of bolus to the esophagus.
40
Esophagus
Muscular tube, collapsible- approximately 10" long.
Carries bolus from laryngopharynx to stomach.
Starts oarastaltic action.
41
Stomach
Expandable muscular sac responsible for the physical and chemical action of digestion.
Chemical - secretion of acid and enzymes
Mechanical - churning or peristalsis
Stores food
42
Small intestine
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.
43
Large intestine
Absorption of water and the formation and elimination of food.
44
Salivary glands
Function is to produce saliva. Three types:
Parotid
Submandibular
Sublingual
45
Saliva
Enzymes to begin carbohydrate digestion.
| Forms bolus, lubricates, maintains alkaline pH in mouth.
46
Pancreas
Function as both an exocrine and endocrine gland.
Produces digestive enzymes and alkaline fluid (exocrine).
OR
Insulin or glucagon (endocrine).
47
Liver
Largest gland inside the body in the upper right quadrant.
Produces bile.
Function is digestion, metabolism, detoxification, storage, production, immunity.
48
Gall Bladder
Stores bile
Concentration of bile
Expels bile as needed during digestion.
Does not produce bile!
49
Bile
Elimination of waste pigment bilirubin.
Emulsifier - allows oil and water to mix - water based digestive enzymes are able to access and digest fatty nutrients.
50
Portal system
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.
51
Digestion
The breakdown from complex to simple.
From mouthful to molecule.
52
Absorption
The uptake of nutrients into the body which must be broken down to the level of molecules to be absorbed.
53
Metabolism
The conversion of nutrients into fuel
54
Alimentary canal
Aka digestive tract
A musculomembranous tube that extends from mouth to anus - approximately 30' long.
55
Walls of digestive tract
Mucosa/mucous membrane
Submucosa
Muscularis
Serosa
56
Mucosa/mucous membrane
Innermost layer of digestive tract, epithelial layer - semi permeable membrane.
Barrier between body and GI tract.
57
Submucosa
2nd layer of digestive tract, just below the mucousa.
Contains glands, blood vessels, nerve and lymph.
58
Muscularis
Muscular layer of the digestive tract, 2 layers of muscles.
Circular and longitudinal.
Function is peristalsis
59
Serosa
Outermost layer of the digestive tract - visceral peritoneum.
Anchored to abdominal wall by mesentry.
60
Peristalsis
Rhythmic muscular contractions
61
Mouth
Where food is masticated
Chewing and the beginning of digestion.
62
Pharynx and esophagus.
Organs of swallowing
Pass bolus
63
Stomach
Where the digestive process begins
64
Small intestine
Digestive and absorption process. Split into three sections:
Duodenum
Jejunum
Ileum
65
Large intestine
Water absorption and prep for waste elimination. About5-6' long, begins at junction of small intestine and ends at anus.
66
Anus
Elimination of waste
67
Mastication
Act of chewing
68
Buccal
Referring to the mouth
69
Bolus
Ball of chewed food matter
70
Deglutition
The act of swallowing.
71
Parotid salivary glands
Aka stenson's duct
Largest/most superior located by mandibular ramus
Duct empties into mouth along cheek.
72
Submandibular salivary glands
Aka whartons duct.
Duct empties onto flow of mouth.
Located inside the mandibular angle
73
Sublingual salivary gland
Aka ducts of rivinus
Many small ducts along the floor of the mouth
74
Pharynx
Funnel shapes muscular tube 3 sections:
Naso
Oro
Laryngo
75
4 parts of stomach
Cardia
Fundus
Body
Pylorus
76
Cardia
Portion of stomach immediately surrounding the esophagus opening.
77
Fundus
Ulterior portion of the stomach, dome shaped under the diaphragm
78
Body of stomach
Middle, main portion of the stomach between the fundus and pylorus.
79
Pylorus
Distal portion of the stomach, narrows into pyloric Antrum
80
Lesser curvature of stomach
The right border of the stomach, concave curve.
81
Greater curvature of stomach
On left border of stomach, 4-5x longer than the lesser curvature.
Convex curve.
82
Gastric rugae
Thick layer of mucosal lining of the body of the stomach.
Numerous folds.
Blends and churns chyme.
83
Ileocecal valve
The opening between the small and large intestine.
84
Duodenum
Portion of the small intestine 8-10", C shaped.
85
Romance of the abdomin
The head of the pancreas is adjacent to the c-loop of the duodenum
86
Jejunum
Second, smallest portion of the small bowel. Has a coiled spring like and feathery appearance when filled with barium.
87
Ileum
The longest portion of the small bowel making up 3/5s it's entirety.
Smallest in diameter, most distal portion of small bowel
88
Ileocecal valve
Opening between the small and large intestine.
