EXAM #5 (UGI, BE, BILIARY) Flashcards
Anatomy: Large Intestine
Begins at junction of _____ _____ and ends at _____
Forms an arch around the loops of _____ _____
Four main parts:
?
Anatomy: Large Intestine
Begins at junction of small intestine and ends at anus
Forms an arch around the loops of small intestine
Four main parts: Cecum Colon Rectum Anal canal
Anatomy: Large Intestine
Approximately __ feet long
_____ = series of pouches along large intestine
_____ = muscular bands that form haustra
_____ is pouchlike portion below the junction of the ileum and colon
Anatomy: Large Intestine
Approximately 5 feet long
Haustra = series of pouches along large intestine
Taeniae coli = muscular bands that form haustra
Cecum is pouchlike portion below the junction of the ileum and colon
Anatomy: Large Intestine
_____ = attached to posteromedial side of cecum (appendix)
Colon has four portions: \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_
Anatomy: Large Intestine
Vermiform appendix = attached to posteromedial side of cecum (appendix)
Colon has four portions: Ascending Transverse Descending Sigmoid
Anatomy: Large Intestine
_____ = sharp angle at ascending and transverse
_____ = sharp angle at junction of transverse and descending
Anatomy: Large Intestine
Right colic flexure = sharp angle at ascending and transverse
Left colic flexure = sharp angle at junction of transverse and descending
Anatomy: Large Intestine
Sigmoid portion forms _____ and ends at _____ at level of third sacral segment
Rectum extends from _____ to _____ canal
Anal canal terminates at the _____
Anatomy: Large Intestine
Sigmoid portion forms S-shaped loop and ends at rectum at level of third sacral segment
Rectum extends from sigmoid to anal canal
Anal canal terminates at the anus
Anatomy: Large Intestine
Function?
Anatomy: Large Intestine
Reabsorption of fluids
Elimination of waste products
Examination Methods
Single-contrast
Double-contrast
May be performed as one- or two-stage procedure
Two-stage examinations with _____ first, then _____ or other _____ after _____ is evacuated
Examination Methods
Single-contrast
Double-contrast
May be performed as one- or two-stage procedure
Two-stage examinations with barium first, then air or other gas after barium is evacuated
Contrast Media
Commercially prepared barium sulfate products generally used for routine retrograde examinations
High-density barium sulfate = newest product
Absorbs more _____
Useful for double-contrast examinations
Contrast Media
Commercially prepared barium sulfate products generally used for routine retrograde examinations
High-density barium sulfate = newest product
Absorbs more radiation
Useful for double-contrast examinations
Contrast Media
_____ usually used in double-contrast studies
_____ may also be used
- More rapidly absorbed
Water-soluble iodinated agents may be orally administered when _____ is contraindicated
- Usually not satisfactory for double-contrast studies
Contrast Media
Air usually used in double-contrast studies
Carbon dioxide may also be used
More rapidly absorbed
Water-soluble iodinated agents may be orally administered when retrograde filling is contraindicated
Usually not satisfactory for double-contrast studies
Preparation of Intestinal Tract
Large intestine must be completely _____ of all contents
Retained _____ can simulate small masses
Restricted diet and bowel cleansing regimen standard for healthy patients
Preparation of Intestinal Tract
Large intestine must be completely emptied of all contents
Retained fecal matter can simulate small masses
Restricted diet and bowel cleansing regimen standard for healthy patients
Enema Tip Insertion
Adjust IV pole height so that bag is no higher than __ inches above level of anus.
Expose anal region only.
Run barium into basin to remove _____ from tubing.
Lubricate enema tip.
Instruct patient to take deep breaths.
Enema Tip Insertion
Adjust IV pole height so that bag is no higher than 24 inches above level of anus.
Expose anal region only.
Run barium into basin to remove air from tubing.
Lubricate enema tip.
Instruct patient to take deep breaths.
