Contrast Studies Ch. 12 Flashcards
Biliary System
Consists of Liver, Gallbladder, and Biliary Ducts
Liver
Located in right upper quadrant above right kidney & extends just below 10th rib.
Largest solid organ in the body
Weighs about 3-4 lbs.
Manufactures bile & stored in gallbladder.
Produces about a quart a day
Lobes of Liver
Two major lobes. Left lobe is smaller and is separated by falciform ligament. Right lobe is largest major lobe.
Two minor lobes-
posteriorly located is the quadrate lobe between gallbladder and falciform ligament.
Posterior to quadrate lobe is caudate lobe. Large inferior vena cava contours over surface of caudate lobe.
Right and Left Hepatic Ducts
bile travels from liver to gallbladder or directly to gallbladder by way of these ducts.
They combine to form the Common Hepatic Duct which turns into the common bile duct and joins the pancreatic duct before it empties into the duodenum through the Hepatopancreatic Duct or (sphincter of Oddi)
40% of people have a separate opening for the common bile duct meaning the pancreatic and common bile duct never connect.
Common Bile Duct
7.5 cm long. width of a drinking straw
located behind the superior portion of the duodenum and head of the pancreas.
Connects with the pancreatic duct and empties into the descending portion of the duodenum.
Gallbladder
pear shaped 7-10 cm long and 3 cm wide.
Fundus- distal end of the broad part of the sac.
Body-Main section of the sac
Neck-narrow proximal end which eventually continues to make the cystic duct.
Contains about 30-40 cc’s of bile
Gallbladder Functions
Stores Bile
Bile is concentrated by hydrolysis (removal of H2O)
Contracts when fats or fatty acids are in duodenum. These foods stimulate a duodenal mucosa to secrete a hormone called cholecystokinin (CCK)
Increased levels of CCK will cause the gallbladder to contract and bile duct to open.
CCK also causes increased exocrine activity in the pancreas.
Cystic Duct
3-4 cm long
several membranous folds along the length which are termed the spiral valve.
This valve prevents the distention or collapse of the cystic duct.
Asthenic & Hyposthenic Patient
Gallbladder located near the level of iliac crest and close to midline. 35-40 degree LAO rotation needed to move gallbladder away from spine.
Sthetic Patient
Gallbladder located between the xyphoid tip and the lower lateral rib margin. 20-25 degree LAO rotation needed to move gallbladder away from spine.
Hypersthetic Patient
Gallbladder is located high and more lateral.
15-20 degree LAO rotation needed to move gallbladder away from spine.
Neoplasms
new growths either benign or malignant (cancer)
Biliary Stenosis
narrowing of the biliary ducts
Congenital Anomalies
condition the patient acquired at birth
Choleliths
Gallstones
Choledocholithiasis
Stones in the biliary ducts
Cholelithiasis
stones in the gallbladder
can be Acute or Chronioc
Milk Calcium Bile
emulsion of biliary stones in the gallbladder. Sandlike calcification or sediment.
Oral Cholecystogram (OCG)
Contrast meduium ingested orally to exhibit gallbladder in an x-ray.
Benefits of Sonography for gallbladder
No ionizing radiation
Ability to detect small calculi that are generally not visual during an OCG
No contrast medium is required for sonography
Less patient preparation: Patient is required to have nothing by mouth (NPO) 8 hours before exam.
Patient prep required 2 or more days for an OCG
Sonography provides quick diagnosis for gallbladder disease and physician man make surgical decision in hours rather than days
Sterile Procedure
Non-sterile tech MUST stay over 18 inches away from the sterile surgical procedure.
ERCP
Endoscopic Retrograde CholangioPancreatogram
Esophagus
Muscular Canal
10 inches long & 2 cm in diameter
Starts behind the cricoid cartilage of the trachea (C5-6)
Stops at the connection to the stomach
First third is skeletal muscle
Second third is skeletal and smooth muscle
Distal third is smooth muscle
Posterior to larynx &n trachea
Anterior to Cspine & Tspine
Thoracic Aorta lies between Tspine and distal esophagus.
Upper esophagus lies between Tspine and aorta
Esophagus cont…
switches position distally
Level of T10 (Xphoid Process T9) esophagus goes through diaphragm to enter stomach at the Esophageal Junction.
actually extends to T11
Two indentations on esophagus-
first at the aortic arch and second inferior at the left bronchus.
Esophageal Junction
location at which the esophagus goes through the diaphragm to enter the stomach
Esophagogstastric Junction
where the esophagus meets the stomach. small circular muscle called the cardiac sphincter lets food and whatever else you eat into the stomach
Cardiac Notch
located slightly superior to the esophagogastric junction
Pyloric Orifice
opening at the distal stomach. muscular circle which allows food to slowly dump in the first part of the duodenum.
Greater & Lesser Curvature
Lesser Curvature located on the medial side of the stomach. Extends from the Cardiac to pyloric orifices.
Greater Curvature located on the lateral side and is 4-5 times longer than the lesser curvature. Extends from the cardiac notch to the pylorus.