89
Cecum
Pouch like portion below the junction of the ileum and colon. Approx 2.5" long and 3" in diameter.
90
Vermiform appendix
Narrow worm like tube attached to the posteromedial side of the cecum.
91
Ascending colon
Passes superiorly from the junction of the cecum
92
Right colic (hepatic) flexure
The sharp angle at the ascending and transverse colon
93
Transverse colon
Has the greatest amount of potential movement
94
Left colic (splenic) flexure
The sharp angle at the junction of the transverse and descending colon.
95
Descending colon
Passes inferiorly
96
Sigmoid portion
S shaped loop and ends at the rectum at the level of the third sacral segment.
97
Rectum
Extends from the sigmoid colon to the anal canal
98
Anal canal
Terminates at the colon
99
Haustra
Series of pouches along the large intestine
100
Taeniae coli
Muscular bands that form the pouches know as the haustra
101
Chole
Bile
102
Cysto
Savor bladder
103
Cholangi
Bile ducts
104
Cholecyst
Gall bladder
105
Chioledoch
Common bile duct
106
ERCP
Endoscopic Retrograde Cholangiopancreatography
107
Cholecystogram
Rad exam of gall bladder
108
Cholangiogram
Rad exam of the biliary ducts
109
Cholecystectomy
Surgical removal of the gallbladder
110
Cholelithiasis
Presence of gall stones
111
T-cube Cholangiogram
Rad exam of the biliary ducts via a surgically places removable tubing
112
Peritoneum
Double walled serous membrane that lines the abdimo-pelvic cavity
113
Omentum
Greater and lesser
Peritoneal folds - fatty insulating (like aprons)
114
Mesentery
Connects and supports intestines to liver
115
Biliary ducts
Any number of tubelike structures that carry bile. Green color do to bile stains (like the gallbladder)
116
Purpose of contrast media
To visualize detail of anatomy. Area of interest must differ in density.
117
As atomic number goes up
Attenuation goes up.
118
Negative contrast.
Low atomic number, decreased attenuation of the X-ray beam.
Air
Carbon dioxide
119
Positive contrast
High atomic number, increase attenuation of X-ray beam
Barium sulfate
Iodine
120
Barium
High atomic number (56).
Held in suspension and subject to separation (flocculation).
Made in various consistencies/concentrations dependent on application.
121
Iodine
High atomic number (53).
| Alementary canal use and parentarel use.
122
When barium cannot be used
Water soluble iodine is used in place, except if hypersensitive to iodine.
123
Advantage of double contrast
Small lesions are not obscured
Mucosal lining of alimentary canal more clearly visualized.
124
The concentration of iodine in ionic contrast media is
50-70%
125
The higher concentration of iodine
The higher risk of adverse reaction
126
KVP controls
Both penetration and contrast.
Low KVP delivers high contrast.
High KVP delivers low contrast.
127
Parentarel
Into or though the skin.
128
Enteral
Through the alimentary canal
129
Ionic
Charged particles/molecules
130
Nonionic
Neutral particles/molecules
131
High osmolarity
Many molecules per fluid volume
132
Low osmolarity
Few molecules per fluid volume.
133
Osmolality
The number of milliosmoles per kilogram of water
134
Osmolarity
The number of milliosmoles per liter of solution
135
Osmosis
The movement of water to equalize solution levels
136
Water follows salt
Water follows salt
137
Excretion with normal renal function
100% excreted within 24 hours, minimal excretion through bile
138
Excretion through impaired renal function
May take several days, increased excretion through bile
139
Adverse reaction risk increases with
Ionic contrast and high osmolarity contrast
140
Esophagus patient prep
NPO after midnight or 8 hours prior
No chewing gum
No smoking
141
Different types of body habitus
Hyposthenic - long stomach
Sthenic - "normal"
Hypersthenic - short and fat
142
Esophagus studies are preferred
To bed one recumbent as the varicose are better demonstrated
143
Why do a scout exam?
To see residual barium, pre-barium comparison, success of prep
144
What is seen during a RAO esophagus exam
Entire esophagus barium filled
Esophagus midway between spine and heart shadow
145
What is seen with a lateral esophagus?
Entire esophagus barium filled
Esophagus midway between spine and heart shadow
146
What is seen with a AP esophagus?
Entire barium filled esophagus
Esophagus midway between spine and heart shadow
147
What is seen in a pa esophagus exam
Entire barium filled esophagus
Esophagus midway between spine and heart shadow
148
What is seen on an LAO esophagus exam
Entire barium filled esophagus
Esophagus midway between spine and hilum
149
Esophageal varices
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
Schatzkis ring
Indicated hiatal hernia, actually the cardiac sphincter muscle above the diaphragm, normally seen below the diaphragm
151
Zenkers diverticulum
Enlarged recess, pocket, or out pouching of the proximal esophagus
152
Esophagitis
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
GERD
Gastroesophogeal reflux disease.