Enema Tip Insertion
Insert tip slowly, steadily, and gently during expiration of deep breath.
Direct anteriorly __ to __ inches, then slightly superiorly
Total distance no more than __ inches
Never force insertion
Ask patient to assist if resistance is met and if patient is capable
Enema Tip Insertion
Insert tip slowly, steadily, and gently during expiration of deep breath.
Direct anteriorly 1 to 1½ inches, then slightly superiorly
Total distance no more than 4 inches
Never force insertion
Ask patient to assist if resistance is met and if patient is capable
Enema Tip Insertion
After tip is inserted, hold in place while patient turns to supine or prone position.
Retention cuff may be inflated at this time.
Free tubing of compression to ensure free flow.
Enema Tip Insertion
After tip is inserted, hold in place while patient turns to supine or prone position.
Retention cuff may be inflated at this time.
Free tubing of compression to ensure free flow.
Double-Contrast BE
Two methods
Closed system
Welin method:
Closed system does not require removal and reinsertion of enema tip
Patient remains on table for entire procedure
Welin method recommended for early detection of _____
Double-Contrast BE
Two methods
Closed system
Welin method:
Closed system does not require removal and reinsertion of enema tip
Patient remains on table for entire procedure
Welin method recommended for early detection of small lesions
Double-Contrast BE
For single-stage closed-system method
Barium introduced and removed via bag position
Air introduced by bag inversion or by manual compression of sphygmomanometer bulb
Double-Contrast BE
For single-stage closed-system method
Barium introduced and removed via bag position
Air introduced by bag inversion or by manual compression of sphygmomanometer bulb
Double-Contrast BE
For Welin method:
Barium introduced to left colic flexure, then tip removed and patient evacuates
Tip reinserted, barium introduced to sigmoid, and air instilled
Patient position altered to coat mucosa
Spot radiographs taken as needed
Double-Contrast BE
For Welin method:
Barium introduced to left colic flexure, then tip removed and patient evacuates
Tip reinserted, barium introduced to sigmoid, and air instilled
Patient position altered to coat mucosa
Spot radiographs taken as needed
PA or AP Large Intestine
Part position:
_____ centered to midline
IR centered at level of _____
CR:
Perpendicular to center of IR
Enters _____ at level of _____
PA or AP Large Intestine
Part position:
MSP centered to midline
IR centered at level of iliac crests
CR:
Perpendicular to center of IR
Enters MSP at level of iliac crests
PA Axial Large Intestine
Part position
_____ in midline
IR at level of _____
CR
Angled __ to __ degrees caudad
Enters _____ at level of _____
PA Axial Large Intestine
Part position
MSP in midline
IR at level of iliac crests
CR
Angled 30 to 40 degrees caudad
Enters MSP at level of anterior superior iliac spine (ASIS)
PA Oblique Large Intestine
Patient position
__- to __-degree RAO or LAO
_____ best demonstrates right colic flexure, ascending colon, and sigmoid
_____ best demonstrates left colic flexure and descending colon
PA Oblique Large Intestine
Patient position
35- to 45-degree RAO or LAO
RAO best demonstrates right colic flexure, ascending colon, and sigmoid
LAO best demonstrates left colic flexure and descending colon
PA Oblique Large Intestine
Part position
Supported by flexed knee and arm of elevated side
_____ centered to midline
IR centered to level of _____
CR
Perpendicular to IR
Enters __ to __ inches lateral to midline of body on elevated side at level of _____
PA Oblique Large Intestine
Part position
Supported by flexed knee and arm of elevated side
MSP centered to midline
IR centered to level of iliac crests
CR
Perpendicular to IR
Enters 1 to 2 inches lateral to midline of body on elevated side at level of iliac crests
Lateral Large Intestine
Part position
_____ centered
Knees flexed slightly for stability
Shoulders, hips, and knees superimposed and perpendicular