Subdivisions of the stomach
Fundus: upper portion of stomach, often filled with a bubble of swallowed air called the gastric bubble in the erect position.
Body or Corpus: middle portion ofstomach and ends with angular notch.
Smaller ending portion of stomach is the pyloric portion which is divided into 2 parts:
Pyloric Antrum is located directly after angular notch
Pyloric Canal is more narrow and ends at the pyloric sphincter.
Rugae
folds of the stomach which aid in digestion
folds help streamline fluids to the pylorus via the gastric canal and also help to aid in increasing size to the stomach
Stomach Position and Barium Distribution
Normally stomach is shape of a “J”. in the lateral position is shows its “J” shape as well.
Laterally the fundus is more posterior than the body and the pylorus is more posterior as well.
AP Supine- Barium is filling the fundus and pylorus
Prone Patient (RAO) Barium fills the body and air fills the fundus
Erect- Barium fills the body and pylorus, air fills the fundus
Duodenum (1st part of the small intestines)
aka small bowel
considered part of the upper gastrointestinal system
Shortest and widest of the small intestine 8-10 inches long
C-Loop of the duodenum hugs the head of the pancreas.
4 parts of the duodenum:
duodenal bulb or cap
Second or descending portion
Third or horizontal portion
Fourth or ascending portion
Duodenal Bulb or Cap
1st most superior portion of the duodenum which begins at the end of the stomach
Descending portion or Second portion of the Duodenum
second part of the duodenum. longest segment, receives the common bile and pancreatic ducts.
Third or horizontal portion
third part of the duodenum. curves back to meet the fourth segment
Fourth or ascending portion
fourth part of the duodenum. ends at the duodenaljejunal flexture which is held by the ligament of treitz.
Ligament of Treitz
ligament which holds the duodenaljejunal flexture
C-Loop
the four segments of the duodenum make up the C-Loop
Hypersthetic body habitus
massive, very large build
stomach does not look like a “J”. Resembles a sloppy bean bag.
Position of stomach is almost totally transverse
5% of population are hypersthetic.
Very high transverse colon
usually two crosswise films are needed to include the whole intestines.
Gallbladder is located high and lateral.
Asthenic/Hyposthenic (very skinny)
Stomach rests in a more “J” shape and located lower in the abdomen
Large intestine is low in the abdomen
Gallbladder located at Iliac Crest near midline.
Sthenic (average build)
50% of population stomach is still somewhat "J" shaped Splenic flecture is located high Gallbladder located at xyphoid tip Midway between lower lateral rib margin.
Radiolucent Contrast Medium
negative contrast
air, CO2 and gas crystals (calcium & magnesium citrate, carbonate crystals) used to produce gas bubbles in the stomach
Radiopaque Contrast Medium
Positive contrast such as barium sulfate (BaSO4)
mixed with H2O to form a colloidal suspension (meaning it never dissolves just suspended in water)
When not to give Barium
if perforations in the peritoneal cavity are present or suspected. You must use a water soluable, iodinated contrast media instead.
Gastrografin or Gastroview
Iodinated contrast media which is water soluable.
tastes bitter. sometimes mixed with pop or soda.
What type of contrast medium to use if patient is allergic to iodine?
Expensive non-iodinated is protocol.
Must get physicians approval to change order.
Double Contrast
using both radiopaque and radiolucent contrast medium. This combination makes the stomach even more visible.
Polyps, diverticula, and ulcers are better demonstrated with double contrast.
Necessary equipment for performing Fluoro
Leads both thyroid and apron that fits. Lead gloves Cups of Barium made to Radiologist and hospital protocol. (may include thin and thick) Cup of water and/or small cc cup of water Straws Crystals or Fizzies Compression Paddle or "F" paddle Emesis basin Pillow and sheet for modesty Barium tablet if applicable Wet wash cloth Couple of towels
Romance of the Abdomen
C Loop of duodenum & pancreas
CCK Cholecystokinin
Hormone secreted by the duodenal mucosa when fats or fatty acids enter the duodenum
Ingestion and Digestion
Oral cavity Pharynx Esophagus Stomach Small intestine
Absorption
Small intestine ( and stomach)
Elimination
Large intestine
Mechanical Digestion
Oral cavity (teeth and tongue)- Mastication, deglutition
Phrynx- deglutition
Esophagus- deglutition, peristalsis (1-8 seconds)
Stomach- mixing chyme & peristalsis (2-6 hrs)
Small Intestine (small bowel)- Rhythmic segmentation(churning), & peristalsis (3-5 hrs)
Chemical Digestion
Substances ingested, digested, and absorbed:
Carbohydrates (complex sugars) turn into simple sugars in the mouth and stomach
Proteins turn into amino acids in the stomach and small bowel
Lipids (fats) turn into glycerol in the small bowel only
Substances ingested but NOT digested:
Vitamins, Minerals, water
Enzymes (digestive juices)-Boilogic catalysts
Bile (from gallbladder) emulsification of fats