154
Loss of motility
Uncoordinated peristalsis of the esophagus
- Barrett's esophagus - dilated proximal and narrowed distal esophagus
- corkscrew esophagus - due to uncoordinated esophageal peristalsis
155
Upper GI patient prep
NPO after midnight or 8 hours prior
No gum chewing
No smoking
156
What is seen in a RAO stomach exam
Entire stomach and Cloop of duodenum
Barium filled body and pylorus
Air in Fundus
157
CR for sthenic patient for RAO stomach
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
CR for RAO stomach Asthenic patient
CR 2" below L2 located at lower lateral rib margin, and midway between the spine and the upside mid coronal plane, 40* oblique
159
CR for RAO stomach for hypersthenic patient
CR to T12 located 3-4" above lower lateral rib margin, and nearer to the midsaggital plane, 70* oblique
160
What is seen in a PA Stomach exam
Entire stomach and Cloop of duodenum, barium in body and pylorus, air in Fundus
161
Central Ray for PA stomach for sthenic and hypersthenic patients
CR to L1, located 1-2" abover lower rib margin, and about half way between the vertebral column and mid coronal plane
162
Central ray for Asthenic patient for PA stomach
CR to L2, located 1-2" below lower rib margin, and about half way between the vertebral column and mid coronal plane
163
What is seen on a right lateral stomach exam
Entire stomach and duodenum
Air filled Fundus
Retrogastric space
Vertebrae in true lateral
164
CR for Right Lateral Stenich patient
CR to L1, located 1-2" above lower rib margin and 1.5" anterior to the mid coronal plane
165
CR for right lateral stomach exam for Asthenic patient
CRto the lower rib margin and 1.5" anterior to the mid coronal plane
166
CR for right lateral stomach hypersthenic patient
CR to T12, located about 3-4" above lower rib margin and 1.5" anterior to the mid coronal plane
167
What is seen on a LPO stomach exam?
Pylorus and duodenal bulb uninstructed and in profile.
Fundus willed w/barium, pylorus and duodenum air filled.
168
What is seen on an AP stomach
Entire stomach and duodenum in full contour
Fundus and body barium filled
True AP, no rotation
169
Why is an AP stomach done in recumbent supine position?
Trandellenburg places stress on the cardiac sphincter
170
What is seen on a small bowel follow through?
Entire small intestine
Stomach on initial images
Timer marker on post barium images
171
Banjo
Inflatable compression paddle with a metallic ring around the balloon to highlight area of interest.
172
Bezoar
A mass of undigested material in the stomach. Usually hair - a trichobezoar.
173
What issue on an AP or PA barium enema
Entire large intestine
174
What is seen on a RAO barium enema
Entire large intestine
| Right colic flexure, ascending, and sigmoid colon open
175
What is seen on a LAO barium enema
Entire large intestine
Left colic flexure, and descending colon open
Recto-sigmoid
176
What issue on a LPO barium enema
Entire large intestine
| Right colic flexure, ascending, and sigmoid colon open
177
What is seen on a RPO barium enema
Entire large intestine
| Left colic flexure and descending colon open
178
What is see on an ap axial barium enema
Recto-sigmoid area
| Transverse and flexures are of required to be seen.
179
What's seen on a PA axial barium enema
Recto-sigmoid area
| Transverse and flexures are not required to be seen
180
What is seen on a left lateral decubutus abdomin
```
Entire colon
No rotation of body
Supine/MSP centered
CR to level of iliac crest
Medial descending, lateral ascending best seen
```
181
What is seen on a right lateral decubutus abdomen exam?
```
Entire colon
No rotation of body
Spine/MSP centered
CR at level of iliac crest
Medial ascending, lateral descending best seen
```
182
What is seen on a lateral rectum exam?
Recto-sigmoid centered
No rotation
Superior colon NOT SEEN
183
What is seen in a ventral decubutus lateral rectum
Rectum air-filled
Recto-sigmoid area
No rotation
184
The enema tip
Often removed for ventral decubutus exam to better see rectal area.
Should be the last image before getting patient to bathroom.
185
Why do a post evacuation exam?
Check for residual barium.
To have a barium filled comparison.
Good view of mucosa.
186
What is seen on a post evacuation abdomen?
Entire colon
Shows how much barium was evacuated from colon
Mucosa seen better than when barium filled
187
Apple core
Sign indicative of carcinoma of the colon seen on a barium enema
188
Post barium instructions
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
What is the amount of KVP used for barium studies?
100 KVP for all barium studies.