IR centered to _____
Lateral Large Intestine
Part position
MCP centered
Knees flexed slightly for stability
Shoulders, hips, and knees superimposed and perpendicular
IR centered to ASIS
Lateral Large Intestine
CR:
Perpendicular to IR
Enters _____ at level of _____
Lateral Large Intestine
CR:
Perpendicular to IR
Enters MCP at level of ASIS
AP Axial Large Intestine
Part position
_____ aligned to midline of grid
IR centered to __ inches above iliac crests
AP Axial Large Intestine
Part position
MSP aligned to midline of grid
IR centered to 2 inches above iliac crests
AP Axial Large Intestine
CR
Angled __ to __ degrees cephalad
Enters patient on _____ to enter inferior margin of _____
AP Axial Large Intestine
CR
Angled 30 to 40 degrees cephalad
Enters patient on MSP to enter inferior margin of pubic symphysis
AP Oblique Large Intestine
Patient position:
__- to __-degree LPO or RPO position
_____ demonstrates right colic flexure and ascending and sigmoid colon
_____ demonstrates left colic flexure and descending colon
AP Oblique Large Intestine
Patient position:
35- to 45-degree LPO or RPO position
LPO demonstrates right colic flexure and ascending and sigmoid colon
RPO demonstrates left colic flexure and descending colon
AP Oblique Large Intestine
Part position
_____ centered to midline
Sponge supporting elevated side
Dependent knee flexed for support
IR centered to level of _____
AP Oblique Large Intestine
Part position
MSP centered to midline
Sponge supporting elevated side
Dependent knee flexed for support
IR centered to level of iliac crests
AP Oblique Large Intestine
CR
Perpendicular to IR
Enters patient __ to __ inches lateral to midline of MSP on elevated side at level of iliac crests
AP Oblique Large Intestine
CR
Perpendicular to IR
Enters patient 1 to 2 inches lateral to midline of MSP on elevated side at level of iliac crests
AP/PA Large Intestine Right or Left Lateral Decubitus
On double-contrast studies, air or “up” is side of interest.
_____ decubitus position demonstrates medial side of ascending colon and lateral side of descending colon.
_____ decubitus demonstrates lateral side of ascending colon and medial side of descending colon.
AP/PA Large Intestine Right or Left Lateral Decubitus
On double-contrast studies, air or “up” is side of interest.
Right lateral decubitus position demonstrates medial side of ascending colon and lateral side of descending colon.
Left lateral decubitus demonstrates lateral side of ascending colon and medial side of descending colon.
AP/PA Large Intestine Right or Left Lateral Decubitus
Part position
Body elevated on radiolucent support to center _____ to midline of grid
IR centered to level of _____
AP/PA Large Intestine Right or Left Lateral Decubitus
Part position
Body elevated on radiolucent support to center MSP to midline of grid
IR centered to level of iliac crests
AP/PA Large Intestine Right or Left Lateral Decubitus
CR
Horizontal and perpendicular to IR
Enters midline of body at level of _____
AP/PA Large Intestine Right or Left Lateral Decubitus
CR
Horizontal and perpendicular to IR
Enters midline of body at level of iliac crests
Anatomy: Alimentary Canal
A _____ tube that extends from the mouth to the anus
Components: \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_ 6 items
Anatomy: Alimentary Canal
A musculomembranous tube that extends from the mouth to the anus
Components: Mouth Pharynx Esophagus Stomach Small intestine Large intestine (terminates at anus)
Anatomy: Esophagus
Long muscular tube
Functions to convey food and saliva from _____ to _____
Lies in midsagittal plane (MSP)
Originates at _____
Anatomy: Esophagus
Long muscular tube
Functions to convey food and saliva from laryngopharynx to stomach
Lies in midsagittal plane (MSP)
Originates at C6
Anatomy: Esophagus
Passes through diaphragm at
_____
Joins stomach at esophagogastric junction at _____
Expanded terminal end = _____
Anatomy: Esophagus
Passes through diaphragm at
T10
Joins stomach at esophagogastric junction at T11
Expanded terminal end = cardiac antrum
Anatomy: Stomach
Dilated, saclike portion of the digestive tract extending between the _____ and _____
Four parts: \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_
Anatomy: Stomach
Dilated, saclike portion of the digestive tract extending between the esophagus and small intestine
Four parts: Cardia Fundus Body Pyloric portion
Anatomy: Stomach
_____ is section surrounding esophageal opening
_____ is superior portion that fills the left hemidiaphragm
Body located between _____ and _____ portion
Interior surface contains numerous longitudinal folds called _____
Anatomy: Stomach
Cardia is section surrounding esophageal opening
Fundus is superior portion that fills the left hemidiaphragm
Body located between fundus and pyloric portion
Interior surface contains numerous longitudinal folds called rugae
Anatomy: Stomach
Last portion is _____ portion
Consists of _____ and narrowed _____
_____ = right border
_____ = left border
_____ = sharp angle at esophagogastric junction
Anatomy: Stomach
Last portion is pyloric portion
Consists of pyloric antrum and narrowed pyloric canal
Lesser curvature = right border
Greater curvature = left border
Cardiac notch = sharp angle at esophagogastric junction
Anatomy: Stomach
Entrance and exit controlled by sphincters
_____ = opening between esophagus and stomach
- _____ controls opening
_____ = opening between stomach and small intestine
- Controlled by _____
Anatomy: Stomach
Entrance and exit controlled by sphincters
Cardiac orifice = opening between esophagus and stomach
Cardiac sphincter controls opening
Pyloric orifice = opening between stomach and small intestine
Controlled by pyloric sphincter
Anatomy: Stomach
Stomach position greatly affected by body habitus
Higher and more horizontal in _____
Lower and more midline in _____
Anatomy: Stomach
Stomach position greatly affected by body habitus
Higher and more horizontal in hypersthenic
Lower and more midline in asthenic
Functions: Stomach
Storage area for food during part of digestion
Secretes acids, enzymes, and other chemicals to chemically break down food
Mechanically breaks down food by churning and peristalsis
_____ = chemically and mechanically altered food that leaves stomach
Functions: Stomach
Storage area for food during part of digestion
Secretes acids, enzymes, and other chemicals to chemically break down food
Mechanically breaks down food by churning and peristalsis
Chyme = chemically and mechanically altered food that leaves stomach
Gastrointestinal Transit
_____ = contraction waves by which the digestive tube propels contents toward the rectum
_____ to _____ waves per minute occur in the filled stomach
Average emptying time for stomach is __ to __ hours
Average transit time to ileocecal valve is __ to __ hours
Gastrointestinal Transit
Peristalsis = contraction waves by which the digestive tube propels contents toward the rectum
Three to four waves per minute occur in the filled stomach
Average emptying time for stomach is 2 to 3 hours
Average transit time to ileocecal valve is 2 to 3 hours
Contrast Media
Radiographic demonstration of the alimentary canal requires use of _____
Barium sulfate is most common contrast for the alimentary canal
Water-soluble iodinated contrast media may also be used (_____) = if suspected perforation
Contrast Media
Radiographic demonstration of the alimentary canal requires use of contrast media
Barium sulfate is most common contrast for the alimentary canal
Water-soluble iodinated contrast media may also be used (gastrographen) = if suspected perforation
Contrast Media
Iodinated solutions move through the GI tract quicker than barium sulfate
Clears the stomach in __ to __ hours
Iodinated solutions do not adhere as well to esophageal _____ as does barium sulfate
Iodinated solutions provide satisfactory examinations of the stomach, duodenum, and large intestine
Contrast Media
Iodinated solutions move through the GI tract quicker than barium sulfate
Clears the stomach in 1 to 2 hours
Iodinated solutions do not adhere as well to esophageal mucosa as does barium sulfate
Iodinated solutions provide satisfactory examinations of the stomach, duodenum, and large intestine
Contrast Media (Iodinated solutions)
Water-soluble media easily removed by aspiration before or during surgery
Also readily _____ by the body and _____ by kidneys in cases of perforation
Contrast Media
Water-soluble media easily removed by aspiration before or during surgery
Also readily absorbed by the body and excreted by kidneys in cases of perforation
Exposure Time: Esophagus
Upright position = __ second or less
Exposure time may be slightly longer for recumbent position
Barium passes slowly if swallowed at end of full _____
Barium is delayed in the lower portion if swallowed at the end of full _____
Deglutition inhibits respiration for several seconds
Exposure Time: Esophagus
Upright position = 0.1 second or less
Exposure time may be slightly longer for recumbent position
Barium passes slowly if swallowed at end of full inspiration
Barium is delayed in the lower portion if swallowed at the end of full expiration
Deglutition inhibits respiration for several seconds
Exposure Time: Stomach
Normal peristaltic activity – exposure time no longer than __ second
Never longer than __ second
Hypermotility requires __ second or less
Exposures made at the end of expiration in routine procedures
Exposure Time: Stomach
Normal peristaltic activity – exposure time no longer than 0.2 second
Never longer than 0.5 second
Hypermotility requires 0.1 second or less
Exposures made at the end of expiration in routine procedures
AP or PA Esophagus
Patient position
Supine or prone without rotation
Head turned to side to facilitate drinking
IR is placed so that top is level with the _____
Central ray (CR) perpendicular to midpoint of IR
Usually at level of _____
AP or PA Esophagus
Patient position
Supine or prone without rotation
Head turned to side to facilitate drinking
IR is placed so that top is level with the mouth
Central ray (CR) perpendicular to midpoint of IR
Usually at level of T5-T6
AP/PA Oblique Esophagus
Patient position
Recumbent __- to __-degree _____ or _____ position
Align IR and elevated side of patient approximately __ inches lateral to MSP
CR enters perpendicular to midpoint of _____
Enters patient at __ inches lateral to MSP at level of _____
AP/PA Oblique Esophagus
Patient position
Recumbent 35- to 40-degree right anterior oblique (RAO) or left posterior oblique (LPO) position
Align IR and elevated side of patient approximately 2 inches lateral to MSP
CR enters perpendicular to midpoint of IR
Enters patient at 2 inches lateral to MSP at level of T5 or T6
Lateral Esophagus
Patient position
Recumbent right or left lateral position
Patient should face radiographer
Arms forward
Midcoronal plane (MCP) centered
CR enters perpendicular to midpoint of _____
Enters patient on MCP at level of _____
Lateral Esophagus
Patient position
Recumbent right or left lateral position
Patient should face radiographer
Arms forward
Midcoronal plane (MCP) centered
CR enters perpendicular to midpoint of IR
Enters patient on MCP at level of T5-T6
Stomach: GI Series
_____ = combination single- and double-contrast during the same procedure
Hypotonic duodenography is a MORE/LESS common examination
Stomach: GI Series
Biphasic examination = combination single- and double-contrast during the same procedure
Hypotonic duodenography is a LESS common examination
PA Stomach and Duodenum
Part position
Align midline of grid to sagittal plane passing halfway between vertebral column and left lateral border of abdomen
Center IR __ to __ inches above _____
Upright requires IR centered __ to __ inches lower
PA Stomach and Duodenum
Part position
Align midline of grid to sagittal plane passing halfway between vertebral column and left lateral border of abdomen
Center IR 1 to 2 inches above lower rib margin (level of L1-L2)
Upright requires IR centered 3 to 6 inches lower
PA Oblique Stomach and Duodenum
Part position:
Midline of IR aligned with sagittal plane passing midway between vertebral column and lateral border of _____ side
IR centered to lower rib margin (level of _____)
Adjust rotation to __ to __ degrees to demonstrate pyloric canal and duodenum
PA Oblique Stomach and Duodenum
Part position:
Midline of IR aligned with sagittal plane passing midway between vertebral column and lateral border of elevated side
IR centered to lower rib margin (level of L1-L2)
Adjust rotation to 40 to 70 degrees to demonstrate pyloric canal and duodenum
AP Oblique Stomach and Duodenum
Part position:
Align midline of IR with a sagittal plane passing midway between the _____ and the _____ of the abdomen
Center IR to a point midway between _____ and _____
Adjust rotation to __ to __ degrees (average is __)
AP Oblique Stomach and Duodenum
Part position:
Align midline of IR with a sagittal plane passing midway between the vertebrae and the left lateral border of the abdomen
Center IR to a point midway between xiphoid process and lower rib margin
Adjust rotation to 30 to 60 degrees (average is 45)
AP Oblique Stomach and Duodenum
RPO/LPO shows the (barium-filled) fundus the best
AP Oblique Stomach and Duodenum
LPO shows the (barium-filled) fundus the best
PA Oblique Stomach and Duodenum
Duodenal loop is best seen in the PA oblique RAO/LAO
PA Oblique Stomach and Duodenum
Duodenal loop is best seen in the PA oblique RAO
Lateral Stomach and Duodenum
Recumbent _____ lateral demonstrates right retrogastric space, duodenal loop, and duodenojejunal junction
Upright _____ lateral position demonstrates left retrogastric space
Lateral Stomach and Duodenum
Recumbent right lateral demonstrates right retrogastric space, duodenal loop, and duodenojejunal junction
Upright left lateral position demonstrates left retrogastric space
Lateral Stomach and Duodenum
Part position
Align plane passing midway between MCP and anterior surface of abdomen to midline of grid
Center IR at level of _____ for recumbent position; _____ for upright position
True lateral position
Lateral Stomach and Duodenum
Part position
Align plane passing midway between MCP and anterior surface of abdomen to midline of grid
Center IR at level of L1-L2 for recumbent position; L3 for upright position
True lateral position
AP Stomach and Duodenum
Patient position
Supine
Trendelenburg’s for demonstration of _____
AP Stomach and Duodenum
Patient position
Supine
Trendelenburg’s for demonstration of hiatal hernia
Anatomy: Small Intestine
Extends from _____ to _____
Average adult length = __ feet
Three portions:
_____
_____
_____
Anatomy: Small Intestine
Extends from pyloric sphincter to ileocecal valve
Average adult length = 22 feet
Three portions:
Duodenum
Jejunum
Ileum
Anatomy: Small Intestine
Duodenum is __ to __ inches long and C-shaped
First portion is called _____
Portion that joins jejunum is a sharp curve called the _____ flexure
Flexure is supported by the suspensory muscle of the duodenum (ligament of Treitz)
Anatomy: Small Intestine
Duodenum is 8 to 10 inches long and C-shaped
First portion is called duodenal bulb
Portion that joins jejunum is a sharp curve called the duodenojejunal flexure
Flexure is supported by the suspensory muscle of the duodenum (ligament of Treitz)
Function of the small intestine?
Digestion and absorption of food
Gastrointestinal Transit
_____ = contraction waves by which the digestive tube propels contents toward the rectum
Average transit time to ileocecal valve is __ to __ hours
Gastrointestinal Transit
Peristalsis = contraction waves by which the digestive tube propels contents toward the rectum
Average transit time to ileocecal valve is 2 to 3 hours
Contrast Media
Iodinated solutions become diluted in the small intestine, so clear anatomic detail CAN/CANNOT be seen.
Does permit a rapid survey of the entire small intestine
Contrast Media
Iodinated solutions become diluted in the small intestine, so clear anatomic detail CANNOT be seen.
Does permit a rapid survey of the entire small intestine
Exposure Time
Normal peristaltic activity: exposure time no longer than __ second
Never longer than __ second
Hypermotility requires __ second or less
Exposures made at _____ in routine procedures
Exposure Time
Normal peristaltic activity: exposure time no longer than 0.2 second
Never longer than 0.5 second
Hypermotility requires 0.1 second or less
Exposures made at the end of expiration in routine procedures
Oral Method of Examination
Examination complete when barium seen in cecum
Typically __ hours after ingestion in patients with normal motility
Oral Method of Examination
Examination complete when barium seen in cecum
Typically 2 hours after ingestion in patients with normal motility
PA or AP Small Intestine
Part position
MSP centered
For __-minute interval, center IR at level of _____
For delayed images, center IR at _____
PA or AP Small Intestine
Part position
MSP centered
For 30-minute interval, center IR at level of L2
For delayed images, center IR at iliac crests
What is the biggest gland in the body?
The liver
Falciform ligament divides liver into two major lobes, what are they?
Two minor lobes evident on visceral surface, what are they?
Right + left lobes
Caudate + Quadrate lobes
Liver
Two blood supplies:
_____ supplies oxygenated blood from abdominal aorta
_____ carries blood from digestive system to be filtered by liver
Liver
Two blood supplies:
Hepatic artery supplies oxygenated blood from abdominal aorta
Portal vein carries blood from digestive system to be filtered by liver
Liver
Primary function from imaging standpoint is production of _____
Liver
Primary function from imaging standpoint is production of bile
Liver
Bile is collected by ducts and carried to _____ for storage or passes into duodenum
Liver
Bile is collected by ducts and carried to gallbladder for storage or passes into duodenum
Biliary System
Consists of what two things?
Two main hepatic ducts in liver?
Biliary System
Consists of bile ducts and the gallbladder
Two main hepatic ducts in liver:
Right
Left
Biliary System
Right and left hepatic ducts join to form…?
Common hepatic duct unites with cystic duct to form…?
Biliary System
Right and left hepatic ducts join to form common hepatic duct
Common hepatic duct unites with cystic duct to form common bile duct
Purpose of an ERCP?
ERCP = looks for obstructions and anatomy in the ductwork, in the liver or pancreas
Gallbladder
Thin-walled musculomembranous sac usually found on visceral surface of _____ lobe of liver
Position of gallbladder varies with body _____
Gallbladder
Thin-walled musculomembranous sac usually found on visceral surface of right lobe of liver
Position of gallbladder varies with body habitus
Gallbladder
Functions to store and concentrate _____
Evacuates bile when activated by hormone, _____
Neck of gallbladder consistent with cystic duct
Gallbladder
Functions to store and concentrate bile
Evacuates bile when activated by hormone, cholecystokinin
Neck of gallbladder consistent with cystic duct
Function of the spleen?
Filter for blood as part of the immune system. Helps fight certain kinds of bacteria that cause pneumonia
Percutaneous Transhepatic Cholangiography
Abbreviated PTC
Performed on patients with _____ when the ductal system has been demonstrated as dilated by computed tomography (CT) or sonography, but the cause is unclear
May also be used to place a _____ _____ to treat obstructive jaundice
Percutaneous Transhepatic Cholangiography
Abbreviated PTC
Performed on patients with jaundice when the ductal system has been demonstrated as dilated by computed tomography (CT) or sonography, but the cause is unclear
May also be used to place a drainage catheter to treat obstructive jaundice
Percutaneous Transhepatic Cholangiography
Patient is _____
_____ side surgically prepared and draped
Local anesthetic administered
Special “_____” needle (Chiba) inserted
Water-soluble iodinated contrast injected under fluoroscopy
After ductal system is filled, spot _____ projections are made
Percutaneous Transhepatic Cholangiography
Patient is supine
Right side surgically prepared and draped
Local anesthetic administered
Special “skinny” needle (Chiba) inserted
Water-soluble iodinated contrast injected under fluoroscopy
After ductal system is filled, spot AP projections are made
Postoperative (T-Tube) Cholangiography
Also called delayed _____
Performed via a T-shaped tube left in the _____ _____ and _____ _____ ducts for postoperative drainage
Postoperative (T-Tube) Cholangiography
Also called delayed cholangiography
Performed via a T-shaped tube left in the common hepatic and common bile ducts for postoperative drainage
Postoperative (T-Tube) Cholangiography
Performed to demonstrate:
_____ and _____ of ducts
Status of _____ of the hepatopancreatic ampulla
The presence of residual or previously undetected _____
Postoperative (T-Tube) Cholangiography
Performed to demonstrate:
Caliber and patency of ducts
Status of sphincter of the hepatopancreatic ampulla
The presence of residual or previously undetected stones
Postoperative (T-Tube) Cholangiography
Tube clamped _____ before procedure
Fills tube with _____ to prevent air bubbles from entering
Air bubbles mimic radiolucent _____
Preceding meal is _____
Cleansing enema _____ hour before procedure, if needed
Preliminary _____ obtained
Postoperative (T-Tube) Cholangiography
Tube clamped day before procedure
Fills tube with bile to prevent air bubbles from entering
Air bubbles mimic radiolucent stones
Preceding meal is withheld
Cleansing enema 1 hour before procedure, if needed
Preliminary KUB obtained
Postoperative (T-Tube) Cholangiography
Patient positioned in _____ position with right upper quadrant centered to IR
Contrast media injected into _____ under fluoroscopy
_____ and _____ images made as indicated
Postoperative (T-Tube) Cholangiography
Patient positioned in RPO position with right upper quadrant centered to IR
Contrast media injected into T-tube under fluoroscopy
Spot and conventional images made as indicated
ERCP
Used to diagnose _____ and _____ pathologic conditions
Useful method when ducts are not _____ and ampulla is not _____
Performed by passing a fiber-optic endoscope through the mouth into the duodenum under fluoroscopy
ERCP
Used to diagnose biliary and pancreatic pathologic conditions
Useful method when ducts are not dilated and ampulla is not obstructed
Performed by passing a fiber-optic endoscope through the mouth into the duodenum under fluoroscopy
ERCP
Patient’s _____ is sprayed with a local anesthetic to make passage of endoscope easier
The hepatopancreatic ampulla is cannulated
Contrast is injected into the…?
_____ and _____ images are taken as indicated
ERCP
Patient’s throat is sprayed with a local anesthetic to make passage of endoscope easier
The hepatopancreatic ampulla is cannulated
Contrast is injected into the common bile duct
Spot and conventional images are taken as indicated
Know the regions of the abdomen (what region liver is in)
Right Upper Quadrant- liver, right kidney, gall bladder, colon, pancreas
Where is the spleen located?
Left upper quadrant behind pancreas
What projection of the stomach demonstrates anterior and posterior surfaces
lateral
What projection of the stomach will demonstrate a diaphragmatic hernia?
AP stomach and duodenum
What exam requires a time marker on the images?
Small bowl series (UGI)
What projection will demonstrate the rectal sigmoid area in a BE?
AP axial large intestine
What projection best demonstrates the right colic flexure?
PA Oblique RAO Large Intestine
What projection best demonstrates the ascending colon?
PA Oblique RAO Large Intestine
PA oblique colon, LAO position clearly demonstrates what?
left colic flexure and descending colon
What projections best demonstrates the left colic flexure?
PA Oblique LAO Large intestine
What is demonstrated in the decubitus BE?
Right Lateral Decubitus Colon- ?
Left lateral Decubitus Colon- ?
What is demonstrated in the decubitus BE?
Right Lateral Decubitus Colon- medial side of ascending colon and lateral side of descending colon
Left lateral Decubitus Colon- lateral side of ascending colon and medial side of descending colon
What is the advantage of having the recumbent for images of the esophagus?
obtains more complete contrast filling of the esophagus (especially the proximal part)
What is the breathing technique for all these projections?
SUSPENDED ON EXPIRATION
